Biliary dyskinesia

Dyskinesia of bile ducts is a collective concept that characterizes functional disorders in the movement and supply of bile along the bile ducts to the duodenum.

There is no specific nosology in the International Classification of Diseases, therefore, different authors use the terms "biliary dysfunction", "motor disorders of the bile duct", for brevity of DZHVP, dysfunction of the gallbladder is included in the group.

Practically the diagnosis of dyskinesia is made to the patient after exclusion of signs of inflammation and stone formation. There is an opinion that such a violation as dysfunction of the gallbladder should be considered the initial stage of other diseases of the biliary system.

What disorders occur with dyskinesia?

The gallbladder accumulates bile produced in the liver under normal conditions, then through its short duct, which merges with the liver, pushes it into the common bile duct( holedoch).According to this "channel" portions of the bile necessary for digestion enter the duodenum.

On its way, the stream encounters obstacles in the form of sphincters:

• Lutkens - on the border with the bubble;
• Mirrizzi - at the point of confluence of the main hepatic duct into the holedoch;
• Oddi - with joint entry into the cavity of the duodenum with the duct of the pancreas.

The impairment of nerve impulse transmission at any level causes untimely reduction of the muscular apparatus of the ducts,

sphincters. The throughput of the sphincters and the consequent contraction of the circular and longitudinal muscle fibers are regulated by the normal nervous system. The need for bile is determined by the body reflexively. When food enters the stomach, the gallbladder already "knows" how much bile acids it takes to digest it.

Classification of

The origin of dyskinesia distinguishes primary( if there are no other digestive disorders) and secondary, when the role of reflex action from other organs is clear. Violation of the contractile function of any hollow organ has 2 options: either muscle tone decreases, motor ability falls( hypotonic form), or muscle fibers contract untimely and intensely to spasms( hypertonic).

Accordingly, the altered motility of the biliary tract is divided into hypokinetic - the contractions are slowed down, not in full, the bile is delayed and does not arrive in the right amount in the intestine, hyperkinetic - spasmodic contractions deduce an excessive volume of bile.

Both types of dyskinesia cause a malfunction in the liver, pancreas, activate pathological changes in pancreatitis, cholelithiasis. Alternating unstable disorders is possible. Some authors distinguish a mixed form. For specific localization, they are isolated from the dysfunction of the biliary system: a violation of the contractility of the sphincter of Oddi, the gallbladder.

Why does it occur?

The causes of dyskinesia of bile ducts are hidden in the disorder of coordination of the biliary system from the side of the autonomic nervous system, central regulation, hormonal mechanisms. The most prone to pathology are women and children. This emphasizes the pronounced variability of the nervous processes, the instability during periods of hormonal adjustment. Details of dyskinesia of bile ducts in childhood can be found in this article.

Hormonal changes in the form of an imbalance in the hormones of the digestive tract( gastrin, cholecystokinin, glucagon), adrenals( angiotensin) and gonads in adults are caused by various conditions, accompanied by stresses, emotional outbursts, diet, chronic diseases.

The undoubted connection of dyskinesia of the gallbladder and ducts with pathological reflex action against the background of inflammatory processes in other digestive organs( pancreatitis, hepatitis, gastritis, enterocolitis)

Dyskinesia of the bile ducts can cause:

• congenital malformations of the digestive and bile excretory organs;
• improper diet, overeating and long breaks;
• passion for fatty and spicy dishes, fast food;
• experienced stressful situations;
• alcoholism;
• acute and chronic parasitic diseases with localization of the pathogen in the biliary tract( giardiasis, opisthorchiasis, helminthiasis);
• inflammatory and postoperative disorders in cholelithiasis, cholecystitis, cholecystectomy, resection of part of the stomach, vagotomy( crossing of the vagus nerve);
• liver damage( viral and toxic hepatitis, cirrhosis, fatty degeneration);
• peptic ulcer of the duodenum and stomach;
• endocrine pathology( diabetes mellitus, hypothyroidism, obesity, tumors);
• premenstrual and climacteric syndromes, pregnancy in women;
• diseases of the nervous system( myotonia, condition after a stroke);
• congenital celiac disease, allergy to food;
• treatment with some medications( somatostatin), the use of hormonal-based contraceptives;
• increased physical activity.

What are the signs of dyskinesia?

Symptoms of biliary dyskinesia arise independently or with the aggravation of other diseases. Manifestations often torture patients, forcing them to search for a long time the cause of their poor health. It is customary to distinguish 3 most common syndromes in the symptomatology.

Painful - differs depending on the type of motor impairment. When hypomotor - pain blunt, accompanied by bursting, a sense of heaviness, prolonged. Localize in the hypochondrium right. Decreased after food intake, choleretic preparations, artificial withdrawal of bile during the procedure of duodenal or "blind" sounding.

Hyperkinetic type of dyskinesia - is characterized by intense contractions( colic), a short duration, often pain caused by fried or fatty foods, alcohol, excitement. Localized in the hypochondrium to the right, give irradiation in the back, scapula, can be shrouded, arise at night. Decrease after a warm water bottle or taking antispasmodics.

Dyspeptic syndrome - includes such symptoms as bloating, nausea, rarely vomiting with bitterness, belching, a constant feeling of bitterness in the mouth, alternating diarrhea and constipation, a decrease in appetite.

Neurotic syndrome - patients with dyskinesia of the biliary tract are often nervous for no reason, dramatically change their mood, are quick-tempered, touchy, suspicious, anxious, not sleeping because of insomnia. In a team with such a person is difficult to contact. It is important that by the middle of the day these symptoms disappear.

What are the signs of dyskinesia of bile ducts diagnosed?

In diagnosis, it is necessary to distinguish the listed symptoms of dyskinesia, related to indirect signs, accompanying many diseases and not having specificity, from objective data of instrumental examination. A medical examination gives only an expected diagnosis of dyskinesia of the biliary tract, which is based on the patient's complaints, the analysis of symptoms, the identification of pain sensitivity in the hypochondrium on the right.

The positive symptoms of the gallbladder( soreness at the projection point, in the supraclavicular area on the right, while tapping along the costal arch, etc.) are usually determined.

The survey complex includes:

• The study of biochemical tests in serum - the value is given to the level of alanine and aspartic transaminases, bilirubin, alkaline phosphatase( increases sharply with sphincter of Oddi spasm), pancreatic enzymes.
• In stationary conditions, provocative tests with substances( cholecystokinin, egg yolk), which can activate the contraction of the muscular layer of the gallbladder and sphincters, are used. They provoke the secretion of bile and the appearance of pain in the patient.
• Ultrasound - the method allows to exclude inflammation of the gallbladder( by size, wall thickness), stones and polyps, neoplasms, gives information on the expansion of the diameter of the biliary tract in case of stagnant phenomena.

Duodenal sounding with the study of the properties of bile - confirms or excludes inflammation caused by a parasitic infection, the composition of salts. Fibrogastroduodenoscopy - reveals the amount of bile in the duodenum, which is considered an indirect sign of dyskinesia. In addition, the area of ​​the sphincter of Oddi is examined to exclude scars, polyps, and tumors.

X-ray method and bladder pathways are studied after the administration of a contrast agent secreted by the liver in bile( cholecystography, cholangiography).Become clearly visible contours, size, structure of the moves, the ability to promote bile. Contrastless magnetic resonance imaging( MRI) provides enough information on the functioning of the bile ducts inside the liver and outside, coordinating with the secretion of the secretion of the pancreas.

To monitor the changes during an attack, ultrasound is combined with provocative probes

Endoscopic procedures include: manometry of the Oddi sphincter zone( pressure increase is fixed) and retrograde cholangiopancreatography. The latter is a rather complicated procedure, it is used for differential diagnostics with tumors in specialized institutions.

The method of radioisotope hepatocholecystography is designed for the capture by the hepatic cells of radioactive technetium and its subsequent withdrawal with bile. Time and degree of absorption, the process of movement along the biliary tracts is important.

What is used in treatment?

Treatment of biliary dyskinesia is constructed after identifying the cause of a strict combination of diet and other methods of exposure. If an apparent dependence of dysfunction on other chronic diseases is found, in order to cure the patient it is first of all necessary to deal with the main cause of dyskinesia. Most often the patient is treated as an outpatient.

Power requirements for

Recommendations for dietary nutrition consist of general rules and separate for patients with dyskinesia of different types. The general ones are:

• Receiving small amounts of food every 4 hours. This helps to avoid stagnation of the bile, restore reflex contractions.
• Exclusion of long breaks, hungry diets, one-time overeating. They increase tone and provoke painful attacks with dyskinesia.
• Refusal from alcoholic drinks, soda water, chilled dishes and drinking. In the cold, there is a reactive contraction of the muscles of the sphincter of Oddi.
• Control of the content of useful carbohydrates, fats and proteins in food, their ratio. Observance of age norms of nutrition on energy costs.
• Preparation of food only in the manner of boiling, quenching and steaming. Prohibition of any fried foods, canning products, smoking.
• At least half of the protein composition should be covered with animal products( milk, fish, lean meat, seafood, eggs).
• Significant restriction of animal fats. Lowering cholesterol in bile improves its properties, prevents stagnation.
• Primary use of vegetable oils: sunflower, cottonseed, soybean, linseed, olive. Included in the composition of polyene fatty acids improve the processes of bile formation and secretion, normalize the exchange of cholesterol.
• The diet should contain enough vegetable fiber due to cereals, berries, fruits, vegetables, juices, the addition of bran. A positive effect on intestinal motility reduces pressure in the duodenum, so the flow of bile through the ducts increases.
• Disclaimer of any products containing essential oils( spicy seasonings, garlic, radish, pickles, mustard, horseradish).

For dyskinesia of the biliary tract, hypotonic type, more fiber and vegetable oils are introduced into the food. It is recommended to take mineral waters with an average degree of mineralization before meals( Borjomi, Arzni, Jermuk, Lipetsk pump room, Essentuki No. 4).They are also used for "blind probing".

Not all types of mineral water are equally suitable for each patient.

In cases with hyperkinesia, eggs are restricted in food, but they include foods rich in magnesium( cereals, buckwheat, bran, vegetables).Of mineral waters are suitable "Essentuki №17", "Narzan", "Slavyanovskaya".

Medical treatment

The exact choice of how to treat dyskinesia of bile ducts depends on the type of motor disability. When hypokinetic dyskinesia is prescribed:

• prokinetics preparations, enhancing tone and activity of muscle fibers in the gallbladder and ducts( Domperidone, Itopride, Metoclopramide;
• tonic tincture( Eleutherococcus, Ginseng, Aralia, Schizandra);
• choleretic drugs from the group of choleretics to stimulate production(Allochol, Hoholog, Oxafenamid, Tsikvalon, Holosas, Hofitol, Cholenzyme), as well as cholekinetics of active biliary excretion( Xylitol, magnesium sulfate, Berberine, Sorbitol).

The drug is contraindicated in cases of hyperkinetic dyskinesia

In hyperkinetic dyskinesia,

• is indicated for the analgesia and relief of spasms: Baralgin, Mebeverin, No-shpa, Drotaverin;
• choleretic from the group of cholespasmolytics, relaxing action( Odeston, Olimetin);
• nitrates( Nitrosorbide, Sustac, Nitroglycerin during an attack);
• M-cholinolytics, blocking the action of acetylcholine( Buscopan, preparations with belladonna, Metacin).

In the treatment of spastic form of dyskinesia, long-term use of benzothiazepines and calcium channel blockers is used. In severe neurotic syndrome, patients need sedatives, sometimes in psychotropic medications.

Physiotherapeutic procedures

Physiotherapy helps with dyskinesia to get rid of pain, calm down, normalize sleep, restore the regulation processes of the biliary system. For the treatment of hyperkinetic type DZHVP designate:

• inductothermy;
• UHF;
• microwave therapy;
• ultrasound;
• electrophoresis with novocaine;
• applications of paraffin or ozocerite;
• common baths( coniferous, hydrogen sulfide, radon).

In hypokinetic flow of dyskinesia, diadynamic currents, sinusoidal and low-impulse currents, ultrasound of low intensity, baths( pearl with oxygen and carbon dioxide) are useful. Often patients are helped by acupuncture.

Is surgery possible to eliminate dyskinesia?

Surgical treatment is used for persistent pain syndrome, lack of effectiveness from medications. The method of choice for dyskinesias is:

• , depending on the dysfunction of the sphincter Oddy, balloon dilatation, stent placement, excision with subsequent plasty( as a temporary aid, the injection of the botulinum toxin into the sphincter by injection);
• removal of the gallbladder( by laparoscopy or a classic incision) is often complicated by the development of postcholecystectomy syndrome, so it is rarely done.

What helps from folk remedies?

People's treatment should not be dealt with without knowing the action of the proposed funds for the type of dyskinesia. The natural choleretic effect is known: milk thistle( butter, butter), tansy, root of turmeric and dandelion, corn stigmas, immortelle flowers, parsley, caraway, yarrow, mint, chicory, dog rose, barberry.

Collection of herbs is more suitable for atony of the gallbladder and its inflammation

To remove the spasms are suitable decoctions from the root of valerian, licorice, chamomile flowers, sage, dill, motherwort, lemon balm. The disease is identified by excluding others. Examination for dyskinesia of the biliary tract can be delayed, but without it it is impossible to choose the optimal treatment. Do not use the advice of incompetent people.

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