Dyskinesia of the bile ducts. Hypotonic biliary dyskinesia (Biliary dyskinesia of the hypotonic type). Possible complications and consequences in adults

• Pain in the right hypochondrium.
  • At hyperkinetic variant of dyskinesia (that is, with increased contractile activity biliary system) pain is acute, paroxysmal, short-term, can radiate to right shoulder or right shoulder blade. As a rule, pain occurs after physical or emotional stress or eating fatty foods.
  • At hypokinetic variant of dyskinesia (that is, with reduced contractile activity of the biliary system), the pain is dull, aching, almost constant, with rare episodes of absence of pain, accompanied by a feeling of fullness in the right hypochondrium.
  • Attacks of biliary colic – severe pain in the right hypochondrium, occurring suddenly, accompanied by rapid heartbeat or a feeling of cardiac arrest, fear, numbness of the limbs.

• Cholestatic syndrome (a set of symptoms that occurs as a result of a decrease in the flow of bile into the duodenum - the initial part of the small intestine). Develops in less than half of cases. Manifestations of cholestatic syndrome:
  • jaundice (yellow discoloration of the skin, mucous membranes (for example, the oral cavity), biological fluids(for example, saliva, tear fluid, etc.));
  • lighter-colored stool than usual;
  • darker than usual urine;
  • hepatomegaly (enlarged liver);
  • skin itching.

• Dyspeptic manifestations (digestive disorders):
  • decreased appetite;
  • nausea and vomiting;
  • bloating;
  • bitterness and dry mouth in the morning (more often with the hyperkinetic variant of dyskinesia - that is, with increased contractile activity of the biliary system);
  • bad smell from mouth.

• Manifestations of neurosis, that is, reversible (can be cured) mental disorder:
  • increased fatigue;
  • irritability;
  • hyperhidrosis (increased sweating);
  • recurrent headaches.

• Decreased sexual activity.

Forms

Depending on the motor skills (muscle contractions) biliary tract There are 2 forms of the disease.

• Hyperkinetic (hypermotor) dyskinesia, that is, with increased contractile activity of the biliary system. More common at a young age.
• Hypokinetic (hypomotor) dyskinesia, that is, with reduced contractile activity of the biliary system. It is more common in people over 40 years of age, as well as in patients with neuroses (that is, a reversible (can be cured) mental disorder).

• Primary biliary dyskinesias – associated with congenital (arising in utero) malformations (disorders) of the development of the biliary tract.
• Secondary biliary dyskinesias - develop throughout life and are associated with various acquired diseases (for example, pancreatitis - inflammation of the pancreas).

Causes

• Causes primary biliary dyskinesias (associated with congenital (arising in utero) malformations (disorders) of the biliary tract):
  • duplication of the gallbladder and bile ducts;
  • narrowing of the gallbladder;
  • constrictions and septa in the gallbladder.

• Causes secondary biliary dyskinesias (developing throughout life) - various diseases, For example:
  • gastritis (inflammation of the gastric mucosa);
  • duodenitis (inflammation of the mucous membrane duodenum);
  • peptic ulcer(formation of ulcers - deep defects) of the stomach or duodenum;
  • pancreatitis (inflammation of the pancreas);
  • cholecystitis (inflammation of the gallbladder);
  • viral hepatitis ( systemic disease with predominant liver damage caused by viruses);
  • neuroses (treatable mental disorders perceived by patients);
  • hypofunction of the endocrine glands (decreased production of hormones), for example, hypothyroidism - hypofunction of the thyroid gland.

• Hereditary predisposition (the disease is transmitted from parents to children).
• Poor nutrition (especially eating large amounts of fatty, fried and spicy foods).
• Worms (flat and roundworms) and Giardia (single-celled organisms with flagella).
• Intestinal infections ( infectious diseases with a predominant lesion digestive system).
• Hormonal disorders (disturbances in the ratio of hormones - biologically active substances regulating all types of body activity). For example, increased or decreased production of hormones, disruption of their composition or transportation.
• Vegetative-vascular dystonia (VSD), or neuro-circulatory dystonia (NCD) is a disorder of the autonomic nervous system (part of the nervous system that regulates the activity of internal organs).
• Psycho-emotional stress (psycho-emotional stress).
• Significant (excessive) physical activity.
• Sedentary lifestyle.

Diagnostics

• Analysis of the medical history and complaints (when (how long ago) pain and heaviness in the upper abdomen, icteric discoloration of the skin, nausea, vomiting, fatigue and other symptoms appeared, with which the patient associates their occurrence).
• Life history analysis. Does the patient have any chronic diseases, are there any hereditary diseases (passed from parents to children), does the patient have bad habits, has he taken any medications for a long time, have he had tumors, has he been in contact with toxic substances ( poisonous substances, took medications, worked in hazardous industries, lived in environmentally unfavorable areas.
• Physical examination. Upon examination, normal skin color or yellowness, decreased or increased nutrition. Upon palpation (palpation), pain in the right hypochondrium is assessed, which intensifies with inspiration. Percussion (tapping) determines the size of the liver and spleen.
• Laboratory research methods.
  • A general blood test may not reveal any abnormalities. In the presence of inflammatory diseases, leukocytosis appears (an increase in the number of leukocytes - white blood cells), an increase in the erythrocyte sedimentation rate - red blood cells (ESR - a nonspecific laboratory indicator reflecting the ratio of varieties of blood proteins).
  • A general urine test reveals a darker color of urine than should be normal; bile pigments (coloring substances secreted by bile) may be detected in it.
  • Biochemical analysis blood. The level of creatinine (a protein breakdown product), uric acid (a breakdown product of substances from the cell nucleus), total protein and its fractions (varieties), alkaline phosphatase(ALP), gamma-glutamyl transpeptidase (GGT), alanine aminotransferase (ALAT or ALT), aspartate aminotransferase (AST or AST), bilirubin (bile pigment - a dye, a breakdown product of red blood cells), electrolytes (potassium, sodium, calcium, magnesium).
  • Lipidogram (analysis of the content of lipids - fat-like substances - in the blood). Can detect irregularities normal content various lipids.
  • Markers of viral hepatitis (signs of the presence of viruses in the body that can damage the liver).
  • Examination of stool for the presence of flatworms, roundworms, and protozoa (single-celled organisms).

• Instrumental research methods.
  • Ultrasound examination (ultrasound) of the abdominal organs reveals changes in the size and shape of the gallbladder, the presence of stones, kinks or constrictions in it.
  • Ultrasound examination of the gallbladder with a test breakfast. After performing an ultrasound examination of the gallbladder on an empty stomach, the patient is given a test breakfast containing a large number of fats (for example, a glass of sour cream or two egg yolks). After 30 and 60 minutes, an ultrasound examination of the gallbladder is performed again. The doctor evaluates how timely and completely the contraction has occurred. gallbladder after eating. This study allows us to evaluate the form of biliary dyskinesia - hyperkinetic (that is, with increased contractility of the muscles of the biliary tract) or hypokinetic (that is, with decreased contractility muscles of the biliary tract).
  • Duodenal sounding. In this study, a probe (tube) is inserted into the duodenum through the nose or mouth. long time. Periodically, portions of bile are taken through a probe for examination. When examining bile, signs of inflammation, stone formation, etc. are revealed.
  • Fibroesophagogastroduodenoscopy (FEGDS) - study of the condition of the surface of the esophagus, stomach, duodenum using endoscopes ( optical instruments). It is carried out if a disease of these organs is suspected as the cause of biliary dyskinesia.
  • Oral cholecystography is a research method in which the patient drinks a contrast agent (that is, making the places of its accumulation visible on an x-ray) substance that accumulates in the gallbladder. Allows you to evaluate the size and shape of the gallbladder, the presence of anomalies (disorders) of its development.
  • Intravenous cholecystography is a research method in which a contrast agent that accumulates in the gallbladder is injected intravenously. Allows you to evaluate the size and shape of the gallbladder, the presence of anomalies (disorders) of its development. Contraindicated in case of allergy (individual hypersensitivity) to iodine preparation.
  • Endoscopic retrograde cholangiopancreatigraphy (ERCP) is a combination of endoscopic and X-ray methods, giving an image of the biliary tract.
  • Hepatobiliary scintigraphy is a radioisotope research method in which a radioactive drug is injected intravenously, selectively accumulating in the liver and biliary tract, which allows them to obtain an accurate image.
• Consultation is also possible.

Treatment of biliary dyskinesia

The goal of therapeutic measures for biliary dyskinesia is to normalize the outflow of bile and prevent its stagnation in the gallbladder.

• • walks in the open air.

• Diet therapy: diet No. 5.
  • Eat 5-6 times a day in small portions to improve bile excretion.
  • Exclusion from the diet of spicy, fatty, fried, smoked foods and canned food.
  • Reduced content of salt in food (up to 3 grams per meal) and spices to reduce fluid stagnation in the body.
  • Reception of mineral waters:
    • high mineralization (that is, with high content salts) with hypomotor dyskinesia of the biliary tract (with reduced contractile activity of the biliary system);
    • low mineralization (that is, with a low salt content) with hypermotor biliary dyskinesia (increased contractile activity of the biliary system).

• Conservative (non-surgical) treatment.
  • Choleretics (choleretic) agents facilitate the outflow of bile.
  • Cholespasmolytics (drugs that reduce increased tone muscles of the biliary tract) are used for the hypermotor variant of dyskinesia.
  • Enzyme preparations facilitate the digestion of food with hypomotor dysfunction.
  • Medicinal herbal infusions are prescribed in courses 2 times a year. The composition of the herbal collection depends on the type of dyskinesia (hyperkinetic or hypokinetic).
  • Duodenal intubation - removal of the contents of the duodenum through a probe (tube) after the administration of drugs that stimulate the release of bile from the gallbladder.
  • Closed tubes (cleansing) of the gallbladder, or “blind” probing - taking choleretic drugs in conditions that facilitate the outflow of bile (in the position on the right side, with a warm heating pad on the right hypochondrium).
  • Treatment with neurotropic (affecting the nervous system) drugs on the recommendation of a psychotherapist.

• Physiotherapeutic treatment (i.e. by physical methods using medical devices).
  • Diadynamic therapy (therapeutic effects electric current different frequencies to the area of ​​the right hypochondrium).
  • Electrophoresis (exposure to the body of direct electric current and medicinal substances administered with its help) with magnesium preparations on the liver area.

• Acupuncture (acupuncture) is a treatment method in which the effect on the body is carried out by introducing special needles into special points on the body.
• Massage (especially acupressure) - that is, affecting certain points human body, affecting the activity of the gallbladder.
• Hirudotherapy (treatment with leeches) affecting biologically active points (projections nerve endings relevant organs) gallbladder, liver, pancreas.
• Surgery not effective, so it is not carried out.
• Spa treatment in balneological sanatoriums (that is, where treatment with mineral waters is carried out), if possible, it can be carried out once a year.

Complications and consequences

Complications of biliary dyskinesia.

• Chronic cholecystitis (inflammation of the gallbladder lasting more than 6 months).
• Cholangitis (inflammation of the bile ducts).
• Gallstone disease (formation of stones in the gall bladder and bile ducts).
• Chronic pancreatitis (inflammation of the pancreas lasting more than 6 months).
• Gastritis (inflammation of the stomach lining).
• Duodenitis (inflammation of the mucous membrane of the duodenum).
• Atopic dermatitis ( cutaneous manifestation allergies – increased sensitivity immune system (system of the body's defenses)). It develops due to the absorption of incompletely digested food and toxic (harmful) substances due to inadequate flow of bile into the intestines.
• Weight loss due to malabsorption nutrients in the intestines.

The disease does not shorten the patient's life.

Prevention of biliary dyskinesia

Primary prevention biliary dyskinesia (that is, before its occurrence).

• Compliance with work and rest schedule:
  • full-fledged night sleep at least 8 hours;
  • going to bed no later than 23:00;
  • alternating mental and physical activity (for example, doing gymnastics after two hours of working at the computer);
  • walks in the open air.

• A nutritious diet with a limit on fatty, fried, smoked, salty foods, with a sufficient content of vegetables and fruits.
• Elimination of psycho-emotional (stressful) situations.
• Timely treatment of neuroses - reversible (that is, can be cured) mental disorders.

Dyskinesia of the biliary tract and gallbladder– is a functional disorder of the extrahepatic ducts, as well as motor function gallbladder.

Biliary dyskinesia is a disease to which there is no clear medical approach. There are many similar examples in medicine. So, in a specific case, there are two approaches to the disease, somewhat different in their ideas about the causes and mechanism of its occurrence.

An earlier idea defines biliary dyskinesia as a violation of the flow of bile into the duodenum due to a disorder of motility of the muscular apparatus of the biliary tract, causing pain in the right hypochondrium.

Causes of the disease

To the main causes of dyskinesia biliary tract include:

There are two main mechanisms in the development of the disease. The first is the pathology of hepatocyte function. As a result, the composition of bile and the functional state of the bile ducts and gallbladder are disrupted. The second mechanism is associated with a violation of the neurogenic regulation of the muscular wall of the bile ducts, both central (neurocirculatory dysfunction, neuroses) and peripheral (with pathology gastrointestinal tract) origin.

Types of dyskinesia

There are two forms of gallbladder dyskinesia: hypertonic (hyperkinetic) and hypotonic (hypokinetic):

• At hypertensive dyskinesia, the gallbladder does not secrete bile, since it is greatly contracted, the tone of the biliary sphincters will be increased.
• At hypotonic dyskinesia is the opposite, bile constantly flows out of the bladder, and the bladder practically does not contract, tone and physical activity bile ducts will be reduced.

Sometimes primary and secondary dyskinesias are distinguished, but in the vast majority of cases they are secondary, and therefore such a classification is impractical. With primary dyskinesia, as a rule, organic pathology of the gallbladder or biliary tract is not noted. With a long course of dyskinesia, stagnation of bile appears in the gallbladder, the colloidal structure of bile is disrupted, which contributes to the occurrence of the inflammatory process and stone formation. Dyskinesia of secondary origin is observed if calculous or acalculous cholecystitis, structural anomalies, kinks, and narrowing of the bile ducts initially existed.

Primary and secondary dyskinesia of the gallbladder are most often observed in young women with low body weight, and there is often a connection with the menstrual cycle. Violations hormonal regulation, unstable emotional background and various pancreatitis are direct paths to the development of biliary dyskinesia. Taking certain medications can lead to congestion in the gallbladder and spasms of the sphincter of Oddi.

Symptoms

Symptoms vary somewhat depending on the type of dyskinesia (hyperkinetic or hypokinetic).

Characteristic of both forms of dyskinesia are symptoms of general neurosis: increased fatigue, tearfulness, irritability, short temper, headaches, palpitations, sweating.

At hyperkinetic dyskinesia of the gallbladder distinctive features are periodically occurring acute spastic pains in the right hypochondrium, which can radiate to typical places: to the right shoulder blade, shoulder, or to the left half chest. Pain occurs suddenly, perhaps repetition during the day, rarely accompanied by nausea, vomiting, and intestinal dysfunction. In the interictal period, heaviness in the right side may bother you.

When hypokinetic dyskinesia characteristic signs will be constant dull pain in the right hypochondrium, which has no clear localization, and a feeling of fullness. Eating or emotional factors can lead to increased symptoms. Most often the patient complains of poor appetite, bitter taste, belching, increased gas formation and constipation. Mixed forms are often found, when one is replaced by another.

Diagnostics

If biliary dyskinesia is suspected, the following studies should be performed:

• Blood chemistry.
• Ultrasound examination of the liver and gall bladder.
• Duodenal sounding.
• Cholecystography.

In the last few years, some authors have formulated a different approach to the causes of biliary dyskinesia. It is more typical for foreign doctors. This approach is more specific. The cause of the disease is dysfunction of the sphincter of Oddi. Incomplete opening of the sphincter occurs, as a result of disruption of the outflow of bile, its pressure in the bile duct and pancreatic duct increases, which causes pain. The cause of disruption of the sphincter may be the growth of muscle, glandular or fibrous tissue.

However, regardless of the approach, the diagnosis of biliary dyskinesia is made after excluding other diseases of the liver and biliary tract.

Treatment of dyskinesia

If the diagnosis of dyskinesia is confirmed by test results, the following is prescribed:

• Sedatives, if dyskinesia occurs of the hypertonic (hyperkinetic) type: bromine preparations, valerian tincture and tablets, motherwort tincture, novo-passit.
• Tonic drugs if dyskinesia is of the hypotonic (hypokinetic) type: tinctures of ginseng, eleutherococcus, schisandra.
• If necessary, anthelmintic and antiprotozoal drugs: levamisole, pyrantel, ornidazole, tinidazole.
• Choleretic agents: allohol, cholenzym, holagol, magnesium sulfate powder, sorbitol.
• Antispasmodics used for hypertensive type of dyskinesia: platyphylline, drotaverine, papaverine, mebeverine.
• Prokinetics (drugs that improve gastrointestinal motility): domperidone, cisapride - for the hypokinetic type of the disease.
• Hepatoprotectors: karsil, essentiale, artichoke in tablets.
• Microbial preparations: Linex, bifiform, lactobacterin, bifidumbacterin, yogurt in capsules.
• Infusions and decoctions medicinal plants: sandy immortelle, tansy, chicory, peppermint, chamomile, rose hips.
• Mineral waters of low mineralization - for the hypertensive type of disease, high mineralization - for the hypotonic type of dyskinesia.

Physiotherapeutic procedures have a positive effect in the presence of biliary dyskinesia:

• Applications of paraffin and ozokerite, electrophoresis of solutions of novocaine or magnesium sulfate (for the hypertensive type of disease).
• Coniferous baths and showers (fan, circular).
• Microwave therapy, inductothermy.
• Acupuncture.

Diet for dyskinesia

During treatment, it is very important to follow a diet.

The menu of patients suffering from hypokinetic type dyskinesia includes foods with increased content vegetable fats. Positive influence The motility of the biliary tract is affected by the consumption of raw vegetables, herbs, and bran.

The hyperkinetic type of dyskinesia requires limiting the intake of animal fats, eggs, meat and mushroom broths.

Folk remedies and methods of treatment

• Rutabaga has a choleretic and anti-inflammatory effect. It is recommended to eat raw or boiled.
• It is recommended to take two tablespoons of freshly squeezed lemon juice every two hours daily.
• The pulp is boiled and raw pumpkin restores and rehabilitates the liver after an acute form of hepatitis, it is also excellent choleretic agent. You need to eat 0.5 kg of pulp per day.
• Pumpkin juice improves sleep and calms the nervous system. Therefore, it is recommended to drink one glass a day, and also for sedative effect- for the night.
• It is recommended to take 50 ml of grapefruit juice half an hour before meals.
• 100 ml fresh carrot juice mix with 100 ml of heated milk to 70-80°C. Drink in large sips, replacing breakfast with this mixture. If the calories received cannot provide the usual reserve of strength for a hard day of work, you need to have a full breakfast, but only an hour after drinking the drink.
• Take a mixture of carrot juice with beet and cucumber juice in equal proportions three times a day, 100 ml, 20 minutes before meals.
• Mix glass tomato juice with a glass cabbage brine. Consume after meals three times a day.
• Take a glass apple juice, add a tablespoon of honey there. Take 100 ml up to four times a day.
• Take 4 parts carrots, one part parsley and three parts celery. Make a juice mixture from these ingredients. Drink half an hour before meals three times a day, two tablespoons.
• It is recommended to take a tablespoon for hypotonic dyskinesia. olive oil, every day, washed down with sweetened lemon juice.
• Pour the wheat grains with water and place in a warm, dark place. Wait until the sprouts are 1 mm in size. Then wash them and grind them using a meat grinder, add a drop of vegetable oil. Use in the morning on an empty stomach.
• Pour Hercules flakes into a glass hot water. After the porridge has cooled, you can eat it. Consume half an hour before meals three times a day.
• Grind the root and six leaves of horseradish. Infuse 500 ml of vodka for a week. Take one tablespoon before meals three times a day.
• Grind the dried melon seeds in a coffee grinder. Then pour 200 ml of boiled milk into a glass of the resulting flour. Let it brew in a thermos for 1-2 hours. Strain. Drink half a glass in the morning on an empty stomach.
• Take two fresh ones chicken yolks, whip into foam, drink. After which, after 5 minutes, drink 200 ml of warm mineral water. Lie down with a warm heating pad under your right side. Effectively eliminates pain in the liver.
  Attention! You need to be sure that the eggs do not contain salmonella.
• Take the fruits of anise, coriander, corn silk, knotweed herb, tricolor violet herb, St. John's wort herb, dandelion root, celandine herb - all in equal quantities. Pour 600 ml of boiling water over three tablespoons of the mixture. Then leave for half an hour and strain. Drink one tablespoon three times a day.
• You need to take four parts of immortelle flowers and St. John's wort herb, one part of chamomile, three parts of knotweed herb, two parts of buckthorn bark. Pour a liter overnight cold water four tablespoons of the mixture. In the morning, boil, then keep on low heat for another 10 minutes. Let cool, strain. Drink a glass of decoction on an empty stomach. Divide the rest into four portions, consuming after meals.
• Take equal parts of bean pods, knotweed grass, smooth herb, corn silk, bear ears grass. Pour a glass of boiling water over a tablespoon of the mixture. Infuse for an hour, pre-wrapped (in a thermos). Then strain. Use the infusion throughout the day, warming it up before taking it.
• You need to take equal quantities of chamomile flowers, a leaf of three-leaf cotton wool, and celandine herb. Pre-grind. Mix. Pour a glass of boiling water over a tablespoon of the mixture. Let it brew for an hour. Then strain. Drink 100 ml in the morning and evening an hour after meals.
• Take one part each of kidney tea, stinging nettle herb, horsetail herb, two parts knotweed herb. Pour 500 ml of boiling water into 2 two tablespoons of this mixture. Infuse for six hours. Take 100 ml warm before meals three times a day.
• Take equal amounts of aureus herb, peppermint leaf, and celandine herb. Pour 200 ml of boiling water into a tablespoon of this mixture. Leave for an hour, strain. Drink one glass of infusion twice a day, half an hour before meals.
• Take equal amounts of sage leaves, caraway fruits, peppermint leaves, angelica roots, and buckthorn bark. Pour 200 ml of boiling water into a tablespoon of this mixture. Take 100 ml half an hour before meals three times a day.
• You need to take three parts of sandy immortelle, two parts of rhubarb root, five parts of common yarrow. Pour 200 ml of boiling water into a tablespoon of this mixture. Then insist and strain. Drink 140 ml of infusion before bed.
• Take 1 part lemon balm herb, 2 parts each buckthorn bark, peppermint leaf, immortelle flowers, 6 parts crushed rose hips, 5 parts celandine herb. Brew 1 teaspoon of the mixture in 300 ml of boiling water. Leave for 15 minutes, drink in one dose with honey.
• Pour olive oil fresh flowers St. John's wort at a rate of one to ten. Infuse for 40 days. Take two teaspoons three times a day, half an hour before meals.
• Pour a glass of boiling water over the dried and crushed rose hips. Put on the fire and boil for another half hour. Leave in a thermos for four hours, strain. Drink 100 ml of infusion three times a day before meals, adding a small amount of honey.
• Pour a glass of boiling water over a tablespoon of lingonberry leaves, leave for half an hour, strain. Take the infusion up to five times a day, two tablespoons.
• Pour 200 ml of boiling water over two teaspoons of peppermint herb, leave for half an hour, strain. Consume throughout the day, taking large sips.
• Pour 400 ml of boiling water over two tablespoons of dill seeds. Place over low heat for another 15 minutes, then cool and strain. Take 100 ml of warm decoction up to four times a day. Duration of treatment is up to three weeks.
• Mix cinquefoil herb, celandine herb and peppermint leaf taken in equal quantities. Pour 1 tablespoon of the mixture into 1 glass of hot water and boil in a water bath for 15 minutes. Infuse for 30 minutes, strain, bring the volume of infusion with boiled water to 1 glass. Take 1-2 glasses of hot infusion per day for the hypertensive form of biliary dyskinesia with spasms.

Self-massage of the abdomen

Self-massage of the abdomen improves intestinal motility, tones its work, promotes the removal of bile from the body, stimulates the activity of the pancreas and stomach, which fully explains its effectiveness, both for the treatment and prevention of diseases of the abdominal organs. Self-massage should not be performed when acute forms diseases of the abdominal organs. To avoid pain in these organs in people with chronic diseases, self-massage is done easily and gently.

• Lying on your back, place your right hand on your lower abdomen (under the navel), and your left hand above it. Lightly pressing (better bottom palms) on the stomach, move the abdominal wall with the right hand to the left, and with the left - to the right. Perform this technique while simultaneously moving your hands towards each other. The abdominal wall will gently slide under your palms. Then change hands (right on top, left on bottom) and do the same movements, but in opposite directions.
• Put left palm on the navel area, and the right one on top and, lightly pressing on the stomach, make rotational movements clockwise and counterclockwise (10 rotations in total).
• Massage the periphery of the abdomen. Place the fingers of your left hand on the area between the navel and the right wing of the pelvis, pressing lightly, perform movements clockwise and counterclockwise, while moving your hands slightly upward. Repeat similar movements under the right hypochondrium (gall bladder area), in the epigastric region, under the left hypochondrium, below it (the area of ​​the descending part of the large intestine) and on the left, between the navel and the left wing of the pelvis (the sigmoid colon area). Make 20-30 circular movements.
  Attention! Massaging the sigmoid colon may cause the urge to stool.

Physiotherapy

A set of exercises for biliary dyskinesiasand chronic cholecystitis:

• IP (starting position) – lying on your back. At the same time, raise your right arm up and bend your left leg. The foot slides along the floor - inhale. When returning to IP, exhale.
• IP – see point 1. Hands are on the belt. Raise your head and shoulders, look at your toes - exhale. When returning to IP, inhale.
• IP - the same. Place your right hand on your stomach, your left hand on your chest. The essence of the exercise is diaphragmatic breathing, that is, with the stomach. Raise both arms, following the movements of the diaphragm and chest - inhale; when exhaling, lower your arms down.
• IP - lying on the left side, left leg in a half-bent position, the left arm reaches up. When rising right hand up - inhale, while bending your right leg, pressing your knee with your right hand to your chest - exhale.
• IP - see point 4. When raising your right arm and leg, inhale, when bending your leg and arm and pulling your knee to your stomach, tilt your head, exhale.
• IP - the same. When moving the right arm straight up and back at the same time, inhale; return to IP – exhale.
• IP - the same. Take both legs back - inhale, IP - exhale.
• IP – in cat pose. Raise your head up, inhale, moving, sliding movements, put your right leg forward between your hands - exhale. Return to IP and repeat the exercises, but with the other leg.
• IP - the same. Left hand straighten, move to the side and lift up - inhale, return to IP - exhale.
• IP - the same. Inhale and, bending your arms, take the position “lying on your stomach” - exhale, return to the IP.
• IP - the same. You need to raise your head, bend in the shape of a boat in the lumbar region - inhale, while tilting your head, arch your back - exhale.

Breathing exercises

The complex of therapeutic exercises can include a number of breathing exercises. These exercises are aimed at changing intra-abdominal pressure, so they must be performed during the rehabilitation period, making sure that unpleasant symptoms do not appear. painful sensations.

• IP (starting position) – standing, hands on hips. Inhale slowly (inhalation of moderate depth), draw in your stomach, exhale strongly and sharply.
• IP - the same. Exhale strongly and sharply, drawing in your stomach as much as possible, and hold your breath for 6-8 seconds. The abdominal muscles should be in a relaxed position.
• IP - sitting on the floor, legs tucked. Hands on knees, back straight. The eyes are closed or raised up, the head is lowered down. The muscles of the shoulders, face, arms, neck, legs are completely relaxed. Take a slow breath (moderate depth) and hold your breath for 1-2 seconds.
• IP - the same. Inhale slowly (1-2 seconds), hold your breath for 2 seconds. Repeat a few more times.

Dyskinesia is a gastrointestinal disease when bile does not enter the duodenum correctly, resulting in impaired digestion. Patients with suspected biliary dyskinesia complain of nausea, vomiting, bitterness and unpleasant odor in the mouth, pain under the ribs on the right side.

The reasons why gallbladder dyskinesia occurs are organic (when the bile ducts are affected) and functional (when the regulatory functions of the nervous system are impaired).

For a diagnosis such as biliary dyskinesia, it is important to identify the causes accurately in order to prescribe adequate treatment, this will help avoid complications in the form of cholelithiasis.

Types of dyskinesia

Biliary dyskinesia is classified by doctors into: primary and secondary according to certain characteristics - the nature of the cause, the time of development.

Primary types of dyskinesia appear against the background of malformations of the ducts, the gallbladder itself and its sphincters. The disease can develop independently or under the influence external factors. With independent development congenital form dyskinesia, its manifestations begin in childhood. But often minor defects in the development of the gallbladder and its ducts are compensated by adaptive mechanisms. And in this case, the disease biliary dyskinesia makes itself felt in adulthood in the presence of factors conducive to this.

Secondary dyskinesias appear due to acquired diseases of other digestive organs against the background of predisposing factors.

Taking into account the peculiarities of contraction of the muscles of the bile ducts, dyskinesia can be classified into one of three forms: hyperkinetic, hypokinetic, hypotonic-hyperkinetic.

Hyperkinetic dyskinesia is also called hypermotor, hypertonic. This form of the disease is characterized by excessive amounts of bile released into the duodenum. The reason is the active contractions of the walls of the gallbladder and bile ducts. More often observed in young patients.

With biliary dyskinesia in a hypokinetic form, the gallbladder works sluggishly, as a result, little bile passes into the duodenum. Such hypotonic (hypomotor) dyskinesia is observed in people over the age of 40 and in those who are prone to neuroses.

Mixed, or hypotonic-hyperkinetic intestinal dyskinesia has signs of both of the above forms of the disease. In this case, one of the organs of the biliary system works actively, the other sluggishly. For example, the gallbladder is actively working, but the ducts are sluggish. The work of organs in an uncoordinated mode leads to violations. Taking into account which organ does not work in harmony, gallbladder dysfunction or sphincter of Oddi dysfunction is distinguished. Each of the ailments requires the prescription of certain medications and procedures.

Causes of dyskinesia

Taking into account the factors that caused the disease, all forms of dyskinesia are divided into primary and secondary. The causes of dyskinesia of the primary type are congenital; there is a defect in the development of the biliary system:

• narrowing/blockage of the lumen in the gallbladder;
• duplication of ducts, gallbladder;
• partitions in the ducts, gall bladder.

The causes of secondary dyskinesias are unfavorable factors and various diseases:

• gastritis, duodenitis, stomach or duodenal ulcer;
• cholecystitis, pancreatitis, cholangitis and cholelithiasis;
• viral hepatitis, stress, neurosis, hypothyroidism, vagotonia;
• postoperative condition after gastrectomy, etc.;
• systemic diseases (diabetes mellitus, dystrophy, etc.).

In addition to the reasons listed above, biliary dyskinesia disease can occur in people at risk for certain factors. Such predisposing factors include:

• heredity;
• deficiency of vitamins and minerals;
• helminthiasis;
• giardiasis;
• improper eating schedule and tendency to eat unhealthy foods;
• intestinal infections;
• inflammation in the abdominal cavity (pyelonephritis, adnexitis, appendicitis);
• hormonal imbalance (during pregnancy, while taking hormones, tumors, PMS, obesity);
• VSD and stress;
• overstrain in the mental and physical sphere;
• physical inactivity, muscle weakness;
• asthenic physique;
• allergic diseases;
• osteochondrosis.

Symptoms of dyskinesia

With a disease such as gallbladder dyskinesia, symptoms may differ, since some patients experience whole line sensations, others - only some. Regardless of the type, the symptoms of bile duct dyskinesia, characteristic of each disease, manifest themselves to varying degrees.

The only difference between the hypermotor type and the hypomotor type will be the nature of the pain. First, you can consider the symptoms of gallbladder dyskinesia, then for each type separately.

All types of dyskinesia are characterized by the presence of dyspeptic, pain, asthenovegetative and cholestatic syndrome, each with its own set of symptoms. The pain syndrome will differ depending on the form of dyskinesia.

Cholestatic syndrome is observed in patients in whom bile is supplied to the duodenum in insufficient quantities. Exacerbation of dyskinesia can be distinguished by the following symptoms:

• the color of stool and urine is darker than usual;
• the skin, mucous membranes, sclera of the eyes, tears and saliva acquire a yellow tint;
• the liver increases in size;
• skin itching appears.

Cholestatic syndrome is detected in 50% of patients with any form of dyskinesia.

Dyspeptic syndrome develops in the form of a digestive disorder due to an incorrect amount of bile entering the intestines. In this case, intestinal dyskinesia is manifested by the following symptoms:

• loss of appetite;
• vomiting, nausea, belching after eating;
• bloating;
• nasty smell from oral cavity;
• the appearance of plaque on the tongue (white, yellowish);
• feeling of dryness, bitter taste in the mouth in the morning, immediately after waking up;
• constipation (with hyperkinetic form), diarrhea (with hypokinetic form).

Asthenovegetative syndrome is a reversible disorder in nervous regulation organ functions. In this nature, gallbladder dyskinesia is defined as follows:

• weakness, increased fatigue;
• sudden changes in mood, irritability;
• sleep disorders;
• increased sweating;
• decreased blood pressure and sexual activity;
• headache.

Pain syndrome with hypertensive dyskinesia

To take painkillers or folk remedies, you need to know the cause of the pain. For dyskinesia sharp pain occurs on the right side under the ribs, radiates to the shoulder blade, right side of the back, arm, collarbone. Sometimes an attack of pain is felt not only under the ribs, but also in the stomach area. Rarely, pain on the right side of the ribs radiates to left side, in the region of the heart.

In this case, an attack of pain is confused with angina pectoris. Intense pain lasts about 20 minutes and can occur many times a day. Pain can be caused by poor diet, severe physical, mental or psycho-emotional stress. When the pain goes away, there remains a feeling of heaviness on the right under the ribs that does not go away.

Painful sensations may be accompanied by nausea and vomiting, which do not bring relief to the patient. When palpating the abdomen, the pain intensifies. The intensity of pain in hypertensive dyskinesia is due to the fact that the gallbladder actively contracts while the sphincters are closed. As a result, the outflow of bile becomes impossible, severe pressure occurs and, as a result, pain.

Pain due to biliary colic

Biliary colic is a severe sudden contraction of the gallbladder. Painful sensations appear under the ribs on the right side, regardless of food intake, stress or physical activity. If the patient does not know that he may have dyskinesia of the gallbladder, such pain can frighten him - the pain is accompanied by palpitations, fear, and numbness of the limbs. Patients may suspect a heart attack, and immediately call " ambulance", that's how scary intestinal dyskinesia can be.

Pain syndrome of hypotonic dyskinesia

With this form of JVP, the pain sensations are diffuse, the approximate location of the pain is right hypochondrium. A person cannot point with his finger exactly where the attack is felt, since the discomfort is widespread throughout right side ribs The pain also radiates to the shoulder blade and right side of the back. This is an aching, dull and bursting pain that is almost permanent. Increased pain is felt when eating fatty foods. If at such moments you stick to a diet and take a choleretic drug, the intensity of painful spasms can be reduced. The total duration of pain reaches several days, sometimes weeks.

The cause of pain is the small contractile activity of the gallbladder, as a result of which excess bile accumulates in it, stretching the bottom and causing constant dull pain. With palpation of the duodenum or duodenal intubation procedure, the pain may decrease or go away. But you shouldn’t stop at this stage - the disease will not go away without treatment.

Symptoms of mixed dyskinesia

Dyskinesia of the hypotonic-hypertensive form is characterized by aching pain in the right side of the ribs, combined with a feeling of heaviness. In addition to pain, the patient may experience dry mouth and possibly constipation. Characteristic signs of asthenovegetative syndrome are sudden changes in mood, high fatigue, irritability for no particular reason.

Other symptoms are either mild or completely absent. The mixed form of dyskinesia is also characterized by an enlarged tongue, on which teeth marks can be seen. Patients suffer from constipation, direct and sigmoid colon filled with poorly excreted feces.

Diagnostics

The doctor analyzes the history of the patient's complaints. Wondering if the pain has been chronic for a long time or if the symptoms have appeared recently. Assess jaundice of the skin, ask about the occurrence various symptoms what they are connected to.

The interview is followed by a physical examination. If biliary dyskinesia is suspected, the color of the skin and mucous membranes and the constitution of the patient are assessed. Palpation is performed to check for pain in the right side of the ribs, which may intensify with inhalation. Tapping determines the size of the spleen and liver.

Laboratory diagnostics

In diseases such as gallbladder dyskinesia, there may be no abnormalities in the general blood test. Inflammatory diseases will be determined high rate leukocytes, acceleration of erythrocyte sedimentation.

Upon delivery general analysis wet her dark color and bile pigments may indicate that the patient has biliary dyskinesia. However, these results alone cannot be used to make a diagnosis; a comprehensive diagnosis is required.

The patient is recommended to donate blood for biochemistry; based on the results, the level of creatine, uric acid, total protein by fraction, alkaline phosphatase, alanine aminotransferase, aspartate aminotransferase, bilirubin, and electrolytes is determined.

A lipidogram will allow you to clarify the level of fat-like substances in the blood, and with it, the presence of violations of the normal lipid content.

Be sure to donate blood for markers of viral hepatitis that can harm the liver. A stool test is performed for the presence of protozoa, roundworms and flatworms.

All of the above tests are designed to exclude concomitant diseases and find the cause of disruption of the gallbladder and ducts.

Instrumental diagnostics

An ultrasound examination can reveal the shape and parameters of the gallbladder, the presence of stones, constrictions and kinks. After an ultrasound examination on an empty stomach, a study is performed with a test breakfast, in which the fat content is increased ( egg yolks, sour cream, etc.). After half an hour and an hour, an ultrasound is repeated, during which the doctor evaluates the contraction of the bladder. With such a study on the gallbladder, dyskinesia is determined by its form (hyperkinetic or hypokinetic).

During duodenal intubation, a probe is inserted into the duodenum through the nose or mouth certain time. With a certain regularity, bile is taken for analysis using a probe, signs of inflammation, the presence of stones, etc. are determined.

During fibroesophagogastroduodenoscopy, the condition of the surface of the stomach, esophagus, and duodenum is assessed using an endoscope. Such a study is prescribed if it is suspected that dyskinesia of the gallbladder is caused by a disease of the above organs.

During oral cholecystography, the patient is asked to drink a contrast agent that accumulates in the gallbladder. Then an x-ray is taken and the size, shape, and presence of anomalies in the development of the gallbladder are assessed.

During intravenous cholecystography, the patient is injected with a contrast agent intravenously. As in the previous diagnostic method, parameters and anomalies in the development of the gallbladder are determined. Such diagnostics are contraindicated in the presence of an allergy to iodine preparations.

Among other instrumental diagnostic methods, endoscopic retrograde cholangiopancreatigraphy, which combines endoscopy and radiography, is often prescribed. This allows you to obtain an image of the bile ducts.

Another diagnostic method that provides an accurate image of the liver and biliary tract is hepatobiliary scintigraphy. The patient is injected intravenously with a radioactive substance, which allows a radioisotope image to be obtained.

Treatment of dyskinesia

The doctor will tell you in detail how to treat biliary dyskinesia after he makes an accurate diagnosis and collects the entire medical history. The treatment is complex, the goal of which is to normalize the flow of bile and prevent its stagnation in the bladder. In general, when diagnosed with gallbladder dyskinesia, treatment is as follows:

• compliance with work and rest schedules;
• dietary table No. 5;
• drinking mineral water;
• choleretic drugs for bile duct dyskinesia are prescribed in combination with painkillers and enzymes;
• physiotherapeutic procedures – paraffin applications, diadynamic currents, electrophoresis;
• massage, acupuncture;
• taking sedatives, tonics and sedatives that normalize the functioning of the nervous system;
• sanatorium treatment.

With a diagnosis such as biliary dyskinesia, treatment is based on taking medications, tubing, and normalizing the daily routine. The rest of the listed points are auxiliary. For the main signs of bile duct dyskinesia to subside, it will take about 4 weeks of treatment.

As for auxiliary methods, when it comes to treating dyskinesia with folk remedies, they can be used longer, repeating courses as necessary.

With a disease such as biliary dyskinesia, symptoms and treatment are closely related, and drugs are selected depending on the type of disease (for bile formation, for bile excretion).

For hypertensive dyskinesia, nicodine, oxafnamide, and mineral waters with weak mineralization are prescribed. Infusions of chamomile, peppermint, motherwort, dill, licorice root and valerian are prescribed as herbal medicine.

When biliary dyskinesia is attributed to hypotonic type, the doctor prescribes magnesium sulfate, flamin, pancreozymin, cholecystokinin, mineral waters with high mineralization. Infusions of chamomile, nettle, rose hips, corn silk, immortelle, St. John's wort and oregano are used as herbal medicine.

When intrahepatic cholestasis is diagnosed, tubages are prescribed twice a week. The patient is prescribed choleretics, tonics, and cholekinetics. If the analysis results indicate increased activity ALT, then choleretics are not prescribed.

Prognosis for treatment of ADHD

Strict adherence to all the doctor’s instructions and the desire to get better can help ensure that biliary dyskinesia will not be felt or bother the patient after just a couple of weeks. In many ways, the success of treatment depends on the normalization of work and rest, a balanced diet, and resistance to stress. Modern techniques and the latest drugs, when used correctly, give excellent results, allowing you to return to a normal lifestyle quite quickly.

Hypokinetic biliary dyskinesia is a disease characterized by a lack of bile during food processing. The disease develops because the gallbladder did not contract in time and the required component did not enter the digestive tract. As a result of this disorder, food is not digested normally, beneficial components are poorly absorbed, and therefore the general vital activity person.

Quite often, this form of the disease is diagnosed in older people, after 40 years, when a person often experiences neuroses and succumbs to stress.

Etiology

The cause of the formation of the disease is a violation of the outflow of bile, its stagnation, deterioration of the tone and motility of the bile and ducts. The risk group of people who may develop such a pathology includes the following individuals:

• increased anxiety;
• nervous;
• with autonomic disorders – headaches, cold extremities, rapid heartbeat, disturbed sleep are noted.

Also, various early gastrointestinal diseases that have already overcome the patient - gastritis, pancreatitis, ulcers - can serve as a provoking factor.

Another reason, according to doctors, may be poor lifestyle and nutrition. Pathology can progress with overeating, frequent diet disruptions and excessive amounts of junk food.

Some patients are diagnosed with a hereditary factor that provokes the development of the disease in childhood.

Various bacteria and infections can serve as factors for the rapid development of pathology.

JVP can also occur under the influence of the following reasons:

• inflammation in the abdominal cavity and pelvis;
• vegetative-vascular dystonia;
• emotional, mental or physical stress;
• inactive way of life;
• asthenic physique;
• muscle weakness;
• chronic allergic diseases;
• osteochondrosis.

Symptoms

Hypotonic JVP develops with characteristic symptoms. Dyskinesia is divided into two forms, but each type has specific signs that help the doctor quickly identify the disease. With hypokinetic pathology, the patient experiences the following symptoms, which are provoked by strong emotional outbursts or diet violations:

• dull, aching, low-intensity pain in the right hypochondrium;
• a feeling of heaviness and expansion of the area under the rib;
• unpleasant sensations do not spread to other areas of the body;
• bitter taste in the mouth;
• nausea;
• loss of appetite;
• belching;
• bloating;
• bowel dysfunction;
• irritability;
• tearfulness;
• rapid onset of fatigue;
• profuse sweating;
• headache;
• yellow coating on the tongue.

If the disease develops in men, libido deteriorates, and in women the menstrual cycle is disrupted.

If the hypokinetic form of dyskinesia has developed to cholestasis, and this is the last stage of stagnation of bile in the bile ducts, then the patient begins to experience more severe symptoms:

• severe itching of the skin of the entire body;
• yellow tint of the skin and mucous membranes;
• darkening of urine;
• lightening of stool to a gray tint.

Diagnostics

If the above mentioned clinical manifestations the patient should immediately consult a doctor. A gastroenterologist will help the patient cope with the identified signs. The physician must determine the cause of such symptoms, what signs were the first, and also identify risk factors. During a physical examination and questioning of the patient, the doctor determines the presence of jaundice of the skin and mucous membranes of the eyes, pain on palpation in the area under the right rib.

Laboratory examinations should be carried out to clarify the diagnosis and for the purpose of differential diagnosis:

• a blood test can show a physician an inflammatory process - leukocytosis with a neutrophil shift and an increased ESR;
• a urine test can reveal bile pigments;
• more information can be provided by a biochemical blood test, which helps determine the signs of cholestasis syndrome;
• To exclude viruses, a test for viral hepatitis is performed.

It is also necessary to conduct instrumental diagnostics:

• Ultrasound of the abdominal cavity - helps to analyze the shape and size of the gall bladder, identify the presence or absence of stones, and anomalies. It is recommended to conduct an ultrasound examination 2 times - on an empty stomach and after a light breakfast;
• duodenal intubation - the work and tone of the organ is determined, the speed of contraction of the organ and the synchronicity of the functioning of the sphincters of the bile ducts are analyzed. The doctor can diagnose lability of the gallbladder reflex, worsened rhythm of bile outflow and excessive secretion of gallbladder bile;
• esophagogastroduodenoscopy – performed to identify diseases of the stomach and small intestine;
• cholecystography – used for accurate visualization of the bile duct using contrast agent. Its shape, size, location and speed of contraction are analyzed;
• ERCP and hepatobiliary scintigraphy - to exclude other pathologies of the liver, pancreas and bile ducts.

Treatment

Therapy of hypokinetic type disease consists of three main methods:

• eliminating the root cause of the disease;
• treatment of cholestasis and its complications;
• restoration of normal functioning of the gallbladder.

For any problems with the gastrointestinal tract, diet therapy is very important. In case of a disease of the biliary system, doctors also prescribe to patients certain rules of nutrition and daily routine:

• the number of meals should be at least 5 times a day in small portions;
• the menu should not contain products made from animal fat;
• any fried, salted, smoked foods are prohibited;
• you need to exclude various sweets, chocolates, coffee, cocoa and soda;
• It is undesirable to consume eggs and legumes due to higher level gas formation;
• reduce the amount of salt;
• food must be cooked in steam bath, in the oven or stewed;
• observe drinking regime and drink the normal amount of fluid per day.

In the diet of a person with similar diagnosis there should be the following products:

• dried bread products;
• dairy products;
• lean meat and fish products;
• vegetables;
• boiled sausage and frankfurters;
• vegetable and butter;
• sugar;
• caramel;
• paste;
• juices from fresh vegetables and fruits;
• sweet fruits and berries;
• cereals;
• light broths.

In addition to diet, the patient should also follow the correct daily routine so that the body has time to rest and recover. For this, patients are recommended the following regimen:

• sleep at least 8 hours at night;
• go to bed no later than 23:00;
• to walk outside.

In order for the treatment of the disease to be as effective as possible, doctors prescribe patients to undergo various physiotherapeutic procedures, as well as the use of medications. Doctors prescribe pills to achieve the following goals:

• normalization of bile secretion;
• eliminating pain syndrome;
• relieving spasms in the sphincter;
• reducing symptoms;
• normalization of the nervous system.

The patient’s condition can be significantly improved by using antispasmodics, enzyme preparations, choleretic, sedatives, sedatives, tonics, etc.

Physiotherapy is prescribed based on the patient’s health condition and the characteristics of the course of the disease. The patient is recommended electrophoresis, diadynamic currents, paraffin applications, acupuncture, massages.

Doctors often use traditional methods eliminating the disease. Such methods of treatment are especially relevant at the time of remission. Doctors advise using herbal decoctions to prevent relapses. But in moments of exacerbation, such therapy must be used extremely carefully after a doctor’s prescription. Decoctions and tinctures can be made from the following plants:

• calamus root;
• barberry;
• birch leaves;
• immortelle;
• centaury;
• coriander;
• corn silk;
• burdock;
• tansy bloom;
• sagebrush;
• Rowan;
• hop;
• chicory.

These herbs can be mixed in different proportions and combined in different ways, but before using them it is important to consult a specialist.

Complications

As a result of untimely or improper treatment, the patient may develop various complications - cholecystitis and cholelithiasis. Quite often, doctors manage to completely eliminate the disease, so the body is not subject to the formation of other pathologies.

Prevention

• get enough sleep;
• moderately engage in mental and physical work;
• to walk outside;
• Healthy food;
• reduce the amount of stress.

These requirements can be followed by both healthy people and patients who want to prevent relapses of dyskinesia.

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Many patients are interested in the question of what JVP means in a diagnosis and how exactly this meaning is deciphered. Dyskinesia is a disease of the gastrointestinal tract, as a result of which bile does not enter the duodenum correctly, as a result of which the digestion process is disrupted. Patients who are suspected of having dyskinesia complain of nausea, bad taste in the mouth, vomiting and pain in the right side.

The reasons why such a pathology occurs can be organic and functional. To carry out treatment, it is important to accurately determine the provoking factor, as this will avoid complications.

Main types of disease

It is important to understand exactly what the deciphering of the diagnosis of ADHD means and how exactly such a pathology manifests itself. JVP is dyskinesia. According to the classification, it can be primary and secondary and is divided according to the nature of the provoking cause and the time of development.

The primary type of bile duct occurs against the background of existing anomalies in the development of the bile ducts. The disease can develop independently or under the influence of external factors. When a congenital form of pathology occurs independently, its manifestations are observed from early childhood. However, in some cases, there may be an asymptomatic course for some time, and symptoms arise only when exposed to certain provoking factors.

Secondary dyskinesias arise as a result of the presence of diseases of the digestive system. Taking into account the characteristics of muscle contraction of the affected organ, the disease can be:

• hyperkinetic;
• hypokinetic;
• mixed.

Hyperkinetic dyskinesia is characterized by significant amount accumulated bile, which is released into the duodenum. The reason for its occurrence is too active contraction of the walls of the affected organ. Often such a disorder is observed in young patients.

Hypotonic GIB is characterized by the fact that the gallbladder does not function well enough, while little bile enters the digestive organs. Basically, this disorder is observed in people over 40 years of age. In addition, quite often this pathology occurs in those who are prone to neuroses.

The mixed type of the disease has signs of both of these forms of the disease. One of the organs of the biliary system works very actively, while others are sluggish. Uncoordinated functioning of organs leads to various types of disorders.

Features of the disease in children

Parents are interested, when first faced with a diagnosis of ADHD in a child, what it is and how such a disease manifests itself. Dyskinesia mainly occurs in children over 3 years of age. They are characterized by hypermotor and mixed types. In some cases, hypomotor symptoms are observed.

Dyskinesia is the most common pathology in children. The causes and basic mechanisms of its occurrence in a child are practically no different from those in an adult. In some cases, the appearance of pathology is due to the active growth of bone and muscular systems and is temporary. However, the provoking factor may be serious violations digestive system.

Doctors distinguish between organic and functional dyskinesia. Organic presupposes the presence of various types of congenital abnormalities in the development of the bile ducts, chronic allergies, systematically poor nutrition, excessive nervous excitability. A disease of this etiology occurs in approximately 10-15% of all cases.

Functional dyskinesia is caused by concomitant pathologies and occurs much more often. In this case, the child has a history of gastrointestinal diseases, viral and bacterial infections, nervous system disorders, helminthic infestations. Special attention it is necessary to pay attention to the hereditary factor, as well as the presence of endocrine diseases.

Dyskinesia in children often manifests itself in the form of atopic dermatitis and symptoms of dysbiosis, which cannot be eliminated using traditional methods. With the development of ADHD in children, symptoms from the nervous system often appear. At the same time, the child becomes capricious, whiny, and gets tired very quickly. Schoolchildren's performance declines sharply. Also, with ADHD, children may experience increased sweating, rapid heartbeat and other symptoms.

When carrying out treatment it is important proper nutrition child both during exacerbation and during remission. children with dyskinesia are carried out within 3 years from the time of the last exacerbation. To prevent the occurrence of such a pathology, it is imperative to monitor the child’s diet and avoid overeating. You also need to protect him from negative stressful situations and eliminate various types of violations in a timely manner.

Causes

When diagnosing VADP, absolutely every patient must know what it is and what causes this pathology, as this will make it possible to get rid of the disease much faster and more effectively. Primary dyskinesia appears under the influence of a variety of negative factors in altered bile ducts. Among the main causes of this disease are the following:

• acute or chronic stress;
• abuse of fatty foods;
• allergies;
• taking certain medications;
• lack of weight.

Secondary VSD in adults is formed against the background of existing pathologies and diseases in humans, significantly complicating their course. Among the main diseases it is necessary to highlight the following:

• cholecystitis;
• hepatitis;
• gastritis;
• ulcer;
• pyelonephritis.

Psychosomatic factor

A psychosomatic factor can provoke the development of various kinds of diseases, including DDVP. In this case, when carrying out medical examination no organic or physical reasons that could cause illness. Psychosomatics is based on identifying emotional manifestations that influence the course of pathology. Among people suffering from ADHD, which developed under the influence of psychosomatic factors, it is necessary to highlight:

• touchy;
• conflict;
• evil;
• greedy people.

In addition, individuals prone to self-sacrifice may suffer from this problem. Treatment involves the use of psychotherapeutic methods, a revision of one’s life principles and positions. Lifestyle adjustments are also required. According to the principle of psychosomatics, most diseases are inherited.

People are also encouraged to learn to forgive and keep anger and irritability under control. A child suffering from psychosomatic disorders is distinguished by strict fulfillment of all given promises, punctuality, and conscientiousness. Such children are distinguished by great vulnerability and suspicion, especially towards everything new and unusual. They are often withdrawn and prone to self-accusation.

Main symptoms

When diagnosing VHD, what it is and exactly how this condition manifests itself is very important for all patients to know. With dyskinesia, the symptoms may vary somewhat, since some patients may experience a whole range of symptoms, while others may experience only part of them. Regardless of the type of this pathology, the signs characteristic of this disease appear to varying degrees.

The only difference between the hypermotor type and the hypomotor type will be the presence of certain, rather characteristic sensations. Regardless of the type of disease, it is characterized by the presence of pain, dyspeptic and cholestatic syndrome. It's a dull pain in the right side it is present almost constantly and subsides a little at night. It can be significantly worse after eating food. During the course of the hypertensive type of disease pain syndrome quite intense.

In a stressful situation or after even minor physical activity, the pain continues for an hour. Between attacks, a person may complain of a feeling of constant discomfort in the right side. At the same time, the patient’s general health is quite normal. The severity of pain differs somewhat depending on the form of dyskinesia.

It is mainly detected in patients in whom bile enters the duodenum in minimal quantities. Exacerbation of the disease can be distinguished by the following signs:

• stool and urine become darker than usual;
• the skin and sclera of the eyes acquire a yellowish tint;
• the liver is slightly enlarged;
• severe skin itching appears.

Cholestatic syndrome is detected in almost half of patients suffering from dyskinesia. Dyspeptic syndrome manifests itself in the form of disruption of the digestive process due to excessive or insufficient amount of bile entering the intestines. In this case, the following signs are observed:

• loss of appetite;
• bloating;
• nausea and vomiting;
• unpleasant belching after eating food;
• plaque formation on the tongue;
• constipation;
• dry mouth.

Bitterness in the mouth is often felt immediately after sleep or some time after eating food, or it can be present constantly. Nausea and vomiting are necessarily provoked by something, and often this symptom appears after consuming fatty foods or overeating. With dyskinesia, vomiting of undigested food mixed with bitter bile mainly occurs at the very peak of pain.

Asthenovegetative syndrome is the occurrence of irreversible changes in the nervous regulation of organ functioning. In this case, dyskinesia has the following manifestations:

• sleep disturbance;
• increased fatigue;
• irritability;
• excessive sweating;
• headache;
• decrease in pressure.

Before carrying out treatment, it is imperative to know what the diagnosis of VSD in an adult is and for what reason pain occurs. With hypertensive pathology, acute pain occurs in the right hypochondrium and radiates to the right side of the back, scapula, collarbone, and arm. Sometimes a painful attack is also felt in the stomach and heart. In this case, many people confuse it with an attack of angina. The intense pain lasts for about 20 minutes and may even recur several times a day. Diet errors, strong psycho-emotional and physical stress can provoke pain. After this, a feeling of heaviness appears.

Painful sensations can also be accompanied by periodic nausea and vomiting, which do not bring relief to the person. When palpating the abdomen, the pain only intensifies.

Symptoms of hypotonic type of diarrhea are associated with the fact that the painful sensations are sufficiently blurred. They are mainly localized in the right side. It is impossible to pinpoint the exact area where the attack is felt, since the discomfort spreads to the entire right side. The pain also radiates to the shoulder blade and back. It is dull, bursting in nature and lasts for a long time. In case of hypotonic type of diarrhea, increased pain occurs after consuming fatty foods.

The mixed form of the disease is characterized by prolonged pain. The pain is combined with a feeling of heaviness. In addition, there may be indirect signs of ADHD, which manifest themselves in the form of dry mouth, and constipation may also occur. Characteristic symptoms may include sudden changes in mood, constant irritability and increased fatigue.

Indirect signs of mixed-type ADHD can be characterized by the fact that the tongue becomes enlarged and you can even notice clear teeth marks on it.

Which doctor should I contact?

The attending doctor will be able to explain what kind of diagnosis this is - JVP. If characteristic signs of pathology occur, you should contact a gastroenterologist. Additionally, consultation with a surgeon, psychotherapist, infectious disease specialist, or nutritionist may be required. They prescribe a comprehensive study that will determine the characteristics of the pathology.

Many patients are interested in the question of what is medical term and diagnosis of ADHD. This disease is recorded for all people suffering from pathology of the gallbladder and its ducts. To make a diagnosis you will need:

• taking anamnesis;
• physical examination;
• laboratory research;
• instrumental diagnostics.

Initially, the doctor collects complaints in order to clarify exactly when pain and heaviness in the abdomen appeared and what caused their occurrence. A study of the patient's medical history is also required. It is worth knowing if a person has chronic or hereditary diseases, as well as bad habits. The doctor then performs a physical examination, which determines normal coloration. skin or their yellowness. During palpation, pain is assessed. Tapping determines the size of the spleen and liver.

Laboratory tests include:

• blood analysis;
• urine;
• lipid profile;
• stool examination;
• markers of viral hepatitis.

A complete blood count may not detect any abnormalities. In the presence of inflammation, leukocytosis appears. A biochemical blood test will help determine the level of creatinine, uric acid, and electrolytes.

A lipidogram allows you to identify abnormalities in lipid levels. A stool examination is carried out to identify helminths. After this, the doctor prescribes an instrumental examination. When conducting ultrasound diagnostics, it is possible to make a diagnosis of ADHD and hepatoriamia, and determine the size and shape of the affected organ. Duodenal examination helps identify signs of inflammation and the presence of stones.

Fibroesophagogastroduodenoscopy involves studying the condition of the surface of the stomach, esophagus and duodenum using an endoscope. Such a study is required if there is a suspicion of diseases of these organs and dyskinesia. Cholecystography helps determine the shape and size of the affected organ, as well as the presence of abnormalities in its development. All these methods will allow you to accurately diagnose gallbladder thyroid gland disease and prescribe subsequent treatment.

Features of treatment

If there is VADP, what it is and how to properly treat such a pathology should be explained by the attending doctor, and how to prescribe therapy after the examination. The treatment is complex and is aimed at improving the natural flow of bile to prevent its stagnation. Therapy implies:

• compliance with work and rest schedules;
• consumption of mineral water;
• diet;
• taking choleretic drugs;
• massage and acupuncture;
• taking sedative medications;
• physiotherapeutic procedures;
• sanatorium treatment.

Once a diagnosis of VSD is made, treatment should begin immediately, as this will prevent the development of complications. It will take approximately 4 weeks for the main signs of the disease to subside.

Folk remedies can be used as an additional therapy method. They can be used for a long time, repeating if necessary treatment courses. Drugs are selected depending on the type of disease.

If you have hypertensive pathology, you need to drink mineral water. Infusions of chamomile, valerian, and mint are used as herbal medicine. For the hypotonic type, the doctor prescribes medications, mineral water with a high degree of mineralization. You can also use means traditional medicine anti-inflammatory and sedative effects.

Drug therapy

When a diagnosis of ADHD is made, a specialist can tell you what it is and how to treat the disease. Drug therapy is selected only by a doctor. If the diet for any type of disease is not particularly different, then the treatment has its own certain differences.

Antispasmodics are used when treating only the hypermotor form of dyskinesia. They help reduce the tone of the biliary tract, relax the sphincters, and also prevent the outflow of bile. Drugs are often prescribed, the main active substance which will be drotaverine. For mild attacks, Papaverine may be prescribed.

Choleretic drugs are used for dyskinesia, but if there is concomitant cholelithiasis, then they are contraindicated. These drugs increase the tone of the gallbladder several times and decrease it in the ducts. The drug should be prescribed only by the attending physician, since this group of drugs is very large, and they contain various active ingredients.

For the hypertensive type of dyskinesia, Gepabene, which contains milk thistle extract, is mainly prescribed. In the case of a hypotonic form of the disease, Hofitol is prescribed. It contains artichoke extract. Both of these drugs are choleretic, but have different effects on the body.

The nervous system has a special influence on the regulation of gallbladder motility. That is why the composition complex therapy must include tonic or relaxing agents. When hypertensive dyskinesia occurs, sedatives of plant origin are prescribed, as well as medications that inhibit the processes of overexcitation of the nervous system. The hypotonic type of the disease requires the use of tonics.

Diet and mineral waters

A diet for ADHD involves frequent and small meals. Your usual diet must contain foods that help remove fat from the liver - fruits and vegetables. Need to limit consumption oily fish, meat, eggs, animal fats. It is necessary to completely exclude from the diet such foods as:

• fried and spicy foods;
• carbonated and cold drinks;
• legumes;
• alcohol;
• onion and garlic.

Such food can provoke a severe spasm of the bile ducts. It is important to always consume food warm and fresh. Products need to be baked or boiled. It is normal to salt food, but during an exacerbation period, salt is limited.

Dinner should be very light and no later than 2-3 hours before bedtime. In case of exacerbation of liver and gall diseases, which are accompanied by gastritis, all dishes should be consumed in pureed form, and fresh vegetables and fruits and black bread should be excluded.

During the period of remission, the diet becomes less strict, but in any case it is not recommended to abuse fatty and fried foods. If you have dyskinesia, you need to stick to a diet throughout your life.

Treatment of JVP with mineral waters is carried out only during the period of remission. In the presence of liver and biliary tract diseases, hydrocarbonate and sulfate waters are used. Before starting treatment, you need to carefully study the composition and properties of mineral water, since each of them affects the digestive organs, so some side effects may occur.

Physiotherapy

Physiotherapeutic treatment, which should be used in combination with other techniques, also has a good effect. In particular, diadynometry is used, which implies a therapeutic effect on the area of ​​the right hypochondrium with electric current of various frequencies. Electrophoresis is also used, which involves the effect of a direct electric current on the body and drugs administered with its help into the liver area.

Acupuncture or acupuncture is a treatment method in which the body is affected by introducing special needles into special points on the body. Massage, especially acupressure, has a good therapeutic effect. That is, by influencing certain places on the body, the gallbladder is affected. Many experts recommend hirudotherapy, that is, treatment with leeches affecting biologically active points - projections of the nerve endings of the corresponding organs.

Possible complications

It is important not only to understand what kind of diagnosis this is - VHD, but also what complications of the disease may occur in the event of incorrect or untimely treatment. Among the main violations it is necessary to highlight the following:

• chronic cholecystitis;
• cholangitis;
• cholelithiasis;
• gastritis;
• chronic pancreatitis;
• duodenitis.

Atopic dermatitis may also occur, which develops as a result of impaired absorption of digested food and the release of toxic substances due to inadequate flow of bile into the intestines. When dyskinesia occurs, a person may suddenly lose weight because the absorption of nutrients is impaired.

Forecast

Strict compliance with all the instructions of the treating doctor and the desire to recover will ensure that literally after several weeks of treatment, dyskinesia will no longer bother the person. The success of therapy largely depends on the normalization of work and rest schedules, resistance to stress, and a balanced diet. Modern techniques and applications the latest drugs give very good results and allow you to return to a normal lifestyle very quickly.

Carrying out prevention

Are very important preventive actions, as they help prevent the development of the disease. Primary prevention of dyskinesia is:

• compliance with the work and rest regime;
• good nutrition;
• eliminating stressful situations;
• timely treatment neuroses.

A full night's sleep should be at least 8 hours and sleep should be no later than 23:00. It is important to alternate physical and mental stress, which is why when working at a computer you need to periodically take a break to do a few gymnastic exercises and also take walks in the fresh air.

Nutrition should be complete; it is important to limit the consumption of fatty, smoked, fried, and salty foods. It is recommended to consume as many fresh vegetables and fruits as possible.

Secondary prevention is carried out in case of dyskinesia. It consists in the earliest detection of the pathological process, for example, during regular preventive examinations. This will allow timely treatment and avoid negative consequences.