Bile, produced in the liver, enters the duodenum through ducts, which are called biliary tract. When the functioning of these ducts is impaired, they speak of biliary dyskinesia. Almost 15% of patients who have identified any abnormalities in the gallbladder, suffer from this disease.
Causes of biliary dyskinesia
No wonder they say that all diseases of the nerves. Overwork and stress are important risk factors for developing AIV.Depending on the cause, primary and secondary forms of the disease are isolated.
The following factors may contribute to the primary impairment of biliary duct motility:
- depression and other mental disorders;
- improper nutrition and violation of his regime (bad chewing, eating dry rations, constant consumption of fatty foods and fast food, overeating, etc.);
- sedentary lifestyle (including in the elderly and bed patients);
- diseases, often congenital, accompanied by a decrease in muscle tone.
Secondary dysfunction of the bile ducts can occur for the following reasons:
- diseases of the liver and the gallbladder itself (,);
- chronic diseases of the digestive system (, etc.);
- intestinal infections (typhoid fever, yersiniosis, brucellosis, cholera, etc.) and;
- hormonal disorders in the body;
- congenital anatomical disorders in the structure of the gallbladder and bile ducts.
Types of disease
There are three types of this disease:
- hypertensive - is more common at a young age and is associated with an increase in the contractile function of the gallbladder and its ducts;
- hypotonic - usually diagnosed in patients older than 40 years, resulting from decreased motility of the gastrointestinal tract;
- mixed - at different times there are symptoms of both types of dyskinesia, their signs, although very similar, still have differences.
Symptoms of biliary dyskinesia
Pain. In hypotonic dyskinesia, dull aching pain in the right hypochondrium is almost always present, subsides at night, and intensifies after eating. In hypertensive type of the disease, the pain syndrome is quite intense, gives to the right arm and scapula, occurs as a result of the ingestion of fatty foods, physical exertion, stressful situation, lasts up to half an hour. And between attacks, patients may complain of heaviness and slight discomfort in the left hypochondrium, general well-being is quite satisfactory.
Bitter taste in the mouth and white or yellowish coating on the tongue. These symptoms are more characteristic of hypotonic type of dyskinesia, but may also be present with hypertonic. Bitterness is more often felt after sleep, after some time after a normal meal or physical exertion, and may be present all the time.
Nausea and vomiting. This symptom is necessarily triggered by something, most often it occurs when a heavy meal of fatty foods, overeating, or if the meal occurs too quickly. When biliary dyskinesia vomiting undigested food with an admixture of bitter bile occurs at the peak of pain.
Disorders of the chair. When biliary dyskinesia disrupts the flow of bile into the intestine. In the case of a hypotonic type of violation, a lack of bile leads to a deterioration of intestinal motility, fat digestion, as a result of which the passage of the food lump in the digestive tract is slowed down, and excessive formation of gases in the intestine occurs. In hypertensive type of bile dyskinesia in the intestine may be sufficient, but it can be released both during the meal and in the empty intestine. As a result, peristalsis increases, water absorption slows down and occurs. Often this happens after an attack.
. In any type of biliary dyskinesia, digestion is disturbed, nutrient absorption deteriorates, and fat metabolism is particularly affected. In addition, with a lack of bile, appetite decreases. With a long course of the disease, patients begin to slowly lose weight.
Treatment of biliary dyskinesia
If the disease is of a secondary nature, then first of all it is necessary to treat the disease, which has led to disruption of the gallbladder and ducts, through which bile flows. Symptoms of dyskinesia can go away on their own with proper treatment of the underlying pathology.
Causes of primary biliary dyskinesia are also subject to correction. If the disorders are of a psycho-emotional nature, then a psychotherapist’s consultation and prescription may be required, and, if necessary, antidepressants and tranquilizers.
Diet
During the exacerbation period, preference should be given to boiled and steamed dishes. For any type of dyskinesia, treatment should begin with a diet, usually the diet corresponds to the table number 5 by Pevzner. Excludes any fried, fatty, smoked, salty, sour foods, whole milk, alcohol, as well as any other products that stimulate the digestive processes. In hypertensive dyskinesia
and additionally excluded fresh fruit.
During the period of exacerbation, especially in the first days, it is better to cook food in a double boiler, grind further, eat 5-6 times a day in small portions of 200-300 g. After the symptoms disappear, you should follow a strict diet for a few more months.
During remission in biliary dyskinesia, the diet becomes less strict, but you should not abuse fatty and fried ones.
In case of any diseases of the liver and gallbladder, it is recommended to keep to the diet constantly.
Drugs for biliary dyskinesia
The appointment of drug therapy should deal with the doctor. If the diet for any type of disease is not fundamentally different, then drug therapy for hyper-and hypotonic dyskinesia has significant differences.
Antispasmodics appointed only with hypertensive form of the disease. They are necessary to reduce the tone of the biliary tract and relax sphincters, preventing the outflow of bile. The most commonly prescribed drugs, the active ingredient of which is drotaverin. Papaverine can also be used in the treatment of this disease, in its effect it is inferior to drotaverine several times and is prescribed for mild attacks.
Choleretic drugs widely used in biliary dyskinesia, but if the patient has a concomitant cholelithiasis, they are contraindicated. These drugs increase the amount of secreted bile, increase the tone of the gallbladder and reduce the tone of the ducts and sphincters, which are found along the path of bile to the intestine. It is better to trust the choice of the drug to the doctor, since the group of medicines is very large, and they contain different active substances.
For example, the drug Gepabene, containing extracts of milk thistle and pharmacy smoke, is prescribed for hypertonic dyskinesia, and Hofitol, the main active ingredient of which is the field artichoke extract, is more often recommended for hypotonic disease. Both drugs belong to the group of choleretic, but have different effects on the body.
The autonomic nervous system has a direct effect on the regulation of the motility of the gallbladder and biliary tract, therefore the means of toning or relaxing it are included in the complex therapy.
When hypertensive dyskinesia is prescribed sedatives of plant origin (infusion of valerian, motherwort, Persen, etc.), as well as drugs that inhibit the processes of excitation in the central nervous system (for example, Bechterew mixture). Hypotonic type of disease requires an appointment means tonic vegetative nervous system (ginseng, Eleutherococcus, Chinese lemongrass, etc.).
Mineral water
Treatment with mineral waters is carried out only in the period of remission. In diseases of the liver and biliary tract, sulphate and sodium bicarbonate waters are used (Smirnovskaya, Slavyanovskaya, Izhevskaya, Essentuki No. 4 and No. 17, Borjomi, etc.). Before starting this treatment, it is necessary to carefully study the composition and properties of mineral waters, since they all affect the digestive system as a whole, and diarrhea can be “earned” as an undesirable effect.
Physiotherapy
With an increased tone of the bile ducts, electrophoresis with papaverine or platyfillin, paraffin baths, magnetic therapy, and pine baths are prescribed.
In case of hypotonic dyskinesia, electrophoresis with pilocarpine, diadynamic therapy and pulsed magnetic therapy are recommended.
Surgical treatment for biliary dyskinesia is not shown.
Which doctor to contact
The gastroenterologist deals with the treatment of biliary dyskinesia. Additionally, you may need to consult a psychotherapist, surgeon, nutritionist, infectious diseases. Examination includes ultrasound of the hepatobiliary zone, duodenal intubation, cholecystography and cholangiography are sometimes necessary.
Specialist of the clinic "Siena-Med" tells about biliary dyskinesia:
Union of Pediatricians of Russia, prof. Potapov A. S. talks about dyskinesia of the biliary tract in children.
Dyskinesia is not called the curvature or inflection of the gallbladder or the paths leading from it, as most believe. The term is derived from the Greek word “kinesis,” which means “movement,” and the prefix “dis-” means “violation.” Thus, biliary dyskinesia is a condition in which the tone or motility of the system carrying the bile from the liver to the duodenum is disturbed. This causes pain in the right hypochondrium, problems with the stool, sometimes - and bitter taste in the mouth, but no examination of any damage to these organs is noted.
Most often, dyskinesia occurs in people who have abnormalities in the development of biliary organs, who have a love for an unbalanced diet, and also in individuals who are often exposed to various traumatic situations. There are other reasons for this condition. The most susceptible to this pathology are women. Treatment of dyskinesia is aimed at eliminating the symptoms, and also - especially if the biliary tract has a slowed speed of movement or poor contractility - to prevent the formation of stones.
Little about anatomy and physiology
Bile is a brownish-yellow liquid necessary for digestion. Its main function is to separate the fats from food with each other, increasing their surface area. Then they are well processed by the lipase enzyme, 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 action of this substance, produced by the liver at ¾, and at ¼ - by the hepatic passages, the small intestine works normally: it takes in the processes of absorption of nutrients, as well as the division and death of its own cells.
In order for all the above processes to occur correctly, the bile must have a normal concentration. This is done by the gallbladder, which “gives” excess water to the vessels. If bile does not linger in the bladder, it enters the intestine in a diluted form and irritates it, causing diarrhea. In case of excessively long stay of bile in the bladder, it enters too concentrated, which is also not useful.
Bile is formed in the liver. Then, along the bile ducts, it must reach the gallbladder, and from it enter the duodenum. The movement of the secret is provided by the difference in pressure in the biliary tract, which occurs as a result of the work of circular muscles - sphincters. So, the sphincter that transmits bile into the gallbladder is closed - it drains from the liver. Then it opens, and the secret flows into the bubble, which was almost empty, and in which the pressure was less than in the duct. When fatty food enters the duodenum, the gallbladder, which is a muscle-equipped organ, contracts. In this case, the sphincter in the bladder neck opens, and the one that starts the entrance to the duodenum is closed, and it opens when the first one closes. Contractions of the biliary tract regulate the sympathetic nervous system and certain substances produced in the stomach and pancreas.
What is dyskinesia, its types
Having considered the anatomy, it is possible to explain in more detail the essence of pathology. So, dyskinesia is a condition:
- if the sphincters (one or more) located in the bile ducts do not relax in time;
- or, on the contrary, despite eating, 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 outflow of bile.
Depending on disorders of motor function and tone, dyskinesia can be:
- hypertensive: sphincter tone increased;
- hypotonic: the tone, on the contrary, is reduced;
- hypokinetic: the movement of the biliary tract is slow, bile is released slowly;
- hyperkinetic: the outflow of bile is active, its portions are ejected abruptly.
Usually, the increased tone is combined with enhanced motility, forming a hypertonic-hyperkinetic (or spastic) type of dyskinesia. The same happens in the opposite situation: with weak motility, the tone of the biliary tract is weakened - the hypotonic-hypokinetic (atonic) type. It happens and mixed type.
Spastic dyskinesia is characteristic for raising the tone of the parasympathetic division. The atonic type of the disease develops with the predominance of the influence of the sympathetic part of the autonomic nervous system.
Causes of disease
The reasons for the violation of the tone or movement of the bile ducts include:
- Congenital malformations of the biliary tract and gallbladder:
- doubling of the bile duct;
- congenital weakness of the bladder wall;
- intrahepatic gallbladder;
- inflection of the gallbladder;
- the gall bladder divided by a partition;
- valves in the bile duct;
- additional gallbladder;
- moving bubble;
- abnormally located bubble.
All these pathologies cause dyskinesia called "primary". Next, we list the diseases acquired (occurring during life), which can be the causes of secondary biliary dyskinesia.
- Food habits: long periods of fasting, the rejection of vegetable fats or, conversely, the use of large amounts of fatty, smoked and spicy foods.
- Constant stress or stressful situations.
- Transferred pancreatitis or other inflammatory pathology of the gastrointestinal tract or female organs.
- Chronic cholecystitis.
- Neurocirculatory dystonia, when the management of the normal sequence of biliary tract contractions is disturbed.
- Constant foci of infection in the body (caries, chronic tonsillitis).
- Diseases of the endocrine organs: obesity, diabetes mellitus, thyrotoxicosis.
- Food allergies.
- Transferred viral hepatitis.
- Worm diseases.
- Giardiasis, in which flagellated protozoa colonize the gallbladder.
- The period of menopause, when the regulation of biliary tract contractility is violated.
- Dysbacteriosis.
- Transferred intestinal infections.
Signs of disease
Symptoms of biliary dyskinesia differ depending on the type of pathology: is it hyperkinetic or hypokinetic.
The main difference between the main types of the disease are pain in dyskinesia:
| Pain characteristics | Hyperkinetic type | Hypotonic type |
| Localization | In the right hypochondrium | In hypochondrium right |
| Character | Acute, colicky | Dull, aching, non-intensive. Can be described as a heaviness or stretching area under the rib |
| Where to give | In the right shoulder blade and shoulder | Feels only under the edge |
| What provoked | Exercise, stress, after fatty foods | Strong emotions, inaccuracies in the diet |
| What other symptoms of pain are associated with? |
Nausea, vomiting, separation of large amounts of urine, constipation / diarrhea. On the background of the attack can be: irritability, sweating, lowering blood pressure, headaches |
Bitter mouth, nausea, loss of appetite, belching air, feeling of "bloated" stomach, constipation / diarrhea |
| What is eliminated | Preparations "No-shpa", "Buscopan" | Passes on its own |
| During the off-period | Nothing disturbs, only short-term pains can appear in the right hypochondrium, “under the spoon”, near the navel | The disease reversibly changes a person's personality: he becomes whiny, irritable, gets tired quickly, mood swings are noted. Nothing hurts outside the attack |
Both types of dyskinesia can cause other symptoms:
- irritability;
- increased sweating;
- recurrent headaches;
- unpleasant smell from the mouth;
- abdominal distention;
- loss of appetite;
- bitterness in the mouth;
- yellow bloom on the tongue;
- decreased libido in men;
- in some women, menstrual disorders.
An extreme manifestation of the hyperkinetic variant is biliary colic. It is manifested by sudden severe pain on the right under the rib, which is accompanied by a panic attack, numbness of the extremities.
The maximum manifestation of hypokinetic dyskinesia is cholestasis - the stagnation of bile in the biliary tract. The following symptoms indicate this:
- severe itching of the entire skin;
- yellowing of the skin and whites of the eyes;
- dark urine;
- feces become light yellow or even grayish in color.
Diagnostics
Symptoms alone are not enough to establish a diagnosis, because similar symptoms 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 eliminate it later.
Biliary dyskinesia is a condition in which the structure of these organs is not disturbed. That is, the diagnosis is made on the fact of violation of contractility or tone on the way from the liver to the duodenum. How to see it?
Ultrasound
Doing an ultrasound scan of the gallbladder with a choleretic breakfast. Initially, after a three-day diet, a “normal” abdominal ultrasound scan is performed. With its help, volumes, sizes, deformations, anomalies of the biliary tract are estimated, an inspection is made for gallstones. Next, a person takes products that should cause a discharge of bile duodenum (it can be: 100 grams of cream or sour cream, fatty yogurt, chocolate or a couple of bananas), and the doctor looks at the sequence and how the bile moves.
Duodenal intubation
By evaluating portions of the contents of the duodenum 12. To do this, a study called "duodenal intubation" is conducted: a person needs to swallow a thin probe, from which, upon reaching the duodenum, the contents will be obtained. The study is conducted on an empty stomach. First, a portion of the usual contents of the intestine is obtained from the probe, which consists of bile, fluid, the pancreas secreted there and the juice of the duodenum itself. Next, in the probe injected cholagogue drug - magnesium sulfate. The gallbladder shrinks and bile is contained in the gut. She is also taken for research. After a time bile flows here, which was previously in the intrahepatic bile ducts. She is also taken for analysis. To establish a diagnosis of dyskinesia, it is important that the time elapses from the moment of introduction of the choleretic to getting the second and then the third portion. The contents of the various lipids in the last two portions are also important.
Cholecystography
With the help of contrasting methods of radiography - cholecystography (extrahepatic bile ducts are examined) and cholangiography (the intrahepatic bile ducts are examined). In the first case, a person needs to take a radiopaque substance through the mouth, after which it will be seen in X-rays, how the contrast reaches the gallbladder, how it comes out of it, in what sequence the sphincters contract and relax. The second method involves an injection: a radiopaque substance is injected directly into the bile ducts, and after the radiologist observes its progress along the biliary tract.
ERCP
When performing ERCP (endoscopic retrograde cholangiopancreatography), a probe with an optical fiber is inserted into the duodenum, and through it, a contrast agent, retrograde (i.e., reverse normal current) is injected directly into the bile duct using X-rays.
Cholescintigraphy
Through radiological research - cholescintigraphy, in which a radioisotope drug is injected into the body, and in the light of special radiation, visualization takes place as it passes into the liver, secretes into the bile ducts, goes to the gallbladder, and then reaches the duodenum.
Magnetic resonance cholangiography
In complex cases, magnetic resonance cholangiography is shown - a non-invasive method of research, when a contrast agent is injected into the body, and its path is observed in a magnetic resonance tomograph. To carry out such a diagnosis, a person will need to be in the cell of the apparatus for about 40-50 minutes, observing immobility.
Blood tests for lipids and bilirubin with its fractions, feces analysis for dysbacteriosis, helminth eggs and coprogram - methods for determining the safety of the function of the biliary tract, as well as eliminate the possible cause of the disease - worms. The diagnosis of these tests is not made.
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: he is appointed by a gastroenterologist taking into account the type of disease, is an integral component of treatment;
- drug therapy: prescribed courses, aimed at stopping the attack, preventing their occurrence in the future, as well as for the prevention of complications.
Diet therapy
Nutrition for dyskinesias is the main “whale” of treatment. Only he, with strict observance of the rules, allows to avoid attacks and to prevent such surgical complications as acute cholecystitis and cholelithiasis.
Diet for dyskinesia contains general rules of nutrition, but there are moments that are radically different in the hypokinetic and hyperkinetic variants.
General rules
It is necessary to take food so that the gallbladder is emptied completely, but it does not cause pain attacks. For this:
- eat a little, 4-5 times a day;
- eat in small portions;
- observe 3-4 hour intervals between meals;
- have dinner in 2-3 hours, while not eating meat at night;
- use low-fat fermented milk products in the morning and evening;
- avoid cold or too hot meals;
- do not heat food on animals or trans fats: margarine, pork, goose or lamb.
| Exclude completely | Exclude only when exacerbated | Can eat |
|
|
|
Peculiarities of nutrition in hypomotor dyskinesia
In the diet should necessarily be products that stimulate biliary tract motility:
- fruits;
- vegetables (baked, stewed, boiled);
- butter and vegetable oil;
- sour cream;
- black bread;
- eggs;
- cream.
Features of power in hypermotor dyskinesia
In this form of the disease, it is necessary to exclude from the diet foods that stimulate bile formation and bile secretion: animal fats, black bread, fatty milk and dairy products, fresh vegetables, broths and soda.
Drug therapy
It also has general uses, and also builds on the type of dyskinesia.
Since dyskinesia is considered a disease, the main cause of which is the nervous regulation, which depends directly on the psyche. Therefore, before treating a violation of the motor activity of the biliary tract with choleretic drugs, you need to start with the restoration of the mental background. If the pathology arose against the background of a depressive state, a course of lung antidepressants is prescribed. If the violation of bile secretion was triggered by neuroses, expressed anxiety, it is advisable to start with tranquilizers or neuroleptics.
Similar appointments are made by a psychotherapist or psychiatrist.
In addition, treatment of the cause of dyskinesia is being carried out: antihelminthic therapy, treatment of allergies, elimination of hypovitaminosis, correction of dysbacteriosis.
Hypotonic-hypokinetic form
In this case, need cholagogue preparations that:
- will increase the tone of the gallbladder: magnesium sulfate, xylitol;
- improve biliary tract motility: for example, cholecystokinin, pancreoimin.
In addition to choleretic need and toning drugs: tincture of ginseng, extract of Eleutherococcus, tincture of lemongrass.
Hypertensive-hyperkinetic form
Here we need drugs that increase the formation of bile: it will become more, the bile ducts will work longer, and not quickly contract, causing an attack of pain. These are such medicines as okafenamid, flamin, nicodin.
Also, if the sphincters are overstressed, they are relaxed. This is done with antispasmodic drugs: no-shpa, buscopan.
In addition, we need such tools that normalize the balance of the parasympathetic and sympathetic systems: valerian tincture, potassium bromide, motherwort tincture.
Treatment by folk methods
Biliary dyskinesia is the pathology for which folk remedies are an excellent addition to drug therapy, and sometimes its only component (for example, in children).
If the tests show the presence of cholestasis (stagnation of bile) and at the same time the liver tissue has not suffered (ALT and AST levels are not elevated in the “liver function tests”), blind sensing is carried out: a solution of sorbitol, mineral water of high salinity or magnesium sulfate is drunk on an empty stomach. Then you need to lie on your right side and put under it. You need to lie down for 20-30 minutes.
Additional treatments
In the treatment of biliary dyskinesia are used:
- physiotherapy: diadynamic currents, electrophoresis, microwave;
- acupuncture;
- acupressure;
- leech therapy;
- treatment in sanatoria gastroenterological profile, in which therapy is carried out with mineral waters.
Complications of biliary dyskinesia
This functional impairment 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 or the stomach, or 12 duodenal ulcer. This is due to the fact that non-concentrated bile is often thrown into the stomach and duodenum in this disease, which leads to their inflammation;
- allergization of the body, which is manifested skin rash;
- weight loss, metabolic disorders, which occurs due to a violation of the absorption of the desired substances without proper treatment of bile.
Disease prevention and prognosis
To pathology has not developed, follow these rules:
- sleep at least 8 hours;
- lie down no later than 11 pm;
- alternate mental and physical labor;
- walk not fresh air;
- eat fully: eat more plant foods, cereals, boiled animal products, less - fried meat or fish;
- eliminate traumatic situations.
If the pathology has already developed, you should follow the recommendations of your gastroenterologist, 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 anomalous structure. Most often it is the inflection of the gallbladder or the presence of septa in it, less often - a doubling or anomalous location of the biliary tract.
In older children, the cause is an emotional load. These are quarrels between parents, family relocation, and a team in kindergarten and school, and a large study load.
Other causes of dyskinesia are:
- hypoxia or;
- frequent sinusitis, chronic tonsillitis;
- transferred hepatitis A, dysentery, salmonellosis;
- helminthic invasions: giardiasis, roundworm;
- allergic diseases;
- vegetative dystonia;
- neurosis;
- neuro-arthritic diathesis.
Dyskinesia in children is a more dangerous disease: without normal emulsification of fats, there will not be a suction of sufficient amounts of essential fatty acids and other substances, as well as fat-soluble vitamins A, D, E and K, each of which is important for a growing organism.
If the parents notice that the child is withdrawn, irritable, gets tired quickly or cries at the slightest provocation, you should contact the pediatric gastroenterologist for the exception of biliary dyskinesia. If at the moment it is not detected, it 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, you should pay special attention to the diet and routine of the child, to prevent its formation.
The fact that the pathology has developed, they say the following symptoms:
- alternation of constipation and diarrhea;
- periodically - especially after eating fatty or fried foods - the appearance of pain in the right hypochondrium;
- itching of the skin, which appeared for no apparent reason, not after an injection, not after a bite, the ingestion of a new food or a new drug.
Diagnosis of pathology is carried out according to the ultrasound scan with 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 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, when hypomotor dyskinesia are prescribed:
- drugs that stimulate the formation of bile: hololol, holosac, allohol, liobil;
- medications that increase the tone of the biliary tract: magnesium sulfate, sorbitol or xylitol;
- herbal therapy: decoctions of dandelion, wild rose, corn stigmas, mint;
- "Blind sensing" taking sorbitol or xylitol;
- mineral waters: Essentuki 17.
When hypermotor dyskinesia treatment is carried out:
- antispasmodic drugs: aminophylline, riabal;
- herbal therapy: decoctions of Hypericum, chamomile, dioecious nettle;
- low-mineralized waters: "Slavyanovskaya", "Smirnovskaya";
- electrophoresis with novocaine on the gallbladder.
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 Scherbak;
- sodium chloride baths;
- to eliminate spasm of the biliary tract: magnetotrapia, electrophoresis of antispasmodics (no-spy,) on the region of the biliary tract;
- with sedative purpose: coniferous baths, bromelektrospon;
- to improve the motor activity of the biliary tract: SMT therapy, magnesium sulfate electrophoresis.
The diet described above fully applies to children. 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 gastroenerologist, a neurologist and a pediatrician. They are scheduled twice a year for an ultrasound scan. Also once every 6 months courses of choleretic therapy are conducted. Once or twice a year, the child is referred for a sanatorium-resort treatment.
Biliary dyskinesia (DZHVP) - these are disorders of contractile, motor ability, changes in the tone of the gallbladder, bile ducts and their sphincters, leading to a violation of the outflow of bile. Dyskinesias are mainly of functional origin and very rarely organic.
At the heart of dyskinesia is a violation of the sequence of contraction and relaxation of the biliary tract and sphincter system. Depending on the etiology, primary and secondary signs of biliary dyskinesia are distinguished. The primary symptoms of dyskinesia: functional diseases of the biliary system, caused by a disorder of neurohumoral regulatory mechanisms.
Bile is produced in the liver from 0.6 to 1.5 liters per day. Regular production of bile is necessary for normal digestion. First, from the liver, bile enters the hepatic ducts, and from there, through the common bile duct and cystic duct into the gallbladder. The gallbladder, contracting, portions of the bile in the duodenum in the area Vaterova nipple. Portion flow of bile and pancreatic juice into the duodenum is regulated by the sphincter (muscle ring) of Oddi.
Biliary dyskinesia is more common in women than in men.
Types of biliary dyskinesia (DZHVP).
- Hypotonic (lower sphincter tone)
- Hypertensive (increased sphincter tone)
- Hypokinetic (hypomotor) - decrease in motor function of the biliary tract
- Hyperkinetic (hypermotor) - increased motor function of the biliary tract
The reasons.
The primary causes of biliary dyskinesia.
- Disorders of the neurohumoral regulatory mechanisms of the biliary tract,
- Long-term, systematic violation of the diet (irregular food intake, overeating, the habit of satisfying to eat before bedtime, abuse of spicy. Fatty foods),
- , stress,
- Sedentary lifestyle, congenital underdeveloped muscle mass.
Secondary causes of biliary dyskinesia.
- Previously suffered acute viral hepatitis,
- infections
- Hormonal disorders (menstrual disorders, endocrine gland insufficiency: hypothyroidism, estrogen deficiency, etc.),
- With gallstone disease, cholecystitis, gastritis, gastroduodenitis, peptic ulcer, enteritis,
- Allergic diseases,
- Chronic inflammation of the abdominal cavity (chronic inflammation of the ovaries, colitis, appendicitis, etc.),
- When the neck or body of the gall bladder is bent (organic causes).
Clinical signs.
Common symptoms.
Patients complain of weakness, fatigue, irritability, insomnia, headaches, tachycardia, sweating, chilliness, cold extremities.
Specific symptoms.
There are heaviness, pain in the right hypochondrium, right epigastric area, abdominal distension, rumbling, flatulence, belching with air, bitter taste in the mouth (especially in the morning), excessive salivation, nausea, vomiting, frequent constipation, less often diarrhea.
For hypermotor dyskinesia, paroxysmal acute pains of varying intensity in the right hypochondrium, often extending to the right shoulder blade and shoulder, bitter taste in the mouth, upset stool, are characteristic. Attacks can provoke spicy, fatty foods, physical stress, stress.
Dull, aching pain, heaviness in the right hypochondrium, loss of appetite are characteristic of hypomotor dyskinesia. Because of the stagnation of bile, nausea, belching, and constipation often appear. Basically, these symptoms appear 1 hour after a meal, but can appear regardless of the meal.
In women, the symptoms of dyskinesia increase in the premenstrual period and the first days of menstruation, often accompanied by nausea and vomiting. Biliary dyskinesia in men can also lead to sexual dysfunction.
The manifestation of certain symptoms, their severity depends on the type and degree of development of dyskinesia, as well as concomitant diseases, the patient's nervous system. The disease for years can manifest itself only by general fatigue, weakness, emotional lability, discomfort and heaviness in the right hypochondrium, without pain.
The disease manifests periods of exacerbation and remission. Attacks are often provoked by violations of the diet, stress, exercise, catarrhal diseases, etc.
Complications.
Prolonged dyskinesia of the gallbladder can lead to chronic cholecystitis, the formation of stones.
Diagnosis of gallbladder dyskinesia.
Anamnesis, examination of the patient.
In case of a pronounced violation of the outflow of bile, cholestasis, sclera jaundice, skin are possible, the tongue may be covered with white or yellowish bloom.
Palpation is painful in the gallbladder, especially on a deep breath, as well as in the epigastrium and choledochopancreatic chauffard Zone - Rive (choledochopancreatic triangle between the median line of the abdomen and the line drawn from the navel to the right upwards at an angle of 45 grams). The liver may be enlarged.
- Ultrasound - determine the volume of the gallbladder before and after (after 30 min) choleretic breakfast. Normally, after a choleretic breakfast, the volume of the gallbladder is reduced by 40%.
- Duodenal soundinge for the purpose of research and analysis of bile, obtained in portions
- X-ray methods: cholecystography and cholangiography.
TREATMENT OF BILKERVASCULAR DYSKINESIA.
First of all, it is important to follow a therapeutic diet, find out the cause of dyskinesia, treat the underlying disease.
Diet therapy.
Showing frequent, fractional meals in small portions up to 5-6 times a day, prescribe
The diet includes foods that promote the removal of fat from the liver (cod, dairy products, especially cottage cheese), vegetables, fruits, and vegetable oil.
In the diet limit eggs, meat, fish and mushroom broths, gravy and soups, animal fats, except for a small amount of butter.
Are excluded:
- spicy, fried dishes, carbonated, cold drinks, alcohol, legumes, onions, garlic. Such food can provoke a strong spasm of the biliary tract.
It is important to always eat only warm and fresh food. Products consumed boiled or baked. Meat and fish can be baked after pre-boiling. Salt food can be normal (with the exacerbation of salt is limited).
Dinner should be light, no later than 2-3 hours before bedtime. During exacerbation of diseases of the liver and gall bladder, accompanied by gastritis, dishes of diet No. 5 are prepared in a shabby form, raw vegetables and fruits, black bread are excluded from the diet; all dishes are steamed or boiled in water (not baked).
Wheat bran can be included in the diet, taken with dishes of 1 tablespoon per day.
In hyperkinetic form, limit products that stimulate bile secretion (fatty meat, fish, poultry, vegetable oil, spices, mushrooms, broths, smoked meats, carbonated foods, etc.). When hypokinetic form recommended vegetables, fruits, butter, cream, sour cream, eggs (in limited quantities).
Drug therapy.
Choleretic drugs: Choleretics and Cholekinetics,
Antispasmodics,
Enzyme preparations
Sedatives.
In hypotonic dyskinesia, choleretics are prescribed.
Choleretics -- drugs that stimulate bile formation, increasing bile secretion and the formation of bile acids. Choleretics come with a content of bile acids (true choleretics), synthetic, vegetable origin.
- Preparations containing bile acids : Cholenyme, Allohol, Holiver, LiobilDehydrocholic acid (Hologon).
- Drugs of synthetic origin: Nikodin, Osalmid, Cyclovalon
- Herbal preparations: Ziflan, Flamin (immortelle flowers), Hofitol (artichoke leaves), Tanatsehol (tansy), Berberine bisulfate, Febichol (turmeric root), Holosas (dog-rose fruit),
- Mineral water also have choleretic properties.
For the correction of the autonomic nervous system are assigned Tonic drugs
:
Extract of Eleutherococcus, 20-30 drops inside for half an hour before meals in the morning. Course - 25-30 days
Ginseng tincture, 15-25 drops inside three times a day for half an hour before meals. The course is 30-40 days.
For hypertensive dyskinesia, cholekinetics are prescribed.
Cholekinetics - choleretic drugs that stimulate the contractile function of the gallbladder and at the same time reduce the pressure and tone of the biliary tract, the sphincter of Oddi, have an antispasmodic effect.
- Gimekromon (Odeston), Cholecystokinin, Magnesium sulfate, Pituitrin, Sorbitol, Xylitol, Mannitol, Gepabene, Flacumin (leaves of skumpii), Konvaflavin (grass lily of the valley Far East).
Antispasmodics - drugs that relax the muscles of the biliary tract and sphincters, lowers blood pressure in the biliary tract, reduce pain.
- Platyfilin, Papaverin, No-shpa, Mebeverin (Duspatalin), used courses to prevent the development of seizures.
- Narcotic painkillers (for example, Promedol) used with a pronounced pain syndrome.
Sedatives: Bromides (sodium bromide and potassium bromide), motherwort tincture, Valerian.
Enzymes:
Festal, Digestal, Mezim-forte, Creon-10 and others.
During remission, without exacerbations.
- Can be carried out Bezbond Tubes according to Demyanov with weak choleretic or mineral water with medium mineralization.
Xylitol, Sorbitol, Magnesium Sulphate (Epsom salt).
Dissolve the drug in 100 ml of warm water and drink it within 10-15 minutes in small sips. During this, you can walk around or lie down for 30-40 minutes on the right side, putting a warm water bottle on your right side.
You can make tubages with heated mineral water, mineral water with honey. Tubes are repeated every 7-10 days. Course - up to 8-10 procedures.
When dyskinesia with a high tone, mineral waters of weak mineralization are recommended - "Slavyanovskaya", "Smirnovskaya", "Essentuki No. 4 and 20", "Narzan". Water should be drunk 1/2 cup 3 times a day 30 minutes before meals, without gas, heated.
When dyskinesia with reduced tone, mineral waters of strong mineralization are also assigned - “Essentuki N17”, “Jermuk”, “Arzni”, and others. It is also necessary to drink 1/2 cup 2-3 times a day 30-60 minutes before meals, without gas, in a heated form.
- Good help Massage and Physical Therapy.
- It is also recommended periodic Spa treatment.
- With the stagnation of bile, you can periodically assign Duodenal sensing for emptying the gallbladder.
- Physiotherapy: electrophoresis, amplipulse therapy, paraffin baths, laser therapy.
Prevention of biliary dyskinesia.
To prevent the manifestation of this unpleasant disease, it is necessary, without delay, to treat all disorders of a neurotic nature, to avoid serious stressful situations, regularly, at the same time, take food every day. More important is also a normal, complete sleep and rest.
To process food, especially fat, the body requires bile, which is produced in the liver. This fluid enters the intestine through special ducts through bladder contractions. Violation of the described process leads to the fact that biliary dyskinesia occurs - the symptoms of the disease do not appear immediately, so this pathology for a long time may go unnoticed.
Biliary dyskinesia - causes
In medical practice, the disease in question is considered psychosomatic. This means that the emotional state of a person mainly affects the progression of dyskinesia. Stress, inner experiences and problems provoke a failure in contractions of the gallbladder, which disrupts the outflow of fluid.
There are 2 forms of the disease - hypokinetic and hyperkinetic types. Depending on the type, biliary dyskinesia symptoms vary.
During the hypokinetic course of the disease, the gallbladder is not sufficiently reduced, therefore there is stagnation of fluid in the ducts. This manifests itself as dull, aching, but not too intense pain in the right hypochondrium, which is permanent. After ingestion of sweet or fatty foods, an unpleasant belching and nausea can occur.
Hyperkinetic form of dyskinesia indicates a too rapid contraction of the gallbladder, has more pronounced symptoms:
- short-term paroxysmal (not longer than 1 hour) pain syndrome, aggravated by intensive walking, running and other physical activities, unrest, stress;
- pain radiates to the right shoulder blade, lower back, arm.
Moreover, there are indirect signs of biliary dyskinesia - nausea, rapid heartbeat, menstrual disorders, irritability, loss of appetite.
Ultrasound signs of biliary dyskinesia
When diagnosing with an ultrasound machine, the state of the gallbladder and ducts is assessed, the presence or absence of stones in them and associated diseases is established.
To determine the disease study is done twice. First, the size of the gall bladder is measured on an empty stomach, then the patient eats some fatty foods, for example, 150–200 g of sour cream and an ultrasound diagnosis is repeated. Spasm of the body and the change in its volume allows us to estimate the nature of the disease and its course. If the gallbladder has not shrunk, or it has not happened enough, it is a hypokinetic form of dyskinesia. In the case of too large a decrease in the studied organ in size, it is possible to make a diagnosis of the hyperkinetic type of the disease.
Exacerbation of biliary dyskinesia - symptoms
Due to the fact that the disease described is often chronic, relapses and exacerbations of its course often occur. 
The attack of biliary dyskinesia is accompanied by such signs.
The normal functioning of the biliary tract (GIS) is regulated by the vegetative nervous system and certain neuropeptide hormones produced in the gastrointestinal tract. If their interaction is disturbed, functional disorders of the tone and motility of the gallbladder, its ducts and sphincters - dyskinesia occur.
According to various sources, more than a third of the world's population knows the symptoms of biliary dyskinesia. However, it is rather difficult to establish a more accurate incidence rate due to the difficulties of diagnosing this pathological condition.
A disease such as biliary dyskinesia in adults is more common than in children. This disease affects people mostly young and middle-aged, while men are ill almost ten times less often than women.
THE REASONS
Biliary dyskinesia may develop primarily as a result of the failure of the neurohumoral regulation of bile outflow under the influence of certain external factors. Secondary dyskinesias form against the background of existing pathologies of internal organs.
Dyskinesia GIT is classified according to the etiology, location and type of identified disorders of motor and tonic function.
According to genesis:
- Primary.
- Secondary.
According to the form:
- Impaired function of the gallbladder and common bile duct (hypo-or hyperkinetic type).
- Sphincter Oddi dysfunction (spasm).
Varian Dyskinesia Variants:
- Hypotonic.
- Hypertensive.
- Mixed - is relatively rare.
SYMPTOMS
Symptoms of dyskinesia of the GPV are very diverse and depend mainly on the mechanism of the development of the disease.
The main manifestations of glandular dyskinesia
- The main symptom of biliary dyskinesia is pain of a different nature and intensity in the right hypochondrium.
- In hypertensive type of the disease, acute, paroxysmal pains, which usually appear at night and are associated with food intake, are characteristic. Such pains often extend to the right shoulder, the scapula.
- Pains of the pulling, aching character develop with the hypotonic variant of the course of biliary dyskinesia. Their duration can be several hours, and sometimes - days. Characterized by a significant decrease in the intensity of pain after eating or choleretic drugs.
- Pain is often accompanied by nausea, belching, vomiting. Frequent constipation or, conversely, diarrhea.
- feeling of heaviness in the stomach.
- Almost always, such patients manifest fatigue, irritability, weakness, sweating, tachycardia, and other signs of autonomic dysfunction.
A characteristic feature of this pathological condition is the absence of an increase in body temperature and other signs of an inflammatory reaction.
When combined with glandular dyskinesia and associated gastrointestinal diseases, manifestations of the underlying pathology (gastritis, hepatitis, cholangitis, etc.) come to the fore, which makes diagnosis much more difficult.
DIAGNOSTICS
Before treating biliary dyskinesia, it is necessary to accurately determine the type of functional impairment in this pathology.
Given that in adults the symptoms and treatment of biliary tract dyskinesia, usually correlate with diseases of the gastrointestinal tract and other internal organs, it is necessary to make the most complete diagnosis in order to identify such comorbidities.
Principles of diagnosis of dyskinesia GVD:
- Anamnesis. All possible factors that lead to the formation of disturbances in the normal functioning of the biliary tract (stresses, lifestyle, past diseases, etc.) are identified.
- Specific complaints and symptoms of the disease.
- Clinical examination. Identified various manifestations of disorders of the autonomic nervous system. During palpation, pain is determined in the projection of the gallbladder. Positive "bubble" symptoms are often diagnosed (Kerr, Murphy, etc.).
- In laboratory tests, abnormalities are usually not detected.
- Ultrasound diagnosis of the gallbladder and biliary tract.
- Contrasting cholecystography.
- Endoscopic methods (fibroesophagogastroduodenoscopy, retrograde cholangiopancreatography).
- Fractional duodenal sounding.
- Radioisotope methods.
TREATMENT
Considering that the symptoms and treatment of dyskinesia of the GPV are directly dependent on the type of impairment of neurohumoral regulation and the nature of the possible comorbidities, it is necessary to formulate an individual approach to the treatment of each patient.
First of all, it is necessary to exclude the effect of predisposing factors (stress, hypodynamia, comorbidities, etc.). Optimization of lifestyle with a sufficient amount of night sleep and daily physical exertion is an important component of successful therapy of this pathology.
In the treatment of biliary dyskinesia, regardless of its type, diet plays a significant role. Sometimes only the observance of the correct diet can significantly improve the condition of the patient with this disease.
The long course of biliary dyskinesia often provokes the occurrence of organic diseases of the biliary system: cholelithiasis, cholangitis, hepatitis, etc.
Sometimes other structures of the gastrointestinal tract are involved in the pathological process, for example, the pancreas with the development of pancreatitis.
PREVENTION
What is biliary dyskinesia is well known to people with low physical activity and unhealthy diet. Therefore, the main focus of prevention is the normalization of lifestyle: regular exercise, good nutrition, elimination of stress factors, etc.
With early diagnosis of biliary dyskinesia, dieting and proper medical treatment, the prognosis for recovery is favorable.
In the case of complications or the presence of comorbidity, the prognosis worsens.
Found a bug? Select it and press Ctrl + Enter
