Dyskinesia of the biliary tract and gallbladder - causes, types (hypotonic, hypertensive), symptoms, diagnosis and treatment (drugs, diet). Causes, diagnosis and treatment of dyskinesia in children. Methods of treatment and diagnosis of biliary dyskinesia

Update: November 2018

Dyskinesia is not a curvature or bending of the gallbladder or the ducts leading from it, as most people believe. The term comes from the Greek word “kinesis,” which means “movement,” and the prefix “dis-” means “disturbance.” Thus, biliary dyskinesia is a condition in which the tone or motility of the system that carries bile from the liver to the duodenum is impaired. This causes pain in the right hypochondrium, problems with stool, and sometimes bitterness in the mouth, but upon examination no damage to these organs is noted.

Most often, dyskinesia occurs in people who have developmental anomalies of the biliary organs, who love an unbalanced diet, as well as in people who are often exposed to various traumatic situations. There are other reasons this state. Women are most susceptible to this pathology. Treatment of dyskinesia is aimed at eliminating symptoms, and also - especially if the biliary tract has a slow movement speed or poor contractility - at preventing the formation of stones.

A little about anatomy and physiology

Bile is a brownish-yellow liquid essential for digestion. Her main function– separate fats from food from each other, increasing their surface area. Then they are well processed by the enzyme lipase, as a result of which the constituent parts of fats - fatty acids - are absorbed into the blood. In addition, bile affects the absorption of proteins and carbohydrates. Under the influence of this substance, produced by the liver by ¾, and ¼ by the hepatic ducts, it works normally small intestine: absorption processes take place in it nutrients, as well as the division and death of its own cells.

For all of the above processes to occur correctly, bile must have a normal concentration. This is done by the gallbladder, which “gives” excess water to the vessels. If bile is not retained in the bladder, it enters the intestines in a diluted form and irritates it, causing diarrhea. If bile stays in the bladder for too long, it comes in too concentrated, which is also not beneficial.

Bile is formed in the liver. Next, it must reach the gallbladder through the bile ducts, and from there enter the duodenum. The movement of secretions is ensured by the difference in pressure in the biliary tract, which occurs as a result of the work of the circular muscles - sphincters. So, the sphincter that allows bile to enter the gallbladder is closed - it drains from the liver. Then it opens, and the secretion flows into the bladder, which was almost empty, and in which the pressure was less than in the duct. When fatty foods enter the duodenum, the gallbladder, which is an organ equipped with muscles, contracts. In this case, the sphincter in the neck of the bladder opens, and the one with which the entrance to the duodenum begins is closed, and it opens when the first one closes. Contractions of the biliary tract are regulated by the sympathetic nervous system and certain substances produced in the stomach and pancreas.

What is dyskinesia, its types

Having examined the anatomy, we can explain the essence of the pathology in more detail. So, dyskinesia is a condition:

• if the sphincters (one or more) located in the bile ducts do not relax in time;
• or, conversely, despite eating, the sphincters do not want to relax;
• if there is a strong contraction of the gallbladder;
• if the gallbladder or ducts contract very sluggishly, reducing the rate of bile outflow.

Depending on the disturbances of motor function and tone, dyskinesia can be:

• hypertensive: sphincter tone is increased;
• hypotonic: tone, on the contrary, is reduced;
• hypokinetic: the movement of the biliary tract is slowed down, bile is released slowly;
• hyperkinetic: the outflow of bile is active, its portions are released sharply.

Usually increased tone combined with enhanced motor skills, forming a hypertonic-hyperkinetic (or spastic) type of dyskinesia. The same thing happens in the opposite situation: with weak motor skills, the tone of the biliary tract is weakened - hypotonic-hypokinetic (atonic) type. There is also a mixed type.

Spastic dyskinesia is characteristic of increased tone of the parasympathetic department. The atonic type of the disease develops when the influence of the sympathetic part of the autonomic nervous system predominates.

Causes of the disease

The following reasons lead to disruption of the tone or movement of the bile ducts:

• Congenital malformations of the biliary tract and gallbladder:
  • doubling of the bile ducts;
  • congenital weakness of the bladder wall;
  • intrahepatic gallbladder;
  • inflection of the gallbladder;
  • gallbladder divided by a septum;
  • valves in the bile duct;
  • accessory gallbladder;
  • mobile bubble;
  • abnormally located bubble.

All these pathologies cause dyskinesia called “primary”. Next, we list acquired diseases (occurring during life) that can cause secondary biliary dyskinesia.

• Dietary habits: long periods of fasting, avoiding vegetable fats or, conversely, eating large amounts of fatty, smoked and spicy foods.
• Constant stress or traumatic situations.
• Previous pancreatitis or other inflammatory pathology of the gastrointestinal tract or female organs.
• Chronic cholecystitis.
• Neurocirculatory dystonia, when the control of the normal sequence of contractions of the biliary tract is disrupted.
• Constantly existing foci of infection in the body (caries, chronic tonsillitis).
• Diseases endocrine organs: obesity, diabetes, thyrotoxicosis.
• Food allergies.
• Previous viral hepatitis.
• Worm diseases.
• Giardiasis, in which flagellated protozoa colonize the gallbladder.
• The period of menopause, when the regulation of contractility of the biliary tract is disrupted.
• Dysbacteriosis.
• Past intestinal infections.

Signs of the disease

Symptoms of biliary dyskinesia differ depending on the type of pathology: whether it is hyperkinetic or hypokinetic.

The main difference between the main types of the disease is pain with dyskinesia:

Both types of dyskinesia can cause other symptoms:

• irritability;
• increased sweating;
• recurrent headaches;
• bad breath;
• bloating;
• decreased appetite;
• bitterness in the mouth;
• yellow coating on the tongue;
• decreased libido in men;
• Some women experience menstrual irregularities.

An extreme manifestation of the hyperkinetic variant is biliary colic. It manifests itself as sudden severe pain on the right under the rib, which is accompanied by an attack of panic, numbness of the limbs.

The maximum manifestation of hypokinetic dyskinesia is cholestasis - stagnation of bile in the bile ducts. The following symptoms indicate this:

• severe itching of the entire skin;
• yellowing of the skin and whites of the eyes;
• darkening of urine;
• the stool takes on a light yellow or even grayish color.

Diagnostics

Symptoms alone are not enough to make a diagnosis, because similar signs can develop with more serious liver diseases. Secondly, it is necessary to establish the cause (for example, malformations of the biliary tract) that caused the disease in order to subsequently eliminate it.

Biliary dyskinesia is a condition in which the structure of these organs is not impaired. That is, the diagnosis is made based on the violation of contractility or tone on the path from the liver to the duodenum. How to see it?

Ultrasound

After performing an ultrasound of the gallbladder with a choleretic breakfast. First, after following a three-day diet, a “regular” ultrasound is performed abdominal cavity. With its help, volumes, sizes, deformations, anomalies of the biliary tract are assessed, and an examination is performed for gallstones. Next, the person takes foods that should cause the release of bile into the duodenum (this could be: 100 grams of cream or full-fat sour cream, full-fat yogurt, chocolate or a couple of bananas), and the doctor looks at the sequence and how the movement of bile occurs.

Duodenal sounding

By assessing portions of the contents of the duodenum. To do this, a study called “duodenal intubation” is carried out: a person needs to swallow a thin probe, from which, upon reaching the duodenum, its contents will be obtained. The study is carried out on an empty stomach. First, a portion of the usual intestinal contents is obtained from the probe, which consists of bile, fluid secreted there by the pancreas and the juice of the duodenum itself. Next, a choleretic drug, magnesium sulfate, is injected into the probe. The gallbladder contracts and the bile contained in it enters the intestine. She is also taken for research. Over time, bile, which was previously in the intrahepatic bile ducts, flows here. She is also taken for analysis. To establish the diagnosis of dyskinesia, the time that passes from the moment of administration of the choleretic drug to the receipt of the second and then the third portion is important. The content of various lipids in the last two servings is also important.

Cholecystography

Using contrast radiography methods - cholecystography (extrahepatic bile ducts are examined) and cholangiography (intrahepatic bile ducts are examined). In the first case, a person needs to take a radiopaque substance through the mouth, after which x-rays it will be seen how the contrast reaches the gallbladder, how it leaves it, and in what sequence the contraction and relaxation of the sphincters occurs. The second method involves an injection: a radiopaque substance is injected directly into the bile ducts, and then a radiologist monitors its progress along the bile ducts.

ERCP

When performing ERCP (endoscopic retrograde cholangiopancreatography), when a probe with an optical fiber is inserted into the duodenum, and through it a contrast agent is injected directly into the biliary tract, the retrograde (that is, opposite to the normal flow) movement of which is examined using X-rays.

Cholescintigraphy

Through a radiological study - cholescintigraphy, in which a radioisotope drug is introduced into the body, and in the light of special radiation, it is visualized how it passes into the liver, is released into the bile ducts, is sent to the gallbladder, and then reaches the duodenum.

Magnetic resonance cholangiography

In difficult cases, magnetic resonance cholangiography is indicated - a non-invasive research method when a contrast agent is injected into the body, and its path is observed in a magnetic resonance imaging scanner. To carry out such a diagnosis, a person will need to stay in the camera chamber for about 40-50 minutes, keeping still.

Blood tests for lipids and bilirubin with its fractions, stool analysis for dysbacteriosis, helminth eggs and coprogram - methods that allow you to determine the integrity of the function of the biliary tract, as well as exclude the possible cause of the disease - worms. These tests do not make a diagnosis.

Treatment

Treatment of biliary dyskinesia consists of:

• diet therapy: it differs in hypo- and hyperkinetic forms of pathology;
• taking decoctions or infusions of various herbs: it is prescribed by a gastroenterologist, taking into account the type of disease, and is an integral part of treatment;
• drug therapy: prescribed in courses, aimed at stopping an attack, preventing their occurrence in the future, as well as to prevent complications.

Diet therapy

Nutrition for dyskinesias is the main “whale” of treatment. Only he, with strict adherence to the rules, allows you to avoid attacks and prevent such surgical complications as acute cholecystitis and cholelithiasis.

The diet for dyskinesia contains general nutritional rules, but there are also points that are radically different in the hypokinetic and hyperkinetic variants.

General rules

You need to eat food so that the gallbladder is completely emptied, but no pain attacks occur. For this:

• eat little by little, 4-5 times a day;
• eat food in small portions;
• maintain 3-4 hour intervals between meals;
• eat dinner 2-3 hours in advance, but do not gorge yourself on meat at night;
• morning and evening eat low-fat dairy products;
• avoid eating cold or too hot foods;
• Do not heat food with animal or trans fats: margarine, pork, goose or lamb.

Features of nutrition for hypomotor dyskinesia

The diet must contain foods that stimulate biliary motility:

• fruits;
• vegetables (baked, stewed, boiled);
• butter and vegetable oils;
• sour cream;
• black bread;
• eggs;
• cream.

Features of nutrition for hypermotor dyskinesia

With this form of the disease, it is necessary to exclude from the diet foods that stimulate bile formation and secretion: animal fats, brown bread, fatty dairy and fermented milk products, fresh vegetables, broths and soda.

Drug therapy

It also has general purposes, and is also based on the type of dyskinesia.

Since dyskinesia is considered a disease, the main cause of which is nervous regulation, which depends directly on the psyche. Therefore, before treating impaired motor activity of the biliary tract with the help of choleretic drugs, you need to start with restoring the mental background. If the pathology arose against the background depressive state, a course of mild antidepressants is prescribed. If the violation of bile secretion was provoked by neuroses, expressed anxiety, it is advisable to start with tranquilizers or antipsychotics.

Such prescriptions are made by a psychotherapist or psychiatrist.

In addition, the cause that caused dyskinesia is treated: anthelmintic therapy, allergy treatment, elimination of hypovitaminosis, correction of dysbiosis.

Hypotonic-hypokinetic form

In this case, you need choleretic drugs that:

• will increase the tone of the gallbladder: magnesium sulfate, xylitol;
• improve motility of the biliary tract: for example, cholecystokinin, pancreozymin.

In addition to choleretic drugs, tonic preparations are also needed: ginseng tincture, Eleutherococcus extract, Schisandra tincture.

Hypertonic-hyperkinetic form

Here we need drugs that increase the formation of bile: there will be more of it, the bile ducts will work longer, and not contract quickly, causing an attack of pain. These are medications such as ocafenamide, flamin, nicodin.

Also, if the sphincters are overstrained, they are relaxed. This is done with antispasmodic drugs: no-spa, buscopan.

In addition, we need such means that normalize the balance of parasympathetic and sympathetic systems: valerian tincture, potassium bromide, motherwort tincture.

Treatment with traditional methods

Biliary dyskinesia is a pathology in the treatment of which folk remedies– an excellent addition to drug therapy, and sometimes its only component (for example, in children).

If tests show the presence of cholestasis (stagnation of bile), and the liver tissue is not damaged (the levels of ALT and AST are not increased in the “liver test” analysis), blind probing is performed: a solution of sorbitol, highly mineralized mineral water or magnesium sulfate is drunk on an empty stomach. Then you need to lie on your right side and put it under it. You need to lie down like this for 20-30 minutes.

Additional treatments

In the treatment of biliary dyskinesia, the following are used:

• physiotherapy: diadynamic currents, electrophoresis, microwave;
• acupuncture;
• acupressure;
• treatment with leeches;
• treatment in gastroenterological sanatoriums, which provide therapy with mineral waters.

Complications of biliary dyskinesia

This functional disorder can lead to the following consequences:

• the formation of chronic inflammation of the gallbladder wall (chronic cholecystitis);
• inflammation of the intrahepatic bile ducts (cholangitis);
• cholelithiasis;
• inflammation of the pancreas;
• gastritis, gastroduodenitis - inflammation of the stomach or stomach, or duodenum. This is due to the fact that in this disease, unconcentrated bile is often thrown into the stomach and duodenum, which leads to their inflammation;
• allergization of the body, which manifests itself as a skin rash;
• weight loss, metabolic disorders, which occurs due to impaired absorption of necessary substances without proper processing by bile.

Prevention of the disease and its prognosis

To prevent pathology from developing, follow these rules:

1. sleep at least 8 hours;
2. go to bed no later than 11 pm;
3. alternate mental and physical work;
4. walk outside in the fresh air;
5. eat well: eat more plant food, cereal products, boiled animal products, less - fried meat or fish;
6. exclude psychologically traumatic situations.

If the pathology has already developed, you should follow the recommendations of your gastroenterologist and pay attention to the psycho-emotional background.

Biliary dyskinesia does not reduce life expectancy, but affects its quality.

Dyskinesia in children

Biliary dyskinesia in young children develops due to their abnormal structure. Most often this is a bend in the gallbladder or the presence of septa in it, less often - doubling or abnormal location of the biliary tract.

In older children, the cause is emotional stress. These include quarrels between parents, family relocation, staff at kindergarten and school, and a heavy academic load.

Other causes of dyskinesia are:

• hypoxia or;
• frequent sinusitis, chronic tonsillitis;
• past hepatitis A, dysentery, salmonellosis;
• helminthic infestations: giardiasis, roundworms;
• allergic diseases;
• vegetative-vascular dystonia;
• neuroses;
• neuro-arthritic diathesis.

Dyskinesia in children is a more dangerous disease: without normal emulsification of fats, the absorption of sufficient amounts of fatty acids and other substances necessary for the body will not occur, as well as fat-soluble vitamins– A, D, E and K, each of which is important for a growing organism.

If parents notice that the child is withdrawn, irritable, gets tired quickly or cries at the slightest provocation, it is worth contacting a pediatric gastroenterologist to rule out biliary dyskinesia. If at the moment it is not detected, this does not mean that the danger has passed; this suggests that there is a predisposition to it, but the pathology has not yet had time to debut. In this case it is worth paying Special attention on the child’s diet and daily routine to prevent its formation.

The following symptoms indicate that pathology has developed:

• alternating constipation and diarrhea;
• periodically - especially after eating fatty or fried foods - pain in the right hypochondrium;
• itching of the skin that appeared for an unknown reason, not after an injection, not after a bite, taking a new food or taking a new medicine.

Diagnosis of pathology is carried out according to ultrasound data with a choleretic breakfast. X-ray contrast, and even more so, radioisotope techniques in children are carried out according to strict indications, and with the advent of magnetic resonance cholangiography they are almost never performed.

Treatment in children

For therapy in children, preference is given to herbal preparations. They are selected depending on the type of pathology.

So, for hypomotor dyskinesia the following are prescribed:

• drugs that stimulate the formation of bile: holagol, holosas, allohol, lyobil;
• medications that increase the tone of the biliary tract: magnesium sulfate, sorbitol or xylitol;
• herbal therapy: decoctions of dandelion, rose hips, corn silk, mint;
• “blind probes” with sorbitol or xylitol;
• mineral water: "Essentuki 17".

For hypermotor dyskinesia, treatment is carried out:

• antispasmodic drugs: aminophylline, riabal;
• herbal therapy: decoctions of St. John's wort, chamomile, stinging nettle;
• low-mineralized waters: “Slavyanovskaya”, “Smirnovskaya”;
• electrophoresis with novocaine on the gallbladder area.

After stopping the attack, rehabilitation is carried out in a sanatorium, where mineral waters and other physiotherapy are prescribed:

• Microwave therapy;
• galvanic collar according to Shcherbak;
• sodium chloride baths;
• to eliminate spasm of the biliary tract: magnetotherapy, electrophoresis of antispasmodics (no-shpa, ) on the area of ​​the biliary tract;
• for sedative purposes: pine baths, bromelectroson;
• to improve the motor activity of the biliary tract: SMT therapy, magnesium sulfate electrophoresis.

The diet described above fully applies to children. A strict diet is prescribed for a year, then - in the absence of attacks of biliary colic - you can gradually expand the diet.

Children with dyskinesia are registered with a pediatric gastroenterologist, neurologist and pediatrician. They are scheduled for scheduled ultrasound twice a year. Also, courses of choleretic therapy are conducted every 6 months. Once or twice a year, the child is given referrals for sanatorium-resort treatment.

Biliary dyskinesia is a disease of the gastrointestinal tract, which is characterized by impaired motility of the gallbladder and the functions of its sphincters, in particular the sphincter of Oddi. As a result of these disorders, problems are found with the delivery of bile to duodenum: its amount may be too small, not enough to digest food, or more than necessary, which negatively affects the entire gastrointestinal tract.

According to statistics, women suffer most from biliary dyskinesia. Some statistics indicate that women are 10 times more susceptible to this disease than men. Moreover, you can get dyskinesia at any age. There are also statistics that GIB in young people is characterized by excessive secretion of bile, and in older age there is an insufficiency of bile for digestion. Treatment of this disease has a positive prognosis if the patient consults a doctor at the first symptoms.

What it is?

Biliary dyskinesia is a functional disorder of the tone and motility of the gallbladder, bile ducts and their sphincters, manifested by a violation of the outflow of bile into the duodenum, accompanied by the appearance of pain in the right hypochondrium. However, there are no organic changes in these organs.

Classification

The definition of the form of dyskinesia depends on how the gallbladder contracts:

Depending on the cause of the development of the pathology in question, doctors can divide it into two types:

Causes

Speaking about the causes of dyskinesia, it is necessary to remember that the disease can be primary and secondary. Depending on this, the reasons that provoked dyskinesia will change.

The primary form of dyskinesia can be caused by the following reasons:

• inconsistency in the work of the parasympathetic and sympathetic parts of the nervous system, as a result of which the bladder itself and the sphincter of Oddi lose their tone;
• stress (acute, chronic), development of psychosomatic pathologies;
• malfunctions of the liver, as a result of which bile is produced with an altered chemical composition;
• unhealthy diet (overeating, eating too much fatty foods, untimely breakfasts, lunches and dinners);
• disturbances in the production of intestinal hormones responsible for the contractility of the gallbladder;
• not systemic food intake, eating too much fatty foods, overeating, insufficient grinding of food, eating in a hurry, etc.;
• allergies, as a result of which the neuromuscular apparatus of the gallbladder is in an irritated state and does not provide normal contractions organ;
• underweight, sedentary lifestyle, muscular dystrophy.

The causes of secondary dyskinesia may include the following:

• a history of chronic diseases of the abdominal organs - ovarian cyst, pyelonephritis, adnexitis, etc.;
• previously suffered duodenitis, peptic ulcer, gastritis, atrophy of the mucous membrane of the gastrointestinal tract;
• helminthic infestation;
• cholelithiasis, hepatitis, cholangitis, cholecystitis;
• congenital anomalies biliary tract and gallbladder;
• endocrine disorders, hormonal fluctuations;
• inflammatory diseases of the gastrointestinal tract caused by pathogenic bacteria, for example, salmonella.

There are recorded cases of diagnosing biliary dyskinesia against the background of a sedentary lifestyle, excess weight (obesity stage 2-3), excessive physical activity(especially if you constantly lift weights) and after psycho-emotional breakdowns.

Symptoms of biliary dyskinesia

The clinical picture of the described pathology is quite pronounced, so diagnosis does not present any difficulties for specialists. The main symptoms of biliary dyskinesia in adults are:

1. Dyspeptic syndrome is characterized by nausea, bitterness and dry mouth, belching with a bitter taste, bloating, unstable stools with a predominance of constipation or diarrhea, and fatty stools. Such symptoms are caused by disturbances in the digestive processes associated with insufficient or excessive flow of bile into the intestinal lumen.
2. Pain syndrome. The occurrence of pain is caused by errors in diet or stressful situations. In the hyperkinetic form of dysfunction, the patient experiences spastic pain in the right half of the abdomen under the ribs, extending to the left half chest, into the shoulder blades or becoming encircling in nature. In the hypokinetic form, the pain is bursting, pulling, with or without irradiation, intensifying or disappearing with changes in body position. The pain can disappear on its own and reappear with varying frequency - from several attacks a day to rare episodes throughout the month.
3. Astheno-vegetative syndrome is characterized by weakness, increased fatigue, a feeling of constant weakness, drowsiness or insomnia, increased level anxiety and other symptoms.
4. Cholestatic syndrome occurs rarely with the hypokinetic variant of dyskinesia, when bile that continues to be produced normally does not enter the intestine in the required volume, but accumulates in the gallbladder, leading to the appearance of jaundice skin and sclera, skin itching, dark urine and light stool, enlarged liver.
5. Symptoms of neurosis - panic attacks, phobias (fears), obsessive thoughts, obsessive actions, aggression, anger, tearfulness, resentment, etc.

If a patient suffers from manifestations of hypotonic dyskinesia, then this condition is characterized by a dull and aching pain, which also manifests itself as a feeling of fullness in the area of ​​the right hypochondrium. Such pain constantly worries the patient, while his appetite noticeably decreases, the person often feels nauseous, and belching occurs. There is no rise in body temperature, clinical analysis blood also does not indicate the presence of abnormalities.

If we are talking about hypertensive dyskinesia, then the pain is paroxysmal in nature. The pain is quite acute, but lasts for a short period of time. Pain may radiate to the right shoulder or shoulder blade. Such attacks occur especially often after consuming fatty foods, strong voltage, both physical and emotional. Very often, patients with hypertensive dyskinesia note the manifestation of bitterness in the mouth, which most often happens in the morning.

Possible complications

As a rule, with biliary dyskinesia, patients seek help from doctors almost immediately after the first attack of pain. But many of them, having removed unpleasant symptoms, stop the prescribed treatment, thereby provoking the development of complications:

• duodenitis - an inflammatory process on the lining of the duodenum;
• the formation of stones in the gallbladder and its ducts – cholelithiasis;
• chronic cholecystitis – inflammation of the gallbladder that lasts more than 6 months in a row;
• atopic dermatitis is a skin disease that is a consequence of a decrease in the level of immunity;
• Chronic pancreatitis – inflammation of the pancreas for 6 months.

Biliary dyskinesia has a fairly favorable prognosis and does not shorten the patient’s life expectancy. But in the absence of proper treatment and non-compliance with the nutritionist’s recommendations, the development of the above complications is inevitable. And even these diseases are not life-threatening, but the patient’s condition will worsen significantly and eventually lead to disability.

Diagnostics

Instrumental examinations of the patient play a significant role in diagnosis. The most effective results are obtained by duodenal intubation, ultrasonography, gastroduodenoscopy, cholecystography.

1. Ultrasound examination for biliary dyskinesia is carried out in two stages. First on an empty stomach, and then again 30-40 minutes after the “test breakfast”. As a result of such procedures, the functionality of the bile ducts is analyzed.
2. Duodenal sounding is carried out using a special probe, which is placed in the duodenum. During the study, bile samples are taken for laboratory analysis. During manipulations, the work of the biliary tract, the opening of their sphincters is monitored, and the amount of bile secreted is analyzed.
3. Oral cholecystography. During the examination, the patient drinks a contrast agent. When it hits bladder, a study of its functioning is carried out, on the basis of which it can be concluded what form of dyskinesia is manifested in the patient.
4. Gastroduodenoscopy is performed using a probe. During this procedure, the condition of the mucous membranes of the esophagus, stomach and duodenum is analyzed. If the mucous membrane of these organs is in a state of inflammation and irritation, then we can conclude that there is an excess secretion of bile acids.
5. Laboratory methods: to assess the condition of the biliary system, a biochemical blood test is used. A blood test for the lipid spectrum, or “lipidogram,” shows the content of high, low and very low density lipoproteins (HDL, LDL, VLDL), as well as cholesterol.

It is also necessary to carry out differential diagnosis diseases with other pathologies of the gastrointestinal tract, in which similar symptoms are noted.

How to treat biliary dyskinesia?

In adults, treatment should be comprehensive, aimed at normalizing the outflow of bile and preventing its stagnation in the gallbladder.

For this purpose, the following methods are used in the treatment of biliary dyskinesia:

1. Diet (table No. 5);
2. Normalization and maintenance of work and rest regimes;
3. Reception of mineral waters;
4. Physiotherapy (electrophoresis, diadynamic currents, paraffin baths);
5. The use of closed tubes and duodenal intubation;
6. Acupuncture;
7. Massage;
8. Sanatorium-resort treatment (Truskavets, Mirgorod, Transcarpathian resorts of Ukraine);
9. Taking medications that normalize the flow of bile, relieve pain, relieve sphincter spasms and eliminate painful symptoms (enzyme, choleretic, antispasmodics);
10. Taking medications that normalize the state of the nervous system (sedatives, sedatives, tonics, etc.).

Mandatory methods of treating dyskinesia are normalizing the work and rest regime, following a diet, taking medications and using tubes. All other methods are auxiliary and can be used at will and if possible. The duration of the mandatory treatment methods for dyskinesia is 3–4 weeks. Auxiliary methods can be used for much longer, periodically repeating courses in order to prevent relapse of the disease.

Medicines

Since dyskinesia is a disease caused by a violation nervous regulation, directly depends on the mental state, then before starting treatment for disorders of motor activity in the biliary tract when using choleretic drugs, it is necessary to restore the patient’s mental background. If the pathology appears against the background of a depressive state, it is necessary to prescribe a course of mild antidepressants. If the disruption of the bile secretion process was caused by severe anxiety, neuroses, then it is advisable to start with antipsychotics and tranquilizers.

Such drugs can be prescribed by a psychiatrist or psychotherapist. In addition, the cause of dyskinesia is treated: correction of dysbiosis, elimination of hypovitaminosis, treatment of allergies, anthelmintic therapy.

The choice of drugs to restore the functions of bile formation and bile excretion depends on the type of dyskinesia.

• At hypotonic type biliary dyskinesia is prescribed Flamin, cholecystokinin, magnesium sulfate, pancreozymin; mineral waters of high mineralization (Essentuki 17, Arzni, etc., at room temperature or slightly warmed 30-60 minutes before meals, depending on the secretion of the stomach). Herbal medicine: corn silk, immortelle flowers, chamomile, nettle leaves, rose hips, St. John's wort, oregano.
• For the hypertensive type of biliary dyskinesia, oxafenamide, nicodin, and low-mineralization mineral waters are used (Slavyanovskaya, Smirnovskaya, Essentuki 4, 20, Narzan hot or heated 5-6 times a day). For herbal medicine, chamomile flowers, peppermint, licorice root, valerian root, motherwort herb, and dill fruits are used.
• For intrahepatic cholestasis, tubes are performed (tubeless drainage of the biliary system, or “blind” probing) 1-2 times a week. Tonics, choleretics and cholekinetics are prescribed. With increased activity of the liver enzyme ALT, choleretics are not prescribed.
• For the hypokinetic type of biliary dyskinesia, sorbitol, xylitol, cholecystokinin, pancreozymin, magnesium sulfate, highly mineralized mineral waters at room temperature or slightly warmed 30-60 minutes before meals are recommended. Herbal medicine as for hypotonic type.
• For the hyperkinetic type of biliary dyskinesia, a short course of antispasmodics, potassium and magnesium preparations, and heated mineral waters of low mineralization are used 5-6 times a day. Herbal medicine: chamomile flowers, peppermint, licorice root, valerian root, motherwort herb, dill fruits.

Therapy is selected individually in each case, and for this you need to contact a specialist. To be appointed comprehensive examination, and after making a diagnosis, the doctor will choose suitable drugs. Self-medication is dangerous: incorrect recognition of symptoms can only lead to worsening well-being.

Diet and proper nutrition

The basis of treatment for dyskinesia is nutrition. Only through strict adherence to the rules can the occurrence of attacks be avoided and surgical complications such as cholelithiasis and acute cholecystitis can be prevented. Diet for dyskinesia involves following general rules nutrition, however, there are points that differ significantly depending on the type of disease (hyperkinetic and hypokinetic).

For any type of dyskinesia, the following foods should be completely excluded from the diet:

• spicy, fried, fatty, smoked, sour, pickles and everything canned;
• fatty meats and fish;
• confectionery products, including chocolate, cocoa;
• pastries from butter dough;
• carbonated drinks, coffee, alcohol;
• seasonings;
• vegetables that irritate the gastrointestinal tract - garlic, onions, radishes, sorrel;
• products that increase gas formation in the intestines (legumes, rye bread, etc.);
• milk;
• marinades.

Features of nutrition in hypomotor dyskinesia. The diet should consist of foods that stimulate biliary motility:

• cream;
• eggs;
• black bread;
• sour cream;
• vegetable and butter;
• vegetables (boiled, stewed, baked);
• fruits.

Features of nutrition for hypermotor dyskinesia:

If this form of pathology is present, it is imperative to exclude daily diet products that stimulate bile secretion and bile formation: soda, broths, fresh vegetables, fatty fermented milk and dairy products, brown bread, animal fats.

For any form of dyskinesia, it is necessary to eat food 5–6 times a day in small portions (the contents of a portion should fit in two handfuls). Do not allow more than 2 hours between meals. All food and drinks should be warm or at room temperature and not cold or hot because it is too hot or low temperature may provoke an attack of dyskinesia. Salt must be limited, consuming no more than 3 g per day, to eliminate fluid stagnation in the tissues. Prepare various dishes follows the methods of boiling, baking or steaming.

Mineral water

Mineral waters should be drunk regularly, 1/2 - 1 glass 20 - 30 minutes before meals, warm, choosing the required variety depending on the form of dyskinesia. Thus, for hypomotor dyskinesia, it is recommended to drink water of high mineralization (for example, Essentuki 17, Batalinskaya, Borjomi, Mashuk, etc.), and for hypermotor dyskinesia, it is recommended to drink water of low mineralization (for example, Darasun, Karachinskaya, Lipetskaya, Narzan, Smirnovskaya, etc.) .

You can and should drink mineral waters, as well as follow a diet, for a long period of time, that is, at least 3–4 months. However, if mineral waters cannot be included in complex therapy diseases, then you can completely stop using them.

Lifestyle with dyskinesia

For a patient with biliary dyskinesia, it is very important to healthy image life, which includes:

• rejection of bad habits,
• moderate physical activity, without physical overload,
• rational mode of work and rest,
• a full night's sleep,

The main component of the lifestyle is healthy eating– exclusion of fatty, fried, spicy, salty, spicy foods, limiting animal products, increasing food consumption plant origin. During the treatment of dyskinesia, one should observe strict diet, or treatment table №5.

Folk remedies

At home, treatment of dyskinesia is best done in combination with traditional methods. But before preparing and taking them, you should consult your doctor.

Infusions, decoctions, extracts and syrups of herbs are used that can activate the formation of bile and improve the motor function of the sphincters and bile ducts.

1. For the hypertonic and hyperkinetic type, mint, chamomile flowers, motherwort herb, licorice root, dill fruits, and valerian root are used.
2. In the hypotonic and hypokinetic form, rose hips, immortelle flowers, St. John's wort, corn silk, oregano, nettle leaves, and chamomile are used for herbal medicine.

Milk thistle, immortelle, tansy, dandelion leaves and root, corn silk, chicory, rose hips, fumaria, parsley, turmeric root, cumin, yarrow have a choleretic effect.

Herbal decoctions are used 20-30 minutes before meals.

Surgery

In the absence of long-awaited relief after adequate and comprehensive conservative therapy doctors use surgical techniques. They can be:

• minimally invasive (usually using endoscopic equipment);
• radical.

In case of identified dysfunction of the sphincter of Oddi, the following is carried out:

• injections directly into this sphincter of botulinum toxin (it significantly reduces spasm and pressure, but the effect is temporary);
• balloon dilatation of this sphincter;
• placement of a special catheter-stent in the bile duct;
• endoscopic sphincterotomy (its excision together with the duodenal nipple) followed (if necessary) by surgical sphincteroplasty.

An extreme measure to combat severe hypotonic-hypokinetic variant of biliary dysfunction is cholecystectomy (complete removal of the atonic gallbladder). It is carried out laparoscopically (instead of an incision on abdominal wall make several punctures for equipment and instruments) or laparotomy (with a traditional incision) by way. But the effectiveness of this serious surgical intervention not always felt by patients. Often after this, the resumption of complaints is associated with the developed postcholecystectomy syndrome. Rarely done.

Biliary dyskinesia in children

For therapy in children, preference is given to herbal preparations. They are selected depending on the type of pathology.

So, for hypomotor dyskinesia the following are prescribed:

• medications that increase the tone of the biliary tract: magnesium sulfate, sorbitol or xylitol;
• drugs that stimulate the formation of bile: holagol, holosas, allohol, lyobil;
• “blind probes” with sorbitol or xylitol;
• herbal therapy: decoctions of dandelion, rose hips, corn silk, mint;
• mineral waters: “Essentuki 17”.

For hypermotor dyskinesia, treatment is carried out:

• herbal therapy: decoctions of St. John's wort, chamomile, stinging nettle;
• antispasmodic drugs: aminophylline, riabal;
• electrophoresis with novocaine on the gallbladder area;
• low-mineralized waters: “Slavyanovskaya”, “Smirnovskaya”.

After stopping the attack, rehabilitation is carried out in a sanatorium, where mineral waters and other physiotherapy are prescribed:

• sodium chloride baths;
• Microwave therapy;
• galvanic collar according to Shcherbak;
• for sedative purposes: pine baths, bromelectroson;
• to improve the motor activity of the biliary tract: SMT therapy, magnesium sulfate electrophoresis.
• to eliminate spasm of the biliary tract: magnetotherapy, electrophoresis of antispasmodics (no-spa, papaverine) on the area of ​​the biliary tract/

Children with dyskinesia are registered with a pediatric gastroenterologist, neurologist and pediatrician. They are scheduled for scheduled ultrasound twice a year. Also, courses of choleretic therapy are conducted every 6 months. Once or twice a year, the child is given referrals for sanatorium-resort treatment.

Prevention

To prevent the appearance and development of pathology, you should:

1. Get proper sleep and rest (sleep at least 8 hours a day);
2. Provide daily walks in the fresh air;
3. Organize proper and balanced nutrition;
4. Eliminate stress and psycho-emotional stress.

At secondary prevention(i.e., after dyskinesia has been identified), it is possible to prevent the disease by following the doctor’s recommendations and regularly undergoing preventive examinations

Some people can live for years and not realize they have a health problem. Mild malaise and nausea in the morning, as well as bile cramps are not taken into account. Most often, the disease comes unexpectedly, so it is recommended to know not only the symptoms of emerging biliary dyskinesia, but also.

Dyskinesia and its types

Dyskinesia is a disease digestive organs, in the presence of which negative changes occur in the functioning of the motility of the biliary tract, as well as the appearance of gallbladder tone. The condition provokes a disturbance in the duodenum, where the process of food digestion is inhibited.

But you shouldn’t refuse treatment. In the absence of treatment, the disease tends to develop into more serious diseases, for example, cholelithiasis or similar very unpleasant ailments of the body.

Bile – necessary component in the body, helping in the digestion process. It is the main substance that separates fats from the total mass of food, thereby making their area larger. As a result of excretion, they are absorbed into the blood.

In order for these actions to be carried out correctly, the bile consistency must have a suitable composition. This issue is dealt with; if there is a large amount of water in the bile, it eliminates it, transferring it into the vessels.

If the motility of the gallbladder is impaired, and the internal fluid, without being filtered, enters the intestines, a disorder is observed and, as a result, diarrhea. In another variant, if bile, on the contrary, long time undergoes processing, water is removed from it in increased quantities, which also negatively affects the functioning of internal organs.

The movement of internal fluid from the liver, where it is formed, to the duodenum is influenced by the work of the sphincters (circular muscles). The latter regulates the flow of bile: first into the gallbladder, and then into the duodenum.

Violation of a coherent system leads to the appearance of dyskinesia. The disease is distinguished based on the activity of muscle contractions (features of motor skills):

1. Hypokinetic - there is a decrease in contractions of the muscles of the biliary tract, the movement of internal fluid is difficult. It usually appears in people who have crossed the threshold of 40 years or in individuals with mental disorders.
2. Hyperkinetic - the activity of muscle contractions, on the contrary, is significantly increased. Called in a sedentary manner life, usually occurs either in children school age, or among the younger generation.

In addition, the disease is classified depending on the causes of occurrence and time of manifestation into primary and secondary forms. Primary dyskinesia manifests itself during the formation of important internal organs, that is, in utero. While secondary is provoked based on the consequences of previous diseases.

Causes of the disease

Define main reason For different cases impossible. In every special case the disease develops individually. A person forms his own habits, eats harmful products nutrition, which has an undoubted impact on the deterioration of general well-being, and can also cause an inflammatory process in the regulatory system.

One of the factors of occurrence is a stressful situation. It is frequent angry tension, nervousness, and bad mood that affect the motility of the biliary tract, narrowing the patency of the ducts.

The causes of improper functioning of the bladder and ducts in the primary form of the disease are birth defects fetal development:

• The bladder is located inside the liver
• Bile ducts are doubled
• The bubble has kinked
• Formation of valves inside the ducts
• An additional gallbladder has formed
• A bubble has formed divided into two parts by a septum
• Weak bladder walls
• The bubble is quite mobile or incorrectly located

Factors that have the ability to influence development are identified secondary form dyskinesia:

• Genetic predisposition
• Diseases that the patient suffered previously (cholecystitis in various forms)
• Dysbacteriosis of the large intestine
• Mental disorders
• Allergic reactions to foods
• Respiratory tract infections
• Inflammatory processes of the digestive tract
• Stones in the kidneys
• Spasmodic condition of the passages through which internal fluid circulates
• Bad habits (excessive consumption alcoholic drinks, smoking abuse)
• Negative influence of external environmental factors (environmental pollution)

In addition, obesity or, conversely, prolonged unsuccessful diets contribute to the emergence of a painful problem.

If you experience pain, you should immediately seek advice from a qualified specialist. Treatment should begin after identifying original reasons that led to this state.

Symptoms of pathology

Signs of the disease do not immediately make themselves felt. Disease a long period develops without any symptoms. The first manifestation of discomfort is pain in the right hypochondrium or biliary colic. Pain when various types dyskinesia is different.

So, the ongoing disease in children is more dangerous illness than in adult patients. The treatment of young patients is strictly controlled by medical professionals.

Thus, dyskinesia is a disease that has no boundaries in age category. Anyone can purchase it; the main thing is that you should not neglect or refuse treatment.

Aug 10, 2017 Violetta Doctor

A disease in which the motility of the gallbladder, its duct and sphincters is impaired. This provokes a violation of the excretion of bile into the duodenum and disrupts the functioning of the digestive tract.

Causes of biliary dyskinesia:

• inflammatory diseases of the gastrointestinal tract
• hormonal disorders
• poor nutrition
• alcohol abuse
• helminthic infestation
• sedentary lifestyle
• stress

There are two forms of biliary dyskinesia. The hypokinetic form is an insufficient contraction of the gallbladder; accordingly, an insufficient amount of bile enters the digestive tract. The hyperkinetic form is an excessive contraction of the gallbladder and excessive flow of bile.

Classification of dyskinesias of the gallbladder and duct:

• according to the tone of the gallbladder:
  • hypotension of the gallbladder,
  • gallbladder hypertension;
• according to the state of motor-evacuation function of the gallbladder:
  • hypokinesia of the gallbladder,
  • gallbladder hyperkinesia;
• according to the tone of the sphincter apparatus:
  • hypotension of the sphincter of Oddi,
  • sphincter of Oddi hypertension,
  • Lutkens sphincter hypotension,
  • Lütkens sphincter hypertension,
  • hypotension of the Mirizzi sphincter,
  • Mirizzi sphincter hypertension.

Symptoms of biliary dyskinesia:

• constant, dull pain (hypokinetic form)
• acute pain (hyperkinetic form)
• bitterness in the mouth
• nausea
• vomiting after eating
• heaviness in the stomach
• constipation
• increased fatigue
• weakness
• sweating
• irritability

With hyperkinetic-hypertensive dyskinesia of the biliary tract (more often observed with vagotonia), acute, colicky pain periodically occurs in the right hypochondrium, radiating to the right shoulder blade, shoulder, or, conversely, to the left half of the chest, the region of the heart. The pain usually occurs suddenly and repeats several times a day. It is short-term and is not accompanied by an increase in body temperature. Sometimes the attack is accompanied by nausea, vomiting, and intestinal dysfunction.

Often, such patients are diagnosed with vasomotor and neurovegetative syndromes:

• sweating,
• tachycardia,
• arterial hypotension,
• headache,
• weakness.

Patients associate the occurrence of an attack of pain in the right hypochondrium not so much with a violation of the diet, but with negative psycho-emotional situations.
When examining patients, their skin is usually unchanged, and body weight is often increased. Palpation determines pain in the projection of the gallbladder. Positive symptoms Desjardins, Kera, Murphy.

Pain syndrome occurs due to a sudden increase in pressure in the gallbladder, which contracts under conditions of a sudden increase in the tone of the Lutkens-Martinov and/or Oddi sphincters.

Hypokinetic-hypotonic dyskinesia of the biliary tract is characterized by constant dull, aching pain in the right hypochondrium without clear irradiation. Excessive emotions or food consumption (especially significant amount) increase pain and cause heaviness in the right hypochondrium. Such patients have poor appetite, often experience nausea, a bitter taste in the mouth, bloating, and constipation. On palpation, pain in the area of ​​the gallbladder is determined.

Pain is a consequence of overstretching of the neck of the gallbladder, where it is synthesized a large number of(excess) anticholecystokinin, which inhibits the formation of cholecystokinin, an important cholekinetic agent, in the duodenum. With a deficiency of the latter, the motor activity of the gallbladder is further reduced (hypokinesis), and its tone is weakened (hypotension).

How to treat biliary dyskinesia?

It is carried out comprehensively and includes: drug therapy, diet therapy, physiotherapy. Most often, treatment occurs on an outpatient basis.

Choice drug treatment depends on the form of dyskinesia.

The hyperkinetic form of dyskinesia is treated with antispasmodics and analgesics. To improve the flow of bile, choleretic drugs are prescribed. Patients with hyperkinetic-hypertensive biliary dyskinesia are prescribed M-cholinergic drugs (atropine sulfate, metacin), xanthines (sufilin, theophylline), cholespasmolytic drugs (no-spa, papaverine hydrochloride). Patients are recommended to drink water - Truskavets and Zbruchanskaya "Naftusya", Morshynskaya No. 6 in a dilution of 3.5 g/l (sulfate-chloride-sodium-magnesium-potassium) - warm or hot, 100-150 ml 3-6 times per day 30 minutes before meals. Such mineral waters reduce the tonic tension of the sphincters of the biliary tract, help normalize the motor function of the gallbladder and at the same time stimulate choleresis (production of bile by the liver).

Electrophoresis of papaverine hydrochloride or platyphylline hydrotartrate on the area of ​​the right hypochondrium, as well as applications of ozokerite, are effective for hyperkinetic-hypertensive dyskinesia of the biliary tract.

In the treatment of patients with hypokinetic-hypotonic biliary dyskinesia, on the contrary, thermal procedures (applications of ozokerite, peloids) are contraindicated. Patients are recommended cholekinetic agents - magnesium sulfate, olive oil, sorbitol, xylitol. Within 5 minutes after ingestion, the sphincter of Oddi relaxes and the gallbladder contracts. These products can also be used for duodenal intubation (20 g of xylitol per 50 ml of water). Such patients are shown mineral waters with high mineralization - Morshynskaya No. 6 at a dilution of 14 g/l in a warm form, 150-200 ml 3 times a day 30 minutes before meals.

At severe hypotension gallbladder to enhance the gallbladder reflex during meals, it is recommended to drink Morshyn mineral water of source No. 6 at a dilution of 14 or 7 g/l 1.5 hours before and 30 minutes after. The hypotonic form requires the use of drugs that improve gallbladder motility and bile acid preparations.

Physiotherapeutic methods of treatment include: UHF, microwave, paraffin, neck massage, electrophoresis, inductothermy.

Effective for hypokinetic-hypotonic dyskinesia of the biliary tract, magnesium and potassium electrophoresis on the area of ​​the right hypochondrium - transversely from the anode, current strength up to 10-15 mA, duration 20 minutes, every other day, 8-10 procedures per course of treatment. Such patients are also shown Bernard currents and electrical stimulation (faradization) of the right phrenic nerve.

For biliary dyskinesia, hydropathic procedures (circular, fan-type rain shower) should be widely used; warm (36-37 ° C) baths lasting 20-30 minutes every other day are indicated, for a course of treatment 8-10 procedures.
All patients with biliary dyskinesia are prescribed exercise therapy in a training mode. Swimming for 5-15 minutes at a moderate pace, with rest intervals every 1-3 minutes, is especially beneficial.

Also effective are 3-4 single transduodenal siphon lavages of the duodenum with warm saline solution sodium chloride, low-mineralized mineral water.

To eliminate stagnation of bile in the biliary tract with hypokinetic-hypotonic dyskinesia, tubeless drainage of the biliary tract - tubage - is recommended 1-2 times a week. To carry out tubage, cholecystokinetic agents are used: Barbara salt (20-30 g of salt per 100 ml of hot water) or olive oil (30 ml), or xylitol (10-20 g per 50 ml of hot water) and the like. After using one of these remedies, the patient is placed in bed for 1-1.5 hours with a heating pad on the right hypochondrium.

Correctly structured, pathogenetically substantiated treatment of patients with biliary dyskinesia can prevent the development of the inflammatory process and stone formation in the gallbladder. On the other hand, with chronic cholecystitis, cholelithiasis and chronic hepatitis treatment should be carried out taking into account the nature of concomitant biliary dyskinesia.

What diseases can it be associated with?

• Duodenitis
• Worm infestation

Treatment of biliary dyskinesia at home

Treatment of biliary dyskinesia carried out mainly at home. In addition to taking medications prescribed by your doctor, great attention should be paid to diet therapy.

Excessive physical and psychological stress should be avoided. At the same time, they prescribe a free daily routine, recommend moving and doing physical exercises. Salted, fried, smoked and pickled foods are excluded from the diet; it is recommended to eat small portions 4-5 times a day. Outside periods of exacerbation, patients can consume 200 grams of boiled meat or fish, 500 grams of carbohydrates and 75-80 grams of fat per day.

If you are overweight (class II-III obesity), you should limit the amount of protein in your diet to 90-120 grams. energy value diet should be 1250-1650 kcal.

Patients with underweight need to strengthen their diet; the ratio of proteins, fats and carbohydrates in the diet should be 1: 1: 4.5.

With a hypotonic form of dyskinesia, the diet should be dominated by products with a choleretic effect, such as black bread, vegetables, vegetable oil, sour cream. In the hyperkinetic form, meals should be small and frequent (up to 6 times a day), excluded from the diet fatty foods, cakes and carbonated drinks.

Sanatorium-resort treatment is indicated (with persistent remission) - Morshyn, Truskavets, Tovtry, Mirgorod, Berezovsky mineral waters, resorts of Transcarpathia.

What drugs are used to treat biliary dyskinesia?

• orally 40-80 mg 2-3 times a day;
• - orally 40-60 mg 3-4 times a day;
• - 300 mcg orally every 4-6 hours;
• - 1 teaspoon orally 2-3 times a day;
• - 1 tablet orally 1-3 times a day after meals;
• - orally 0.1 g 3-4 times a day for 3-4 weeks;
• - 2 tablets orally 2-3 times a day 15-30 minutes before meals.

Treatment of biliary dyskinesia with traditional methods

From folk recipes various choleretic herbs(sage, St. John's wort, elecampane, etc.), which are brewed separately or in combination with each other.

A positive choleretic effect is observed from drinking vegetable juices (carrots, pumpkin, celery, spinach, etc.) half a glass 2-3 times a day.

Treatment of biliary dyskinesia during pregnancy

During pregnancy treatment of biliary dyskinesia consists mainly of following a diet. Choleretic teas made from rose hips, yarrow and immortelle are also recommended for pregnant women. In case of severe pain, the attending physician will prescribe antispasmodic drugs, which are allowed to be taken during pregnancy.

Which doctors should you contact if you have biliary dyskinesia?

Multi-stage duodenal intubation helps in diagnosing biliary dyskinesia; it is performed in the morning on an empty stomach.

Thus, multi-stage duodenal intubation makes it possible to distinguish five phases and diagnose such variants of biliary dyskinesia.

• The first phase, or choledochus phase, lasts 10-15 minutes, during which 15-20 ml of the contents of the common bile duct and duodenum are obtained through the probe.
• The second phase, or the phase of the closed sphincter of Oddi, lasts 3-6 minutes, at which time the release of bile from the free end of the probe stops. The duration of the second phase is more than 6 minutes, indicating hypertension of the sphincter of Oddi.
• The third phase, or phase “A”-bile, lasts 2-5 minutes, when 3-5 ml of light yellow bile is secreted. It begins with the opening of the sphincter of Oddi and ends with the opening of the Lutkens-Martynov sphincter. A contraction of the third phase indicates hypotension, and a lengthening indicates hypertension of the sphincters of Oddi and Lutkens-Martynov.
• The fourth phase, or the “B”-bile phase, begins with the opening of the Lutkens-Martynov sphincter and the appearance of dark olive “B”-bile. This phase ends with the release of amber “C” bile through the probe. The duration of the cystic phase (also called the Meltzer-Lyon reflex) depends on the motor activity of the gallbladder, and the amount of B-bile produced depends on its tone. In healthy people, the “B” phase of bile lasts 20-30 minutes, during which 30-50 ml of viscous dark brown bile is obtained. With hyperkinetic dyskinesia of the gallbladder, “B” bile is released rapidly, in bursts for 10-15 minutes, accompanied by colic-like pain. With hypokinetic dyskinesia of the gallbladder, the release of “B”-bile is sluggish, with significant interruptions, for 60-90 minutes, after probing there is a clear improvement general condition the patient, the feeling of heaviness in the right hypochondrium decreases, pain disappears. With hypertension of the gallbladder, little “B”-bile is secreted - 15-20 ml, and with hypotension, the amount of “B”-bile increases to 80-100 ml or more. The introduction of a second stimulus allows you to additionally obtain a certain amount of bile, which is observed normally or with gallbladder hypertension.
• The fifth phase, or the “C”-bile phase, lasts 10-20 minutes, during which 10-30 ml of “C”-bile is released. The delayed release of “C”-bile is explained by hypertension of the Mirizzi sphincter or weak synthetic function of the liver. Quick Appearance“C” - bile indicates hypotension of the Mirizzi sphincter. In some medical institutions In order to better identify the bile fraction, chromatic multi-stage duodenal sounding is used. For this, methylene blue is used, 150 ml of which in a gelatin capsule is taken orally by the patient 14-15 hours before probing. The methylene blue dye becomes discolored in the liver and is excreted in the bile. In the gallbladder, it oxidizes and turns into a colored chromogen, which provides bile with various shades of blue-green color, which allows you to clearly differentiate “B” bile.

Without detracting from the value of multi-stage duodenal intubation, to definitively determine the nature of biliary dyskinesia, they resort to ultrasound and (or) x-ray examination. Thanks to the first, it is possible to objectively assess the condition of the gallbladder on a real scale and, indirectly, the condition of the sphincter apparatus. X-ray examination biliary tract (cholecystography) is carried out 18-20 hours after ingestion of iodine-containing tablets (yopagnost, cholevid), a cholecystogram is obtained on an empty stomach and 30, 60, 90, 120 minutes after Boyden's test breakfast (2 egg yolks).

Biliary tract (dyskinesia) is a functional disorder consisting of impaired coordination of movements of the gallbladder, ducts and sphincters, resulting in inappropriate flow of bile into the duodenum. This means that with biliary dyskinesia, the flow of bile into the duodenum does not meet the needs - that is, there is either too much or too little. A distinctive feature of dyskinesia is exclusively functional character disorders in which there are no pathological changes in the gall bladder, liver, ducts and sphincters.

Correlation of terms denoting functional disorders of the biliary tract: biliary dyskinesia, gallbladder dyskinesia, biliary dyskinesia

The term "biliary dyskinesia" is now widely used to refer to a functional disorder of the outflow of bile from the liver and gallbladder into the duodenum due to a lack of coordination contractile activity bile ducts, sphincters and bladder wall. This term was coined back in Soviet period, and is still used today. A synonym for the term “biliary dyskinesia” is the definition "biliary dyskinesia". In the western medical literature The term “biliary dyskinesia” corresponds to the definition "gallbladder dysfunction".

Term "gallbladder dyskinesia" is not a complete synonym for biliary dyskinesia, since it reflects the modern, and not yet Soviet, classification of functional disorders of the hepatobiliary system. Thus, at present, all variants of functional disorders of the outflow of bile into the duodenum, arising as a result of uncoordinated contractile activity of the ducts, gallbladder and sphincters, are combined under the term "functional biliary disorders". And it is this term that can be considered synonymous with “biliary dyskinesia.”

Moreover, in the modern classification, depending on the malfunction of which structures of the biliary system the disease developed, the entire set of functional biliary disorders is divided into two types:

• Dysfunction (dyskinesia) of the gallbladder (the functioning of the gallbladder and/or bile ducts is impaired);
• Dysfunction of the sphincter of Oddi (the work of the sphincters that separate the gallbladder, ducts and duodenum is impaired).

Modern classification definitions, in comparison with the old Soviet “biliary dyskinesia,” are more detailed, one can (conditionally) say highly specialized, since they reflect in which part of the biliary system there is a functional disorder. That is, when they talk about gallbladder dyskinesia, they mean that a person has impaired contractile activity of this particular organ, and not of the bile ducts or sphincters, as a result of which the bladder either practically does not work or pushes out bile too intensely. Accordingly, when we talk about dysfunction of the sphincter of Oddi, it means that the outflow of bile is impaired due to incorrect and uncoordinated operation of the valves that open the passage from one part of the biliary system to another (one sphincter separates the gallbladder from the bile duct, the other separates the bile duct from the duodenum intestines, etc.).

In the further text of the article we will use the old term “biliary duct dyskinesia” to refer to conditions that in the modern version are called “functional disorder of the biliary system”, since Soviet names are much more often used by both doctors and patients, as a result of which their perception is much more lighter than the current ones. But we will present modern classifications of “biliary dyskinesia,” as well as approaches to therapy and a description of clinical symptoms.

Essence and brief characteristics of biliary dyskinesia

Biliary dyskinesia is a functional disorder, and therefore, strictly speaking, not a true pathology, since there are no pathological structural changes in the organs of the biliary system. In other words, with dyskinesia, the function of normal uniform contractions of the smooth muscles of the gallbladder, ducts and sphincters is impaired, as a result of which bile is not pushed at the required speed and in the required quantity into the duodenum. But at the same time, apart from disruption of the contractile activity of organs, there are no pathological changes in them. It is precisely because of the absence of pathological changes in the structure of organs that dyskinesia is a functional disorder.

To clearly understand what happens with dyskinesia and why it provokes clinical symptoms, you need to know the structure and functions of the biliary system. So, the biliary system consists of the gallbladder and bile ducts. The bile itself is formed in the liver, from which it enters the gallbladder and accumulates in it until a bolus of food enters the duodenum. After food enters the duodenum, at the level of reflexes, a command is given to secrete bile, which is necessary for the digestion of fats. Once the team reaches the gallbladder, it begins to contract due to the smooth muscles present in its wall. Due to these contractions, bile is pushed into the bile ducts, along which it moves to the duodenum. Bile also moves through the ducts due to the rhythmic contractions of the latter. Next, bile from different ducts is collected into one common one, from which it flows into the duodenum, where it participates in the process of digesting food, breaking down fats.

Each section of the biliary system is separated from each other and from the duodenum by a special anatomical education- the sphincter, which is usually always tightly closed and opens only at those moments when bile needs to pass through. Thus, the opening of the gallbladder, through which bile passes into the ducts, is closed by one sphincter. The opening of the common bile duct, which delivers bile to the duodenum, is also separated from the smaller ducts flowing into it by its sphincter. Finally, the common bile duct, from which bile enters the intestine, is also separated from the latter by its own sphincter ( sphincter of Oddi). The presence of sphincters allows you to keep bile from periodically pouring out outside of meals and “release” it only when needed, that is, after ingestion food bolus into the duodenum.

In general, the process of bile entering the duodenum is as follows:
1. The process starts after food enters the intestine due to the activation of the corresponding reflex mechanisms. These reflex mechanisms simultaneously command the initiation of contractions of the gallbladder and ducts, as well as the opening of the sphincters.
2. Next, the sphincters open, thereby eliminating obstacles to the outflow of bile from the bladder and its passage through the biliary tract to the duodenum. Against the background of the opening of the sphincters, rhythmic contractions of the smooth muscles of the bladder lead to the flow of bile into the ducts.
3. The gallbladder sphincter then closes to prevent bile from flowing back into it.
4. Further, due to the rhythmic contractions of the muscles of the ducts, the bile moves to the duodenum, into which it enters through the opened sphincter of Oddi.
5. When bile enters the intestine, a reflex is activated to close all sphincters and stop the transport of bile.
This is how the process of transporting bile to the duodenum from the gallbladder normally looks like.

But if the contractile activity of the smooth muscles of the bladder or ducts is impaired, for example, insufficient or, on the contrary, excessively strong, then bile does not enter the intestine in the required quantity at the right time. Also, bile does not enter the intestine at the right time if the opening and closing of the sphincters occurs inconsistently with the movement of bile through the ducts and out of the bladder. And it is precisely such disturbances in the flow of bile into the duodenum, arising from uncoordinated muscle contractions of the bladder and ducts or openings of the sphincters, that are called biliary dyskinesia.

That is, in fact, all organs work normally, there are no pathological changes in them, but the lack of proper coordination of their activities leads to an abnormal flow of bile into the duodenum, not in the required quantity and not at the right time, which is accompanied by clinical symptoms . It is precisely because of the absence of pathological changes in the organs of the biliary tract that very often the causative factors of biliary dyskinesia are various disorders of the autonomic nervous system (reflexes), such as vegetative-vascular dystonia, neuroses, neuritis, etc.

Causes of biliary dyskinesia

Depending on the nature of the causative factors, all biliary dyskinesias are divided into two large groups– primary and secondary. The primary types include variants of dyskinesias caused by congenital malformations of the biliary system. Secondary are all dyskinesias that occur during a person’s life under the influence of various unfavorable environmental factors.

Causes of primary dyskinesias biliary tract are the following congenital malformations of the biliary system:

• Duplication of the gallbladder or ducts;
• Narrowing or complete blockage of the lumen of the gallbladder;
• The presence of septa in the gallbladder or ducts.

• Duodenitis (inflammation of the duodenum);
• Peptic ulcer of the stomach or duodenum;
• Pancreatitis;
• Cholangitis (inflammation of the bile ducts);
• Cholelithiasis;
• Viral hepatitis;
• Neuroses;
• Hypothyroidism (not enough hormones thyroid gland in blood);
• Conditions after surgery on the abdominal organs (for example, after gastric resection, gastrointestinal or intestinal anastomoses);
• Vagotonia (increased tone of the vagus nerve);
• Heavy systemic diseases no organs digestive system(diabetes mellitus, myotonia, dystrophy, etc.).

Predisposing factors for the development of biliary dyskinesia include the following:

• Hereditary predisposition;
• Poor nutrition and errors in diet (frequent snacking, dry food, irregular meals, overeating, eating fatty foods and foods, poor chewing, etc.);
• Lack of vitamins, minerals and plastic substances consumed in food;
• Helminthiasis (infection with flat or roundworms);
• Any intestinal infections;
• Inflammatory diseases of the abdominal cavity and pelvis (adnexitis, pyelonephritis, solaritis, appendicitis, etc.);
• Hormonal imbalance (for example, pregnancy and postpartum period, taking hormonal medications, hormonally active tumors, obesity, premenstrual syndrome, etc.);
• Vegetative-vascular dystonia;
• Stress;
• Excessive psycho-emotional, mental or physical stress;
• Sedentary lifestyle;
• Asthenic physique;
• Muscle weakness;
• Allergic chronic diseases (bronchial asthma, urticaria, year-round allergic rhinitis, etc.);

Types and forms of the disease

Currently, biliary dyskinesias are classified into several types depending on one or another symptom that serves as the basis for distinguishing the types of the disease.

So, depending on the nature of the causative factor and the time of development, biliary dyskinesia is divided into primary and secondary.

Primary dyskinesias

Primary dyskinesias are caused by various congenital malformations of the gallbladder, ducts and sphincters. These variants of dyskinesia can develop either independently or under the influence of predisposing factors. If dyskinesia develops independently, then, as a rule, it manifests itself from childhood, and the formation of the disease does not require the action of any predisposing factors, since the defects in the structure of the biliary system are too pronounced and their presence does not allow the gallbladder, ducts and sphincters to function normally. However, in a number of cases, congenital malformations are completely compensated by various adaptive mechanisms, if the structural defects are not too pronounced. In such situations, the development of dyskinesia occurs solely under the influence of predisposing factors, and the disease does not first appear at an early age.

Secondary dyskinesias

Secondary dyskinesias form during a person’s life and are caused by various diseases organs of the digestive tract and the influence of predisposing factors. That is, secondary dyskinesias develop under the influence of any other disturbances in the functioning of various organs and systems.

Depending on the characteristics of the contractile activity of the muscles of the biliary tract, dyskinesia is divided into three forms:
1. Hyperkinetic (hypermotor) form;
2. Hypokinetic (hypomotor) form;
3. Hypotonic-hyperkinetic form.

Hyperkinetic (hypermotor, hypertonic) dyskinesia

Hyperkinetic (hypermotor, hypertensive) biliary dyskinesia is characterized by increased contractility of the gallbladder and ducts, as a result of which too much bile is released into the duodenum. This form of dyskinesia most often develops in young people.

Hypokinetic (hypomotor, hypotonic) dyskinesia

Hypokinetic (hypomotor, hypotonic) dyskinesia is characterized by sluggish contractility of the gallbladder and ducts, as a result of which an insufficient, very small amount of bile enters the duodenum. Most often this form The disease develops in people over 40 years of age or in those suffering from neuroses.

Hypotonic-hyperkinetic form

The hypotonic-hyperkinetic form is characterized by the presence of symptoms of both hypokinetic and hyperkinetic biliary dyskinesia. IN in this case one organ of the biliary system, for example, the gallbladder, has increased muscle contractility, that is, it works in a hyperkinetic form, while another organ (for example, the bile ducts), on the contrary, contracts sluggishly and functions in a hypokinetic mode. Accordingly, different parts of the biliary system operate in different uncoordinated modes, which leads to the development of a mixed type of dyskinesia.

Depending on which part of the biliary tract works inconsistently with the others, dyskinesias are divided into two types:

• Gallbladder dysfunction;
• Sphincter of Oddi dysfunction.

Symptoms

The symptoms of biliary dyskinesia may vary, since some people do not exhibit the entire range of clinical complaints, but only some of them, while others, on the contrary, have all the symptoms. In principle, regardless of the type, dyskinesias are characterized by the same spectrum of clinical symptoms, which can manifest in humans in varying degrees of severity and various combinations. The only significant difference in the clinical manifestations of hypermotor and hypomotor types of biliary dyskinesia is the nature of the pain syndrome. All other complaints and symptoms for both types of biliary tract dysfunction differ insignificantly. Therefore, in order to avoid confusion, we will first consider the general clinical symptoms inherent in all forms of dyskinesia, and then in separate sections we will present the features of the pain syndrome and general symptoms, characteristic of each type of disease.

General symptoms of all forms of biliary dyskinesia

Any form of biliary dyskinesia is characterized by the presence of pain, dyspeptic, cholestatic and asthenovegetative syndromes, each of which is manifested by a certain spectrum of symptoms. The pain syndrome is significantly different in hyperkinetic and hypokinetic forms of dyskinesia, and cholestatic, dyspeptic and asthenovegetative ones are approximately the same in any type of functional disorder of the biliary tract.

Cholestatic syndrome develops due to insufficient flow of bile into the duodenum and is characterized by the following symptoms:

• Yellowness of the skin, mucous membranes, sclera of the eyes and biological fluids(saliva and tears become yellowish);
• Dark-colored stool (darker than usual);
• Dark colored urine (darker than normal);
• Increased liver size;
• Skin itching.

Dyspeptic syndrome characterized by indigestion due to an inadequate amount of bile entering the intestines, develops in almost all people suffering from any form of dyskinesia, and is manifested by the following symptoms:

• Belching of air, usually after eating;
• Nausea and vomiting;
• Bloating;
• Bad breath;
• White or yellowish coating on the tongue;
• Bitterness and dry mouth in the morning immediately after waking up (usually inherent in the hyperkinetic form of biliary dyskinesia);
• Constipation (characteristic of the hyperkinetic form of dyskinesia);
• Diarrhea (characteristic of the hypokinetic form of dyskinesia).

• Severe fatigue and weakness;
• Irritability;
• Mood swings;
• Sleep disorders;
• Hyperhidrosis (excessive sweating);
• Attacks of rapid heartbeat;
• Low blood pressure;
• Low sexual activity.

Pain with hypertensive biliary dyskinesia

The pain is usually localized in the right hypochondrium, often spreading to the right half of the back, shoulder blade, collarbone or arm. Sometimes the pain is localized not only in the right hypochondrium, but also in the epigastric region (stomach). In rare cases, pain from the right hypochondrium radiates strongly to the left half of the chest, localizing in the heart area. In such situations, an attack of biliary dyskinesia is very similar to the pain of angina pectoris.

The nature of the pain is sharp, acute, paroxysmal, and feels very intense. The pain lasts for a relatively short period of time (no more than 20 - 30 minutes), but can occur several times a day. The total duration of such attacks of pain is at least three months.

Pain usually occurs after any errors in nutrition or after physical, psycho-emotional and mental overload. When the pain goes away, a feeling of heaviness remains in the area of ​​the right hypochondrium, which does not stop and does not go away over time.

Pain in the hyperkinetic form of biliary dyskinesia may be accompanied by nausea and vomiting, which, however, does not bring relief to the person. Palpation (palpation of the abdomen with hands) of the abdomen and the procedure of duodenal intubation increase pain, as a result of which people tolerate these manipulations very poorly.

Intense pain in the hypermotor form of biliary dyskinesia is associated with too strong contractions of the gallbladder against the background of closed sphincters. As a result, the bladder contracts, but the bile does not flow out because the sphincters remain closed.

Pain due to biliary colic

Choleretic for dyskinesia

Choleretic for dyskinesia is selected according to the form of the disease. For the hypermotor form of dyskinesia, the use of choleretic drugs from the group of cholekinetics and cholespasmolytics is indicated. At the same time, you need to know that antispasmodics are taken at the beginning of treatment for 7–14 days to relieve pain, after which cholekinetics are taken for 3–4 weeks.

Cholekinetics include drugs such as Sorbitol, Mannitol, Flamin, Berberine sulfate, Holosas, Holemaks, Holos, Oxafenamide, Gepabene, Magnesia, Cormagnesin, etc.

Cholespasmolytics include drugs such as Papaverine, Drotaverine, No-Shpa, Duspatalin, Odeston, Platyfillin, Metacin, etc.

In case of hypomotor form of dyskinesia, it is necessary to take choleretic drugs of the choleretic group and myotropic antispasmodics. Choleretics are taken from the very beginning of therapy for 4–8 weeks, and myotropic antispasmodics are taken in episodic courses lasting 7–14 days to relieve pain. The breaks between courses of use of antispasmodics are equal to the duration of the course of treatment.

Choleretics necessary for use for hypomotor dyskinesia include drugs such as Allohol, Lyobil, Cyqualon, Holagogum, Holagol, Flacumin, Convaflavin, Febichol, Sibektan, Tanacechol, etc. Only two drugs are classified as myotropic antispasmodics - Odeston and Duspatalin.

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