Dyskinesia of bile ducts in children

Dyskinesia of bile ducts in children is a functional disease. This means that the disease is not accompanied by any anatomical changes. The disorder of the regulation of the muscle tone of the gallbladder and ducts leads to a disruption of the motor activity in the biliary( bile-excreting) system, causing disruption of the supply of bile acids to the duodenum. As a result, the entire process of digestion of the child suffers.

The role of dyskinesia in the pathology of digestion in children

Functional disorders include dysfunction of the gallbladder, accumulating bile, border sphincters and canals( hepatic duct, holedoch).In the structure of the lesion of the biliary system in children, dyskinesias occupy a strong first place, followed by: inflammation( cholecystitis, cholangitis), congenital anomalies and cholelithiasis.

Among children with diseases of the digestive system on biliary dyskinesia( DZHVP) account for up to 90% of cases. Without timely treatment, the disease in the future provokes and promotes inflammation in the child's gallbladder, thickening of bile with precipitation of salts forming stones, damage to the pancreas.

Why does it occur in childhood?

The causes of dyskinesia of the gallbladder and pathways in early childhood are due to underdevelopment of the regulation of contractions of circular and longitudinal muscle fibers from the side of the nervous system. In the infants, they are considered a consequence of the baby's brain damage during childbirth, severe maternal pregnancy, oxygen deficiency( hypoxia, asphyxia).

Anomalies of the bile duct and bladder are laid in the embryonic period. May be caused by illness of the mother, malnutrition. Distinguish the following types of developmental disorders, accompanied by difficulty in the outflow of bile:

• dyscholia associated with the formation of hepatic tissue;
• pathology of sphincters;
• kinks and changes in the shape of the gallbladder;
• infection of ducts.

Pediatricians attach great importance to the formation of biliary dyskinesia in a child against the background of acute infectious diseases( hepatitis type A, salmonellosis, dysentery, parasitic intestinal infections( helminthiases, amoebiasis, giardiasis), chronic tonsillitis, maxillary sinusitis, neuro-arthritis diathesis.older age in schoolchildren and adolescents the main causes are:

• neuroses and vegetovascular dystonia;
• unstable psychoemotional reactions;
• non-compliance(long breaks, hobby for fast food, snacks for dryness)
• lack of physical activity
• hormonal adjustment

Anatomical position of the bladder and ducts is accompanied by an increased risk of dysfunction in the defeat of neighboring organs

It has been established that the reduction of the gallbladder is significantly influenced bydigestive hormones( gastrin, cholecystokinin, secretin, glucagon).Their production is disrupted by inflammatory diseases - gastritis, gastroenteritis, duodenitis, enterocolitis, pancreatitis.

In such cases, dyskinesia of bile ducts in children can be considered as a complication. The presence of diabetes in the child and other endocrine diseases is an important risk factor for dyskinesia. Pediatricians attach importance to the hereditary predisposition in the family, the propensity to allergic reactions.

What are the types of DZHVP?

Only 2 forms are included in the International Statistical Classification: spasm of the sphincter of Oddi( an inlet for bile and pancreatic juice in the intestine) and dyskinesia of the gallbladder with the main duct. Due to violations it is common to divide all dyskinesia:

• for primary - are formed by a violation of the nervous and hormonal regulation of the contractile function;
• secondary - follow other diseases of the digestive system, nervous and endocrine system, the mechanism involved reflex pathways of impulse transmission.

Dyskinesia in children differ in the nature of muscle tone and muscle activity:

• hypermotor( hyperkinetic, hypertonic) - accompanied by increased tone, spastic rapid contraction of the gallbladder muscle and ducts, increased volume of intestinal bile;
• hypomotor( hypokinetic, hypotonic) - is caused by relaxation of the muscles, rare contractions, provokes stagnation of bile in the bladder, lack of intestines;
• mixed - characterized by the lack of consistency of symptoms, the alternation of excessive spasms with stagnation.

Provoking a painful attack may lead to the transfer of the child to the preparatory group with a reduction in the load

How does the dyskinesia manifest in the child?

Symptoms of biliary dyskinesia depend on the type of function impairment. In childhood, a hypotonic form rarely occurs. All manifestations are usually combined into syndromes. Differences can be traced through the table.

The main symptomatology of DZHVP in children

In hyperkinetic dyskinesia, palpation in the zone of the gallbladder is painful even outside of the attack, the doctor reveals "bubble" symptoms when tapping on the right costal arch, in the projection zone of the bladder. He draws attention to profuse urination. The marked attack is accompanied by palpitation, arrhythmia, blanching of the skin, cold snap of hands, panic condition.

In the case of atony and overgrowth with bile congestion, the liver may be enlarged, but the edge is soft and painless. A severe degree of manifestation is mechanical jaundice. Skin and sclera become yellow, urine darkens, feces discolor.

With a mixed form, the signs of vegetative neurosis appear to the fore. The child becomes whiny, capricious, inattentive. Schoolchildren are disturbed by the memorization and assimilation of material, and their academic performance is falling.

It is important to support the child, and not to blame for the simulation

How the children are diagnosed

Children with unclear pain in the biliary tract should necessarily be examined by a gastroenterologist. To correctly diagnose, it is necessary to exclude primarily inflammatory diseases, developmental anomalies, to reveal such causes as lambliasis, helminthic invasion. The survey complex includes laboratory and instrumental methods.

Blood test - does not show specific abnormalities, but gives an opportunity for leukocytosis, an increase in ESR suggest an inflammatory process. Eosinophilia indicates parasitic infection. In the serum of venous blood, the level of bilirubin is checked, the parameters of liver samples( asparagine and alanine transaminases), alkaline phosphatase, aldolase. Elevated values ​​speak for hepatitis, inflammation of the pancreas.

In the analysis of stool, a coprogram is checked( digestibility indicators of food).Dyspepsia is manifested by undigested fibers, increased mucus. With microscopy, it is possible to identify worms, lamblia. Duodenal sounding is necessary for the examination of bile. The volume, the chemical composition( the increased content of salts during stagnation precipitates and forms stones) is estimated. Under the microscope, you can see lamblia, mushrooms.

To facilitate the swallowing of the probe, preliminary anesthesia of the root of the tongue is carried out with a special solution of

. The ultrasound of the gallbladder and ducts allows checking the dimensions, the shape of the gallbladder, the patency of the pathways, anomalies, and stones. To determine the violation of contractility of the muscular layer and sphincters, ultrasound is repeated after a provocation( give an egg, drink Xylitol solution).

Fibroduodenogastroscopy is performed for older children, small only under general anesthesia. The method allows you to examine the upper sections of the digestive tract, take the analysis of bile from the duodenum, check the acidity of the gastric juice.

X-ray examination using contrasting substances, magnetic resonance tomography is practically not done for children, since it is difficult to ensure immobility during the photographs. In a study of a teenage child, cholecystocholangiography, a magnetic resonance technique, can be used.

How to treat a child with dyskinesia?

Treatment of biliary dyskinesia requires an integrated approach and patience. Usually, children are treated on an outpatient basis under the supervision of a gastroenterologist. With severe pain, you need to call an ambulance, because even with a clarified diagnosis, there is a chance of simultaneous occurrence of cholecystitis, appendicitis and other diseases.

A child of any age needs attention to their complaints. Such neurological symptoms as increased irritability, crying, poor sleep are caused by a failure of the digestive process and a neurosis-like condition. Calm games, joint walks, the belief that everything can be corrected by treatment, have a significant impact on the fragile psyche.

Diet

The organization of dietary nutrition for a child with biliary dyskinesia requires:

• categorical rejection of snacks, drinking nuts, chips, soda water;
• feeding every 4 hours;
• exceptions of any fried, fatty foods, hot sauces, sweets, soda water;
• serves only warm food on the table( hot dishes and ice cream are forbidden);
• meat and fish are cooked in a double boiler or boiled, with good tolerability allowed to extinguish;
• in food should be enough plant fiber, vitamins( cereals, fruit, vegetable salads);
• , vegetable oil( olive, sunflower, soybean) is added to the ready meals, butter is used less often;
• to support the balance of the intestinal flora recommended yoghurts, "rastishka", fermented milk with bifido- and lactobacilli.

There are no doubts that this baby is expected by all possible digestive disorders due to negligence of parents.

. Medical and physiotherapy treatment.

. For children, doctors try to pick up the least serious preparations of plant origin, the dose of tablets is calculated by weight and age. In the hypertensive type of dyskinesia calming doses with valerian, motherwort are recommended.

Pain is removed by antispasmodics( Papaverin, No-shpa, Drotaverin), holespazmolitikami( dry bile, Flamin).Children willingly are treated by methods of physiotherapy. Effective applications of warm paraffin, diathermy, electrophoresis, inductothermy. Massage of the cervical-collar zone is prescribed with pronounced neurologic symptoms.

With a rare hypokinetic form of dyskinesia, stimulating procedures and medications are needed. It is recommended exercise massage, massage. Cholagogue preparations are chosen that can strengthen the "pushing" of bile, contractility of ways. Cholinokinetics( xylitol, magnesia solution, sorbitol), magnesium sulfate have a similar effect.

From herbal preparations are suitable broths of dogrose, corn stigmas, calendula. To prevent stagnation and purification of the gallbladder, it is recommended to do once a week tjubazh( blind probing) with mineral water, Xylitol, magnesia, vegetable oil.

Stimulation with the help of physiotherapeutic methods is carried out by galvanization, Bernard currents, electrophoresis with magnesium sulfate. It is very useful to the child once a year to drink natural mineral waters at the resorts of Pyatigorsk, Kislovodsk, Essentuki. You can buy bottled water, but it is devoid of biological active substances that do not persist, and the origin is doubtful.

What can I choose from popular recommendations?

Traditional medicine uses advice on the inclusion in the food of the child some useful products. For example,

• jelly from oatmeal flakes;
• on an empty stomach with a hypotonic form to drink a tablespoon of olive oil and drink tea with lemon;
• cooked trousers( grinded pork is recommended to eat a little before feeding);
• broth of wild rose.

Prognosis and prevention of

If you organize the proper care and nutrition of the child, you can overcome the causes of dyskinesia. Special attention is required by adolescents. The independent choice of products often provokes, but does not cure the disease. In the upbringing of the child, it is necessary to include an explanation of the appropriateness of proper nutrition.

Many doctors consider dyskinesia the initial stage of various diseases of the digestive system. Especially it is characteristic for the subsequent development of cholecystitis, pancreatitis, cholelithiasis, dysbiosis. Therefore, it is so important to treat dyskinesia of bile ducts in childhood.

Adherence to diet and nutrition depends on the efforts and control of surrounding adults. Studies, appointed by a pediatrician, gastroenterologist should be carried out regularly. Perhaps the doctor will refer the child to a neurologist for the necessary correction of behavior. Timely treatment will help prevent pathology in growing up.