Biliary dyskinesia is a functional disease of the biliary system, which is based on a violation of the motility of the gallbladder and bile ducts, as well as the process of bile excretion. Pathology can develop according to hyperkinetic or hypokinetic type; manifested by pain in the right hypochondrium, nausea, dyspepsia, neurosis-like symptoms. Diagnostics includes ultrasound of the biliary system, cholecystography, cholangiography, duodenal probing, scintigraphy. Conservative treatment: diet, intake of choleretics and antispasmodics, spa therapy, phytotherapy, hirudotherapy, physiotherapy.
Meaning
Biliary dyskinesia is based on motor-tonic dysfunction of the gallbladder and bile duct sphincters. At the same time, emptying of the gallbladder and the flow of bile into the duodenum is disrupted. Dyskinesia is the most common functional disorder of the hepatobiliary system and is the leading cause of cholestasis, as well as the formation of gallstones and ducts. Pathology occurs predominantly in women. The most susceptible to the development of functional disorders of the biliary system are young people (from 20 to 40 years old) with an asthenic constitution and low nutrition.
Causes of biliary dyskinesia
Biliary dyskinesia in modern gastroenterology as a psychosomatic pathology developing against the background of traumatic situations. The anamnesis of patients with biliary dyskinesia often indicates family, professional and sexual difficulties. Often, biliary dyskinesia is a manifestation of general neurosis or diencephalic syndromes.
A significant role is assigned to the violation of the nervous regulation of the gallbladder, as well as changes in the level of gastrointestinal hormones and endocrine glands (with menopause, adrenal insufficiency, single cyst and polycystic ovaries, hypothyroidism, thyrotoxicosis, diabetes mellitus, obesity). In addition to psychogenic and endocrine disorders, alimentary causes are considered among the etiological factors: food allergy, irregular nutrition, the use of low-quality food in combination with a sedentary lifestyle.
Biliary dyskinesia is often combined with other diseases of the digestive system: chronic gastritis, gastroduodenitis, peptic ulcer, pancreatitis, enteritis, cholecystitis, cholangitis, cholelithiasis, postcholecystectomy syndrome. Often, biliary tract dysfunction is accompanied by chronic inflammatory processes in the abdominal cavity and pelvic organs – salpingoophoritis, chronic appendicitis, etc.
With the phenomena of dyskinesia, helminthic and parasitic invasions of the gastrointestinal tract (helminthiasis, giardiasis), dysbiosis, viral hepatitis B, intestinal infections (dysentery, salmonellosis) can occur. Allergic pathologies, such as obstructive bronchitis, atopic dermatitis, allergic rhinitis, may be predisposing factors to the development of the disease.
Classification
According to the etiological mechanism, primary and secondary biliary dyskinesia are distinguished. Primary dysfunction is caused by a violation of the neurohumoral regulation of the activity of the hepatobiliary system due to neuroses, vegetative-vascular dysfunction and dietary errors. Secondary dyskinesia develops by the mechanism of the viscero-visceral reflex against the background of other diseases of the digestive system.
By the nature of the violation of the motor-tonic function of the gallbladder and sphincters, dyskinesia is distinguished, proceeding according to the hypertonic-hyperkinetic and hypotonic-hypokinetic type. Hypertonic-hyperkinetic (spastic) dyskinesia develops with an increased tone of the parasympathetic autonomic nervous system; hypokinetic-hypotonic (atonic) – with a predominance of the tone of the sympathetic nervous system.
In both cases, as a result of the inconsistency of the gallbladder and the sphincters of the bile ducts, the flow of bile into the lumen of the duodenum is disrupted, which leads to a disorder of the digestive process. Depending on the type of dyskinesia (hyperkinetic or hypokinetic), various clinical manifestations develop.
Biliary dyskinesia symptoms
In the hypertonic-hyperkinetic variant of pathology, the leading symptom is acute colicky pain in the right hypochondrium, radiating into the right shoulder blade and shoulder. A painful attack usually develops after an error in diet, excessive physical exertion or psychoemotional stress. Pain syndrome can be accompanied by nausea, sometimes vomiting, constipation or diarrhea, polyuria. The pain goes away on its own or is easily stopped by antispasmodics.
Outside of seizures, the state of health is satisfactory, there are periodically occurring, short-term pain of a spastic nature in the right hypochondrium, epigastrium, and the umbilical region. Often hypertensive dyskinesia is accompanied by vasomotor (tachycardia, hypotension, cardialgia) and neurovegetative (irritability, sweating, sleep disorders, headache) manifestations. Palpation of the abdomen during a painful attack reveals a symptom of Kera – maximum soreness in the projection of the gallbladder. The phenomena of intoxication and signs of the inflammatory process are absent in blood tests.
Hypokinetic-hypotonic dyskinesia is characterized by constant, non-intense, dull, aching pain in the right hypochondrium, a feeling of heaviness and stretching in this area. Against the background of strong emotions and eating, dyspeptic disorders develop – bitterness in the mouth, belching of air, nausea, decreased appetite, flatulence, constipation or diarrhea. Palpation of the abdomen reveals moderate soreness in the projection of the gallbladder, a positive symptom of Ortner. Neurosis-like manifestations are noted: tearfulness, irritability, mood swings, increased fatigue.
Diagnostics
The diagnostic task is to verify the disease, determine the type of biliary dyskinesia, and exclude concomitant diseases that support dysfunction. Ultrasound of the gallbladder and biliary tract is aimed at determining the shape, size, deformity, congenital anomalies, concretions of the biliary system. To determine the type of dyskinesia, ultrasound is performed on an empty stomach and after taking a choleretic breakfast, which allows assessing the contractile function of the gallbladder.
An informative diagnostic method is fractional duodenal probing with the study of duodenal contents. By probing the duodenum 12, the tone, motility, reactivity, and state of the sphincter apparatus of the extrahepatic bile ducts are determined. With hyperkinetic biliary dyskinesia, the level of the lipoprotein complex and cholesterol in portion B decreases; with hypokinetic, it increases.
X-ray examination includes cholecystography and cholangiography. With their help, the architectonics and motility of the biliary tract are evaluated. In a comprehensive examination, Oddi sphincter manometry, cholescintigraphy, MRI of the liver and biliary tract can be used. It is advisable to study the coprogram, feces for dysbiosis and helminth eggs.
Biliary dyskinesia treatment
Treatment should be of a complex orientation, including normalization of the regime and nature of nutrition, rehabilitation of foci of infection, desensitizing, antiparasitic and anthelmintic therapy, elimination of intestinal dysbiosis and hypovitaminosis, elimination of symptoms of dysfunction. Diet therapy plays an important role: the exclusion of the intake of extractive products, refractory fats, confectionery, cold dishes, products that cause gas formation in the intestine.
Much attention is paid to the correction of the state of the autonomic nervous system. With a hypertonic-hyperkinetic type of dysfunction, sedatives (bromides, valerian, motherwort) are prescribed; with hypotonic-hypokinetic – tonic agents (extracts of leucea, eleutherococcus, tinctures of zhen-shen, lemongrass, aralia). In case of giardiasis or helminthic invasion, antiparasitic and anthelmintic therapy is carried out.
Restoration of the function of bile formation and bile excretion in different types of dyskinesia is also carried out differentially. With hyperkinesia, choleretics (dry bile, pancreatic extract of cattle, flamin, hydroxymethylnicotinamide, oxafenamide), slightly mineralized mineral waters in heated form, antispasmodics (drotaverine, papaverine, platyphylline), herbal preparations (decoctions of chamomile, peppermint, licorice root, dill fruits) are indicated.
From non-drug methods, courses of psychotherapy, acupuncture, hirudotherapy, ozokerite and paraffin applications, diathermy, inductothermy, microwave therapy, electrophoresis with antispasmodics, acupressure, collar area massage are recommended for patients with hypertonic-hyperkinetic biliary dyskinesia.
In the hypotonic variant, cholekinetics (xylitol, magnesium sulfate, sorbitol), highly mineralized water at room temperature, phytotherapy (decoctions of immortelle flowers, nettle leaves, rosehip fruits, oregano, St. John’s wort) are prescribed. With signs of intrahepatic cholestasis, “blind” probing (tubes) is indicated. To increase the overall tone, physical therapy, stimulating water treatments, toning massage are prescribed.
Of the methods of physiotherapy, diadinamotherapy, electrophoresis with magnesium sulfate on the liver area, low-intensity ultrasound, SMT therapy, low-frequency pulse currents are used. Patients with biliary dyskinesia are shown the supervision of a gastroenterologist and neurologist, annual wellness courses in balneological sanatoriums.
Prognosis and prevention
The course of pathology is chronic, however, with the observance of a diet, a healthy lifestyle, timely and proper treatment, the disease can proceed without exacerbations. Otherwise, complications from the hepetobiliary system – calculous cholecystitis and cholangitis may develop. Prevention of primary dyskinesia requires compliance with the principles of healthy nutrition, timely correction of disorders of the psycho-emotional sphere; prevention of secondary dyskinesia – elimination of the underlying disease.