Gallbladder dyskinesia - violation of the filling or reduction of the gallbladder of a functional nature, as a result of which the outflow of bile in the duodenum worsens. Manifested by biliary pain, dyspepsia, cholestasis, neurotic disorders. To make a diagnosis, liver tests and lipidograms, ultrasound of the liver and gallbladder, cholecystography, rhPG, hepatobiliary system scintigraphy, feces analysis of helminth eggs should be carried out. Treatment of dyskinesia of the gallbladder is only conservative: diet, adherence, taking medications to restore the function of the biliary tract, physiotherapy, sanatorium-resort treatment.
What is the difference between hypomotor and hypermotor dyskinesia?
Bile is a special fluid that is produced in the liver. Bile secretion improves the absorption of fat and activates the movement of food lump in the intestine. Before entering the intestine, bile travels a difficult path through the biliary tract.
When biliary tract dyskinesia problems with the removal of bile. Experts identify two main forms of the disease: hyperkinetic and hypomotor. To begin, let's talk about the hyperkinetic type. In this case, the tone of the body is increased, it is reduced too quickly and strongly. Along with this, the sphincters are not revealed enough.
This leads to the emergence of severe pain in the right hypochondrium. In some cases, a painful attack may be short-lived, and sometimes it lasts for an hour. To provoke a new attack can stress, anxiety. During critical days, the gallbladder tone is increased, so in women the exacerbation of the disease is associated with the menstrual cycle.
If the hypertensive form of dyskinesia is more often affected by young people and adolescents, the hypotonic type of the gallbladder is more common in older people. In this case, the pain is longer, but it is mild. The aching pain can last for days.
Now let's talk about the symptoms of the hyperkinetic form:
- pain in the form of colic. Intense pain in the right hypochondrium occurs after stress or nutritional errors. A pain flare usually lasts about half an hour and occurs several times a day. Soreness radiates to the back, arm, shoulder blade and even to the region of the heart, due to which the disease may be confused with an attack of angina,
- loss of appetite due to spasmodic and excessively reduced gallbladder,
- weight loss due to poor food breakdown and insufficient nutrient absorption,
- nausea and vomiting
- disorders of the autonomic nervous system: hypertension, sweating, weakness, tachycardia, headache.
When hypokinetic dyskinesia of the biliary tract (JVP) there is a more pronounced clinical picture. In addition to pain, nausea and vomiting, there is belching, bitter taste in the mouth, bloating, obesity, and more.
In both forms of JVP, the yellowness of the skin and mucous membranes is observed. This is due to a violation of the outflow of bile secretion. Along with this, the stool becomes discolored, and the urine becomes dark. Also, when the bile is thrown back, a white or yellowish bloom appears on the tongue.
What is gallbladder dyskinesia?
In a healthy body, the sphincters and smooth muscle walls of the biliary tract relax and tighten in concert, according to the body's need for bile.
Dyskinesia of the gallbladder is a violation of its evacuation capacity, as a result of which the activity of the gastrointestinal tract becomes uncoordinated. Due to a decrease in consistency in the work of the digestive system, bile is not released into the intestinal lumen in the quantity and at the time required by the body, which causes digestive upset.
The sphincters do not relax in time, excessively strong (hypermotor dyskinesia) or insufficiently contracted biliary tract walls are present. The development of the disease is etiologically caused by primary pathology, or secondary diseases.
Primary violation of evacuation capacity is connected:
- with anomalies of biliary tract development,
- with the pathology of the system of regulation of bile excretion due to neurotic and hormonal disorders.
Secondary disorders develop against the background of other diseases:
Hypomotor or hypotonic dyskinesia
Hypomotor dyskinesia of the gallbladder - what is it? This is a decrease in tension and contractile activity of the smooth muscle wall layer, leading to insufficient bile evacuation. Appears in people with activated stress factors of the sympathetic nervous system, under the influence of which the tension of the muscle cells of the digestive tract organs decreases.
Hyperkinetic type dyskinesia is characterized by an increase in the frequency of bile evacuation into the intestinal cavity, regardless of the needs of the organism. It is more common in boys, girls and adolescents.
And in fact, and in another case, the release of bile acids becomes ineffective for the adequate performance of its emulsifying functions. Hypomotor dyskinesia causes a decrease in the natural flow of bile and its excessive accumulation. Dysfunction of the biliary tract with a constant release of bile acids provokes, on the one hand, irritation of the walls of the intestine and stomach, and on the other, impaired dissolution of fats due to low bile concentrations.
Dyskinesia of the gallbladder causes symptoms of indigestion and pain syndrome, depending on the type of disturbance of the contractile activity of the biliary tract.
Hypomotor dyskinesia of the gallbladder is accompanied by a feeling of fullness and tenderness in the region of the liver. The following symptoms are also characteristic:
- feeling of bloating
- bitter taste
- delay in bowel movements,
- increase in body weight.
Pain is provoked by violations of the dietary regime, psycho-emotional overload, physical activity. Attacks of pain last about half an hour, radiating to the right shoulder, side, shoulder blade. Colic is often accompanied by gagging, but during a quiet period, these symptoms of dyskinesia of the gallbladder are usually absent and do not require treatment. In between attacks, there is a feeling of tension in the liver. There is a decrease in appetite and weight loss.
Dyskinesia of the gallbladder often accompanies the symptoms of vegetative-vascular disorders and neurotic conditions, so treatment should be comprehensive and include:
- correction of psycho-emotional state,
- the appointment of agents that stabilize the motor activity of the biliary tract.
Neurotic disorders are corrected by:
- creating comfortable conditions at work and in the family,
- regular day regimen
- psychotherapist's observations
- prescription psychostimulant or sedatives.
Dyskinesia and its treatment in the complex require adherence to a special diet with the exception of fatty and fried foods, smoked and canned foods, and bakery products.
Hypokinetic dyskinesia is corrected using foods enriched with magnesium and a large number of plant fibers.
- buckwheat porridge,
- cottage cheese,
- sunflower oil,
- dairy products with a high percentage of fat.
An important place in the treatment of biliary dyskinesia of the bladder bladder is occupied by special drugs that enhance the secretion of bile (choleretics) and contribute to its secretion (cholekinetics). Berberine sulfate, barberry leaves, decoction of tansy, xylitol or sorbitol are used as cholekinetics. Most of the choleretics used also have cholekinetic properties, that is, they facilitate the flow of bile.
To improve the process of digestion, choleretics are used, having in their composition bile acids:
In the treatment of biliary dyskinesia, herbal preparations are also used:
- peppermint infusion
- decoction of immortelle herb
- decoction of corn silk.
Recommended carrying out tubing or blind sensing - a special procedure that allows you to remove excess bile. How to treat gallbladder dyskinesia using tubage: after dieting for at least one day, drink one glass of warmed mineral water with a weak choleretic agent, put a heating pad in the liver area for several hours, observing bed rest. Toning physical exercises and physiotherapeutic procedures (faradization, galvanization) are useful.
Therapy of hypertensive dyskinesia includes a diet with restriction of fatty and irritating foods and drugs that increase the production of bile and relieve spasm of sphincters.
- myotropic antispasmodics (drotaverine, gimecromone, papaverine),
- agents that reduce the effect of the parasympathetic nervous system (gastrocepin),
- eglonil for patients with the neurotic mechanism of disease development,
All drugs are used for 3-4 weeks, and then change. A course of physiotherapy with a calming effect is recommended (electrophoresis with novocaine), medicinal waters with a low concentration of minerals, thermal procedures, an infusion of licorice root. Treatment of dyskinesia of the gallbladder in the absence of an effect is supplemented by the appointment of surgery to dissect the spastic sphincter.
Features of biliary dyskinesia in a child
Dyskinesia in children is caused by the immaturity and lability of the nervous system. In infants under the age of one year, impaired contractile activity of the biliary tract results from damage to the central nervous system during pregnancy and during labor.
Parents are able to notice some signs of this pathology on their own while closely observing the child.
Signs of biliary dyskinesia in a child:
- the imposition of white tongue
- yellow shade of the white of the eyes,
- cracks in the corners of the mouth,
- grayish or pale skin tone,
- disturbance of heartbeat.
Dyskinesia in children causes symptoms similar to those in adults. A strong pain syndrome in the hyperkinetic form of the disease is stopped by antispasmodics at age appropriate dosages. Choleretics are shown (kholon, flamin, tsikvalon, oxafenamide), herbal preparations for a course of 2-3 weeks, and then replace the drugs with others. Good physical therapy, physiotherapy procedures (paraffin baths, magnetic therapy, electrophoresis, etc.)
In identifying hypomotor dyskinesia of the gallbladder in a child, measures are taken aimed at general recovery:
- water treatments.
Showing drugs with tonic effect:
- wild pepper extract,
- tincture of aralia,
- magnesium preparations.
The basic course of therapy includes the appointment of sugar substitutes with choleretic action and vegetable oils. Thermal procedures are not shown, as they reduce the tone of the sphincters. Recommended medicinal water with a high content of minerals.
In all cases of dyskinesia in children, the improvement of the psychological climate in the family, the establishment of a regimen, a healthy diet and sufficient physical activity are shown.
Prognosis and possible complications
- The accumulation of bile in the hypokinetic form of the disease provokes the appearance of cholecystitis and contributes to the formation of stones.
- The uncontrolled release of bile into the intestinal lumen in the hyperkinetic type of gallbladder dyskinesia irritates its walls and causes the development of inflammation of the mucous membranes of the intestine and stomach, the appearance of ulcerative lesions.
- Violation of the transport of fat and fat-soluble vitamins contributes to the occurrence of beriberi and anemia, weight loss.
The disease is prolonged with exacerbations, but the prognosis in the case of adequate treatment is favorable.
Nature of the problem
Gallbladder dyskinesia is a disorder of the normal activity of a hollow organ located in the immediate vicinity of the liver.
Its size can vary depending on age and gender, instead of the standard form in the form of a pear, the appearance of the gallbladder can be elongated, doubled.
Certain factors (hereditary pathologies, abnormal development or the impact of negative causes of various etiologies can lead to the appearance of jumpers and kinks in it.
When bile stasis occurs in the body, the symptoms of the violation are also seen in an increase in its volume.
Such variability makes it difficult to diagnose by external signs, although it is extremely necessary.
After all, the hollow organ communicates with the liver via the cystic duct, which forms a single whole in the aggregate by the hepatic duct, and opens into the 12-pertum intestine.
The duties of the hollow organ and the hepatobiliary system involved in the production of bile include not only its production within the limits of the permissible rate.
- accumulates caustic fluid produced by hepatocytes in significant quantities, getting it from the intrahepatic ducts,
- using a specifically arranged mucous membrane, the state of the bile substrate is brought to the desired concentration (epithelial cells remove excess fluid, chlorine and sodium ions),
- produces storage of the resulting bile,
- as required supplies it to the intestinal lumen for natural needs.
Biliary dyskinesia can occur from disorders and diseases of the gallbladder.
Gallbladder dysfunction - from a violation of the conductivity of the intrahepatic and bile ducts.
This can be caused by an incorrect composition of bile secretion, leading to the formation of calculi, a disorder of any of the factors involved in the regulation of a complex process.
In any form of dyskinesia, as in the state of relative norm, the following are responsible for the implementation of the regular activities of the hepatobiliary system:
- parasympathetic and sympathetic divisions of the autonomic nervous system,
- vagus (or the vagus nerve that provides innervation to the gallbladder, and not only him,
- hormones produced by the intestinal system that are responsible for the digestive process (the most famous are glucagon and cholecystokinin),
- specific molecules of protein compounds, known as neuropeptides, the purpose of which is to prevent the contraction of GI (they, in fact, perform the functions of hormones).
The appearance of gallbladder dyskinesia can be caused by any failure of hormonal production, a negative state of each of the organs of the hepatobiliary system, the presence of biliary dyskinesia, a decrease in their contractile activity or the same capacity of a hollow organ, or one of its compartments,pathological changes of the epithelial layer of the wall, inevitably leading to a violation of the concentration of bile.
Tracing the mechanism of launching a negative scenario is sometimes simply impossible, because there can be many causes of gall dyskinesia.
Causes of gallbladder dyskinesia
Dyskinesia of the gallbladder, depending on the period of occurrence of the disease, can be primary and secondary. Primary dyskinesias are usually associated with congenital malformations of the gallbladder and gallstones: doubling or narrowing of the bladder and ducts, scars and constriction. The cause of primary dyskinesia may be a congenital impairment of the motor activity of the smooth muscle cells of this organ, reducing their sensitivity to hormonal mediators.
Secondary dyskinesia of the gallbladder is formed against the background of another pathology: hormonal (contraceptive use, somatostatin, prostaglandins), somatic (cirrhosis of the liver, myasthenia, celiac disease, amyloidosis, diabetes), biliary tract pathology (GCB, cholecystitis, strictures, discoordination, lustralis, diabetes). sphincter of oddi).
In the pathogenesis of dyskinesia of the gallbladder, most often lies an increase in pressure in the GP with a decrease in the contractility of the gallbladder walls. In this situation, its emptying does not occur, bile does not enter the duodenum, which causes digestive disorders. Less commonly, dyskinesia is caused by the inability of the gallbladder to develop enough pressure to evacuate bile into the duodenum. In patients with dyskinesia, pain in the right hypochondrium occurs with much less stretching of the bladder walls than in healthy people. This is due to increased sensitivity to pain.
Symptoms of gallbladder dyskinesia
The main manifestations of dyskinesia of the gallbladder are recurring bouts of pain in the right hypochondrium for at least three months for six months. In the hypokinetic variant, the pain is constant, dull, oppressive, practically unrelated to food intake. The pain increases with changing the position of the body, as this increases the pressure in the abdominal cavity, worsens the flow of bile.
In the hyperkinetic form of the disease, the pain is acute, occurs after errors in the diet and psycho-emotional overstrain, radiating to the right shoulder, lower back. Often pain occurs at night, accompanied by nausea and vomiting. In addition, biliary colic may occur: an attack of acute sudden pain in the right hypochondrium, significantly worsening the patient's condition and requiring medical assistance.
Also characterized by cholestatic syndrome associated with a violation of the flow of bile into the duodenum and its stagnation in the biliary tract. It develops in less than half of patients with dyskinesia of the gallbladder, is manifested by icteric staining of the skin and mucous membranes, discoloration of feces and the appearance of a saturated urine color, itching of the skin, an increase in the size of the liver.
Violation of the dynamics of bile leads to dyspeptic symptoms: nausea and vomiting, abdominal distension, feeling of bitterness, bad breath. Almost always, dyskinesia of the gallbladder is accompanied by disorders of the nervous system (irritability, increased fatigue, increased sweating, headaches), a disorder of sexual function.
Diagnosis of gallbladder dyskinesia
Like many other functional disorders of the digestive system, gallbladder dyskinesia is a diagnosis of exclusion. A consultation with a gastroenterologist allows you to identify the criteria for diagnosing this disease: the presence of the gallbladder, the absence of organic diseases of the hepatobiliary system, normal levels of direct bilirubin, transaminases and blood lipase (when performing liver function tests and lipidograms).
Ultrasound of the gallbladder is the most informative method for the diagnosis of dyskinesia. Ultrasound helps to visualize the shape and size of the gallbladder, the nature of its contents, the presence or absence of inclusions, kinks and buckles. Detection of gallbladder deformity increases the likelihood of diagnosing its dyskinesia. Also during ultrasound examination, the contractility of the bladder walls is evaluated.
Ultrasonic cholecystography is carried out within two hours after taking a special choleretic breakfast, containing a large amount of fat — sour cream, egg yolks. During this study, the rate and extent of the gallbladder's initial shape after its contraction is evaluated. Normally, the bladder should shrink by one third within half an hour after stimulation.
Dynamic scintigraphy of the hepatobiliary system is of great importance for the differentiation of organic and functional changes. This research method allows to assess the excretory function of the liver, the accumulative activity of the gallbladder, to determine the degree of patency of the biliary tract and sphincters. During scintigraphy, samples can be taken with cholecystokinin, metoclopramide, nitroglycerin. When the bladder is emptied by less than 40%, the diagnosis of gallbladder dysfunction is not difficult. If emptying occurs normally, a further diagnostic search is carried out. It is imperative that an RCP is performed, if no stones and an inflammatory process in the biliary tract are detected during the study, an Oddi's sphincter manometry is prescribed to rule out stenosis.
Fractional duodenal intubation (chromatic) makes it possible to evaluate not only the functional ability of the gallbladder, but also the quality and quantity of bile excreted, its bacterial contamination during inflammation. Esophagogastroduodenoscopy also makes it possible to identify associated organic diseases of the digestive tract, to trace the passage of bile into the duodenum.
For differential diagnosis may require magnetic resonance imaging of the liver and biliary tract, CT scan of the biliary tract, analysis of feces on helminth eggs.
Treatment of gallbladder dyskinesia
Patients with gallbladder dyskinesia can receive the necessary medical care in the gastroenterology department. Mainstreaming in the treatment of dyskinesia is diet. In the case of the hyperkinetic variant, food intake that causes contraction of the gallbladder (vegetable and animal fats, broths) is limited. When hypotension of the gallbladder, these products, on the contrary, include in the diet. Meals should be frequent, fractional, one should not eat fried, smoked, extractive dishes. It is recommended to give up alcohol and smoking, to reduce weight to normal, to avoid excessive physical exertion.
Drug treatment also depends on the type of gallbladder dyskinesia. When hypomotor form prescribed prokinetics (domperidone), choleretics and cholekinetics. In hypermotor dyskinesia, antispasmodics, nonsteroidal anti-inflammatory drugs, tricyclic antidepressants are used. With a long course of the disease, it may be necessary to take gallstones. Surgical treatment of gallbladder dyskinesia is ineffective.
The prognosis for dyskinesia of the gallbladder is favorable, the disease does not affect the life expectancy of the patient. Prevention can be primary and secondary. Primary prevention is to observe a healthy lifestyle, proper nutrition, elimination of stress. Secondary prevention is the early detection and treatment of a disease.
DZHVP happens primary and secondary. It is worth noting that pathology rarely occurs as a separate disease.The primary process can be caused by the following reasons: nervous overstrain (no structural changes in the organ are observed), eating disorders: overeating, fasting, quick snacks, abusing fatty, fried, lack of exercise, muscle weakness, underweight, allergy, bronchial asthma and more.
The secondary process occurs against the background of existing diseases:
- diseases of the digestive tract: gastritis, duodenitis, colitis, peptic ulcer,
- chronic diseases of the abdominal cavity and pelvic organs: adnexitis, pyelonephritis, ovarian cyst,
- violation of the liver, gallbladder and biliary tract,
- bacterial inflammation of the gastrointestinal tract,
- congenital anomalies of the gallbladder,
- endocrine disorders.
The disease is characterized by the appearance of the following symptoms:
- constant attack of pain, which has a dull, arching, aching character. Soreness appears in the right hypochondrium area, while there is no clear location. Usually pain increases after eating. This is due to the stagnation of bile secretion and stretching the bottom of the gallbladder,
- belching that occurs after a meal or in between meals. This is due to the ingestion of air during meals,
- nausea, which may result in vomiting. In vomit impurities appear bile. Usually, nausea occurs after an error in nutrition,
- bitterness in the mouth, which increases after eating, in the morning and after exercise. This is due to the reflux of bile secretions from the duodenum into the oral cavity,
- bloating. A feeling of bursting may be accompanied by pain. Usually, after the discharge of gases, the pain flash subsides. Flatulence occurs due to rotting and fermentation,
- constipation. Arises due to slower movement of the food bolus through the intestines. Fecal masses become dense and decrease in volume. Also, stool retention is associated with a lack of bile acids,
- obesity. Occurs due to insufficient breakdown of fats. They begin to debug on the subcutaneous fatty tissue and internal organs,
- autonomic disorders: bradycardia, hypotension, dizziness, sweating. It is believed that neurological disorders occur due to the instability of the cardiovascular system to stressful situations. Due to psycho-emotional experiences, less oxygen is supplied to the internal organs.
Dyskinesia in children
The immaturity and lability of the nervous system can cause the development of JVP in childhood. In children under one year, the disease is often the result of damage to the central nervous system during pregnancy or childbirth.
If we talk about older children, then dyskinesias can be caused by stress, emotional overload, unhealthy diet, physical inactivity, food allergies. JVP in children is manifested in the following symptoms:
- white on the tongue
- sclera yellowness,
- the appearance of cracks in the corners of the mouth,
- skin becomes white or even grayish,
- disturbance of heartbeat.
The hypomotor form is treated with the help of massage, water procedures and physiotherapy exercises. Toning medicines give a good effect: Ginseng, Wild Pepper Extract, Aralia Tincture, and magnesium preparations.
Diagnosis and treatment
To make an accurate diagnosis, a gastroenterologist will need the results of the following studies: general and biochemical blood tests, ultrasound diagnosis of the liver and gall bladder, duodenal intubation, drug tests, cholecystography.
The therapeutic process of dyskinesia includes the use of drugs that stabilize the motor activity of the biliary tract. In addition, for a complete cure, you must follow a diet and normalize the psycho-emotional state.
Neurotic disorders can be corrected by creating comfortable conditions at home and at work, observing the correct regimen of the day, observing the psychotherapist and taking sedatives or psychostimulants.
In the hypokinetic form of dyskinesia, it is recommended to use foods rich in magnesium and vegetable fibers:
- cottage cheese,
- vegetable oil,
- fatty dairy products.
Also, do not forget about products that have choleretic effect: sour cream, cream, vegetables, black bread, vegetable and butter, boiled egg.
During an exacerbation of the disease it is better to exclude such products: fatty meat and fish, smoked meats, fatty, fried, alcoholic beverages, confectionery, canned foods, pickles, whole milk, legumes.
It is better to use products in the boiled, baked look. It is also useful to cook food for a couple. Yesterday's bread, dairy products, lean meat and fish, cereals, vegetables, vegetable soups are allowed.
To enhance the production and separation of bile secretions prescribe choleretic drugs, which include bile. We distinguish effective choleretics, appointed by JVP:
- Holenzyme. Tablets stimulate the production of bile, improve the functioning of the gallbladder and generally normalizes the processes of digestion,
- Allohol. The drug eliminates the processes of decay and fermentation. Tablets promote bile secretion and improve the mobility of the gallbladder,
- Holiver. In addition to the fact that the tool normalizes bile secretion, it has a hepatoprotective effect and contributes to the elimination of harmful cholesterol.
Auxiliary role in the treatment of dyskinesia have drugs of plant origin: peppermint infusion, decoction of immortelle, decoction of corn silk. A blind sensing technique is used to clean the liver, gallbladder and ducts. It helps to improve the contractile function of the gallbladder, thereby releasing bile and pathogens.
For the procedure used vegetable oil, choleretic herbs, honey, sorbitol, yolks, magnesia and more. After a person has taken the drug, he should lie on his right side and apply a heating pad on the liver area. In this position should lie, not turning over, for an hour.
As an adjunct, traditional medicine may be prescribed. In order to increase the flow of bile try these tips:
- drinking green tea
- Take a steam bath in the Russian bath once a week using a broom,
- Take a teaspoon of olive oil before eating,
- use of infusion of birch leaves,
- daily take a mixture of tomato juice and pickled sauerkraut.
The disease threatens the development of cholecystitis, pancreatitis, gastritis, and also contributes to the formation of stones. As a result of the disruption of normal fat splitting, anemia and vitamin deficiency are possible. There may also be uncontrolled weight loss. With timely treatment, the prognosis is favorable. The disease is characterized by a long course with exacerbations.
Preventive measures will help to prevent the development of the disease, if DGVP is already present, they will help to delay the onset of relapse or even eliminate it completely. Prevention is, first of all, respect for the right lifestyle, including diet. Diet - this is not a temporary phenomenon, but the decision every day to eat the right foods.
Moderate exercise is a good way to prevent stagnation. Also do not forget about a full sleep and the observance of the correct mode of work and rest. Timely conduct preventive examinations.
So, hypokinetic dyskinesia of the gallbladder can cause many problems. Treatment of the disease should not be postponed until later. Prompt measures taken to facilitate the speedy recovery. If you follow simple preventive measures, you can prevent the occurrence of the disease or at least forget about the problem for a long time.
Diagnostics, prescription of diet and drugs are handled by a qualified specialist. In extreme cases, when conservative methods do not give any results, the specialist may decide to conduct surgery.
Anatomy and physiology of the gallbladder
It is a hollow pear-shaped organ. It is located approximately in the center of the right costal arch. Size up to 14 cm, depending on age, capacity 30-70 ml. Distinguish the bottom, neck, body. The wall includes muscle, mucous membrane of the epithelium. Glandular cells, connective sheath. Muscles include smooth fibers that support the shape of the body. The neck connects with the cystic duct, ends with the sphincter, which prevents bile from entering the intestine unnecessarily. On the other hand, gall binds to the liver. The organ is placed in such a way that the wide end extends somewhat beyond the edge of the liver.
The main function of the body - the accumulation of bile, which produces the liver. Substance enters through ducts. Secretion of bile occurs after food in the stomach. Components are involved in the breakdown of food, ensure the normal functioning of the digestive tract. Absorbed by the walls of the small intestine, excreted in the urine.
Bile movement begins when the bladder muscles contract. Internal pressure is created, then the sphincter relaxes, bile enters the duodenum. Bile breaks down fats, promotes the absorption of vitamins, micro-, macroelements, stimulates the secretion of gastric juice.
The concept of dyskinesia
In a healthy body sphincter, muscles work in concert. When food enters the stomach, the bile enters the small intestine through the bile ducts. Violation of the muscles, the difficulty of movement of bile along the ducts is called dyskinesia. The substance is released into the duodenum in insufficient quantities, disturbed digestion.
Dyskinesia is observed with excessive compression of the muscles, as well as insufficient. Primary disorders are associated with an abnormal structure of the body, neurotic, hormonal disorders. Often the cause of the malfunction of the biliary tract are autoimmune diseases. Secondary dyskinesia develops due to improper lifestyle, diet, impaired regimen, metabolic disorders, chronic diseases.
Therapy is carried out with medicines, folk remedies, surgically. It is imperative to adhere to a healthy diet, maintain a mobile lifestyle, but not overwork physically, emotionally.
Hypomotor or hypotonic dyskinesia
Depending on the activity of the bladder muscles, there are several types of dyskinesia. Hypomotor or hypotonic develops with insufficient muscle activity, when the gallstone is not able to throw into the intestine the necessary amount of bile. Appears with the pathological work of the central nervous system. Contribute to the development of pathology frequent stress, nervous exhaustion, depression, shock. Often appears in women after 45 years as a result of age-related changes. One of the characteristic symptoms is a bitter aftertaste.
The outflow is disturbed, bile accumulates in the bladder, leading to an increase in organ. There is a dull pain under the right edge, relief comes after eating. Pressing on the liver does not cause pain, in general, the state is assessed as normal, there is a slight discomfort. During therapy, the main action is aimed at stimulating the flow of bile.To do this, use homeopathic medicines, folk remedies, some products. Medication is prescribed only in severe forms.
Differentiation of concepts
Pathology, called gallbladder dyskinesia, does not develop separately from the biliary tract system (ducts) connected to it, therefore the term is considered synonymous, but not quite complete.
The diagnosis of dyskinesia is set in the case of a complex violation of the functionality of this part of the hepatobiliary system, therefore, although it remains in medical circulation to refer to dyskinesia of the gallbladder, the term dyskinesia of the biliary ducts and the gall bladder is considered more correct.
In foreign medicine, all this condition is called gallbladder dysfunction. Such a disorder can be safely called dyskinesia of the biliary tract, bladder, bile duct and dysfunction, this is of fundamental importance only for those who consider synonymic correspondence in the compilation of medical terms dictionaries.
Types and forms of JP
Dysfunctions of the gallbladder are distinguished by types and forms. Forms are differentiated into primary and secondary.
Secondary - the result of the action of pathologies already present in the body, the primary develops under the influence of functional changes that have already developed, but are not amenable to hardware diagnostics.
The process of pathology progression occurs gradually, failures increase, and at a certain stage a negative state arises, with all relying symptoms.
There are three types that gall dyskinesia acquires in clinical practice:
- hypomotor dyskinesia of the gallbladder, characteristic of patients of a certain age (as is usually after 40), in which an insufficient amount of bile is secreted,
- hypertensive dyskinesia, when the production of bile is carried out in an excess amount, and it does not fit even into the distended volume of the bladder (in this case, there are frequent emissions of excess secretion into the surrounding intraintestinal space,
- hyper- and hypotonic dyskinesia in the combined course, noted, most often in adolescent and early reproductive women.
The development of the hyperkinetic form of dyskinesia is noted mainly in the female half of humanity.
This correlates with a more pronounced hormonal activity in the body. It is associated with natural reproductive function, the presence of the menstrual cycle, ovulation and pregnancy, during which hormonal changes.
Causes of the primary form of the disease
The primary form of biliary dyskinesia is caused by negative factors not associated with concomitant acute or chronic diseases of the internal organs.
To increase or decrease the contractile activity of the biliary tract are the reasons arising from objective effects on any of the systems responsible for the normal activity of the hollow organ or bile duct:
- Pathological activity of the autonomic nervous system that is not associated with its negative changes (occurs when stress situations develop, nerve conduction disturbances caused by the psycho-emotional state, an imbalance between different nervous system sections, or neuronal conduction. This form of gall bladder disturbance, ducts affects relaxation sphincters, occurring under the action of nerve impulses or contractions of the gallbladder.
- Dyskinesia of the biliary tract may result in improper nutrition. The lack of a specific regime, a rare meal, but in large quantities, the use of products that are harmful or unusual for the food mentality in combination with alcohol - this is constantly evidenced by gastroenterology.Diagnosis of biliary dysfunction can be observed due to violations, which resulted in the developed bile is not spent on digestion, but accumulates in the biliary tract. In this type of dyskinesia, over time, there is a parallel existence of gastrointestinal pathologies, which have evolved due to violations of the regime or method of eating foods (insufficiently unstained, eaten on the move, overnight, etc.).
- 3. The disruption of the contractile ability of the gallbladder can be observed due to muscular weakness caused by body type, lack of physical activity, constant diets, or the presence of allergies in the body that disrupt nerve connections and the form of dyskinesia associated with constant irritation of nerve fibers.
Drug treatment for primary form is not required in each case. The activity of the biliary tract, sphincter, smooth muscle of the bladder can be adjusted using simple but effective measures: diet, stress avoidance, good nutrition helps a lot when treating this form of dyskinesia.
If the primary form has arisen on the basis of hereditary or congenital malformations, surgical intervention is proposed to remove or correct the pathologies of prenatal development.
Reasons for the emergence and development of the secondary form
Secondary biliary dyskinesia refers to any form that is observed against the background of the pathologies already present in the body.
They led not only in violation of the functionality, but also to changes in the internal organs. These can be pathological processes in the area of the bladder, ducts and sphincters, diseases of the organs that are in contact with them in a single interacting system.
Various diseases of the digestive organs can lead to the occurrence of hypermotor dyskinesia, as well as to the insufficiency of the secretion of bile secretions:
- a form of dyskinesia caused by direct diseases of the biliary system (cholangitis, cholecystitis, cholelithiasis),
- pathologies of the pancreas (pancreatitis, neoplasms),
- diseases of the stomach and intestines (gastritis, ulcers, polyps and tumors, inflammatory and infectious processes),
- endocrine disorders (thyroiditis, lack of specific horns, diabetes mellitus of any type),
- liver pathologies (cirrhosis, hepatitis, hepatosis, functional insufficiency, echinococcosis, etc.),
- increased vagal nerve tone and other diseases of the nervous system (neuritis).
Constant development of untreated systemic disease leads to disruption of the formed relationships or disabling the rest of the system.
Secondary dyskinesias often become a symptom that determines the development of a significant lesion in pancreatitis and liver disease.
For the progression of the secondary form is equally likely for the flow of the hypotonic type, the presence of hyperkinetic dyskinesia of the gallbladder and combined.
All of these are secondary forms of gallbladder activity disorder, the treatment of which depends on the successful removal of the provoking factor.
Hypomotor dyskinesia is diagnosed more often than the other two functional disorders.
Hypomotor dyskinesia of the gallbladder differs from the hypermotor type in a violation of motility in the direction of decreasing the usual activity.
Hypokinetic hypomotor is characteristic of elderly people, with the presence of a significant decrease in the production of bile secretion and the lack of contractility of the gallbladder walls.
The hypokinetic form of dyskinesia is caused by age-related disorders or hormonal disruptions.
The main symptoms of hypomotor dyskinesia - lack of appetite, upset stool, pain in the right side, but rarely - severe, most often - dull and aching.
When hypomotor type of biliary dyskinesia signs of the presence may be flatulence and belching, gagging, characteristic taste in the mouth.
It causes symptoms and signs characteristic of many diseases of the digestive system.
The process of identifying dyskinesia, manifested in the hypermotor type of biliary dyskinesia is possible only with a comprehensive examination.
It is noted that hypomotor dyskinesia of the gallbladder is often manifested in middle-aged women who are prone to neurosis or hormonal imbalance (as natural, tai and caused by insufficient thyroid activity).
Excessive secretion of bile
In the hyperkinetic form of biliary dyskinesia, the reverse occurs. Bile secretion is produced in excess of the existing need.
The diagnosis of hypermotor type biliary dyskinesia is based on strengthening the ability to reduce the walls of the gallbladder, but, against the background of enhanced, spastic contractions, the opening of the sphincter is not fully accomplished.
This causes pain attacks of an acute nature, accompanied by intense pain on the right.
Sometimes they are confused with signs of liver disease. Dyskinesia attacks hypermotor variety can give short and long (sometimes up to an hour).
In women, such a painful manifestation may be associated with a violation of the menstrual cycle or even its simple passage.
The disease often occurs in adolescents with unstable hormone levels, in children is the development of right hypochondrium syndrome associated with persistent colic in the right side.
Childhood forms of the disease are not always associated with the pathologies of the digestive organs, often this may be due to intrauterine developmental disorders or difficult births.
Hypomotor dyskinesia of the gallbladder is rarely encountered and is considered a characteristic sign of age-related changes.
General principles of treatment of the disorder
Hypotonic dyskinesia, a form with hyperactive motility and combined, combining the symptoms of both, can occur in an individual clinical picture for which symptomatic tactics are selected based on the results of a diagnostic study.
The main thing in the treatment of any of them, be it hypotonic dyskinesia, hypertensive or combining the symptoms of both combined - a complex method of treatment:
- healthy lifestyle, with proper and clear nutrition, fractional and frequent, adjusted diet, recommended for this type of disease:
- drug treatment of pathologies existing in the body and of the hepatobiliary system, especially
- physiotherapy, spa or spa treatment, reception of mineral waters.
Dyskinesia of the gallbladder, not received timely treatment leads to the emergence of more dangerous conditions in which such principles of therapy can not do.
A timely visit to the doctor at the first signs of the disease will help avoid surgeries, massive drug therapy and even death, which can occur in acute cholecystitis or gallstone disease.
Among all diseases of the gallbladder and bile ducts, dyskinesia is 12, 5%.
About 10 times more often women than men suffer from this disease. What is associated with the features of hormonal and metabolic processes of the female body (for example, changes during pregnancy, taking oral contraceptives). Especially prone to illness women of young age asthenic physique.
Among children, teenagers are most often ill.
In 2/3 of all cases, it is a secondary disease that develops on the background of lesions of the gastrointestinal tract (colitis, duodenal ulcer and / or stomach ulcer, pancreatitis, gastritis).
The hypotonic form is most common (about 60-70% of all cases).
In modern medicine, the disease was first described by surgeons in the years 1903-1909, who operated on a patient with severe pain in the right hypochondrium. However, having opened the abdominal cavity, they found neither stones nor inflammation in the gallbladder. After that, the therapists began to carefully study the disease.
However, even in antiquity, it was observed that there is a connection between negative human emotions and gallbladder disease, as well as its ducts. Therefore, these people are called "gall".
In addition, everyone knows about the four types of temperament, which are described in the treatises of medicine by doctors of antiquity.
For example, anger and irritability speak of an excess of energy at the point of the gallbladder - a hypertensive variant of dyskinesia (choleric type of temperament). That is, the wall of the gallbladder is stressed and greatly reduced.
While bitterness, lethargy and a tendency to depression indicate a lack of energy at the point of the gallbladder - a hypotonic variant of dyskinesia (melancholic type of temperament). That is, the gallbladder wall is sluggish and poorly reduced.
The mechanism of secretion of bile from the gallbladder
The most important neurohumoral factors governing this complex process are:
- The autonomic nervous system (sympathetic and parasympathetic divisions), which regulates the work of almost all internal organs
Normally, when the vagus nerve (vagus) is activated, which provides for sensory and motor innervation of most of the internal organs, the gall bladder contracts, and the sphincter of Oddi relaxes. If there is a violation of consistency in the work of the sympathetic and parasympathetic divisions of the autonomic nervous system, this mechanism is disturbed.
Intestinal hormones (motilin, cholecystokinin-pancreoimin, gastrin, secretin, glucagon), which are produced in the gastrointestinal tract during meals
When exposed to cholecystokinin in normal doses, the gallbladder contracts, and the sphincter of Oddi relaxes (gall bladder motility is inhibited in large doha). Gastrin, secretin, glucagon have the same effect as cholecystokinin, but less pronounced.
Neuropeptides (neurotensin, vasointestinal polypeptide, etc.) are a type of protein molecule with hormone properties
They prevent the contraction of the gallbladder.
As a result of the close interaction of these factors during the meal, the muscular layer of the gallbladder contracts 1-2 times, increasing the pressure in it to 200-300 mm of water column. Therefore, the Lutkens-Martynov sphincter relaxes, and the bile enters the cystic duct. Next, bile enters the common bile duct, and then through the sphincter of Oddi - 12 PC. When a disease occurs, this mechanism is violated.
The main functions of bile in digestion
- Creates the necessary conditions in 12 PCs for pepsin (the main enzyme of gastric juice) to lose its properties
- Participates in the breakdown of fats, contributing to their absorption, as well as the absorption of fat-soluble vitamins (A, E, D)
- Improves motor function (motility) of the small intestine and increases appetite.
- Stimulates mucus secretion and the production of intestinal hormones: motilin, cholecystokinin-pancreozemin and others
- Activates enzymes necessary for protein digestion (trypsin and lipase are enzymes of pancreatic juice)
- Promotes reproduction of epithelial cells of the intestinal mucosa
- It has antibacterial properties, which weakens when bile stagnates.
Primary dyskinesia of the gallbladder and biliary tract
At the beginning of the disease, there are only functional disorders that are not detected with the research methods (ultrasound, x-rays). However, as the disease progresses, structural changes in the gallbladder and its ducts develop.
The most common causes of primary JVP
- Nervous stress (acute and / or chronic), disruption in the work of the autonomic nervous system (the development of psychosomatic diseases that do not lead to structural changes in organs and tissues).
There is an imbalance in the work between the sympathetic and parasympathetic divisions of the autonomic nervous system. Therefore, coordinated contraction, as well as relaxation of the gallbladder and sphincters (Oddi, Lutkens-Martynov), is disturbed.
In addition, the production of cholecystokinin is disturbed (it increases or decreases), therefore, dysmotility of the gallbladder and biliary tract are aggravated.
Dietary errors and / or violations in the diet (irregular eating, overeating, systematic consumption of fatty or poor-quality products, insufficient chewing of food, fast food, and so on).
The production of intestinal hormones involved in the process of reducing and relaxing the gallbladder and biliary tract is impaired.
Asthenic body type, lack of body weight, sedentary lifestyle, congenital muscular weakness.
The muscles of the gallbladder and biliary tract are relaxed. Therefore, they can not fully reduce in response to a meal.
Allergic diseases (bronchial asthma, chronic urticaria, food allergies, and others).
Allergens affect the neuromuscular apparatus of the bile ducts and gallbladder, causing increased irritation. Therefore, the relationship between the processes of their reduction and relaxation is disrupted.
Secondary dyskinesia of the gallbladder and biliary tract
It occurs on the background of already developed diseases or conditions. Changes are clearly visible with the input research methods.
The most common causes of secondary DZHVP
- Gastritis, duodenitis, colitis, enteritis, gastric ulcer and 12 pcs, gastrointestinal mucosal atrophy (cell size reduction or death, therefore they do not perform their functions).
The production of the gastrointestinal mucosa of intestinal hormones (cholecystokinin, gastrin, secretin and others), affecting the motility of the gall bladder and biliary tract, is impaired.
When an ulcer or gastritis with high acidity increases the production of pepsin by the cells of the stomach, which, once in 12 PCs, acidifies the medium in it. As a result, the tone of the sphincter of Oddi rises, disrupting the outflow of bile.
Chronic inflammatory processes in the abdominal organs and the small pelvis: adnexitis, ovarian cyst, pyelonephritis, solarium (inflammation of the solar plexus) and others.
An irritation of the affected organ occurs, and in response to it reflex changes occur in the gallbladder and biliary tract (viscero-visceral reflexes). As a result, the relationship between the processes of contraction and relaxation of the gallbladder, as well as its ducts, is disturbed.
Hepatitis, cholangitis (inflammation of the biliary tract), cholecystitis (inflammation of the gallbladder), gallstone disease.
Inflammation of the mucous membrane of the gallbladder and biliary tract develops. Therefore, the sensitivity to factors changes (increases or decreases), which normally regulate the processes of their reduction and relaxation.
In gallstone disease there is a mechanical obstacle to the outflow of bile.
Inflammatory diseases of the digestive tract caused by pathogens (eg, salmonella).
Toxins (waste products) of viruses and bacteria affect the neuromuscular apparatus of the bile ducts and gallbladder, causing increased irritation. Therefore, the relationship between the processes of their reduction and relaxation is disrupted.
Worm infestation (giardiasis, opisthorchiasis).
Parasites in the bile ducts and gallbladder, mechanically prevent the outflow of bile. They also irritate the nerve endings with their antennae and tweaks attached to the mucous membrane. Therefore, the motor function of the gallbladder and its ducts is impaired.
Congenital malformations of the gallbladder and bile ducts: waist and inner membrane in the bladder, bend at the level of the body or neck, and so on.
There is a mechanical obstacle to the outflow of bile.
Endocrine diseases and disorders (obesity, hypothyroidism, lack of testosterone or estrogen). Changes in the woman’s body during menopause and menstruation (usually 1-4 days before her start, the patient’s general condition is disturbed) or taking hormonal contraceptive drugs.
The production of cholecystokinin decreases, or the sensitivity of receptors located on the walls of gallbladder cells and its ducts to it decreases.
Ultrasound examination (ultrasound)
Allows you to determine the shape and presence of congenital anomalies of the gallbladder, as well as the degree of emptying.
- Stomach ache
- Yellowness of the skin
- If, when probing the abdomen, the doctor discovers an education
- Enlarged liver and spleen
- An increase in the size of the gallbladder indicates a stagnation of bile - hypotonic dyskinesia.
- A decrease in the size of the gallbladder is a sign of its excessive contraction (hypertensive form) or congenital underdevelopment (hypoplasia).
- The thickening of its walls - acute cholecystitis or chronic cholecystitis in the acute stage.
- Movable focal formations inside the gallbladder - stones.
- Motionless focal formations - a stone stuck in the bile duct or Lutkens-Martynov sphincter.
- Focal lesions soldered to the gallbladder wall - the stagnation of bile (cholestasis) or a tumor.
- Expansion (dilatation) of the common bile duct - biliary dyskinesia.
- The presence of sediment at the bottom of the gallbladder - hypomotor dyskinesia.
- Conducting diagnostic tests to assess the ability to shrink the gallbladder with Sorbitol, Magnesium sulfate, egg yolks. With increased contractility - hypermotron dyskinesia, with reduced - hypomotor form of the disease.
Basic x-ray examinations
They are the leading methods in the diagnosis of gallbladder diseases, as well as biliary tract.
Based on the ingestion of preparations containing iodine (Biliselektan, Holevid, Yodobil and others).
- Examination of the structure and detection of the presence of gallstones
- Investigation of the excretory and cumulative (concentration) function of the gallbladder, as well as its elongation.
The inability to determine the condition of the biliary tract, because they are not visible in the pictures.
The patient on the eve of the study at 19.00 takes two raw eggs. Starting from 21.00, takes a contrast agent with an interval of 30 minutes, drinking water. Contrast material is absorbed in the intestine into the blood, and then secreted by liver cells.
In the morning, several overview pictures of the right side of the abdomen are taken on an empty stomach. Then the patient is offered a choleretic breakfast (as a rule, it is the yolk of the egg) and again produce a series of shots.
In hypertensive form, the gallbladder dramatically and rapidly decreases from the initial volume: by 75% in the first 5-15 minutes, by 90% in the next 1.5-2 hours. Then for a long time is in such a state, not being emptied due to the fact that there is a spasm of the sphincter of Oddi.
In the hypotonic form, the gallbladder is enlarged, and its reduction after choleretic breakfast is very slow from the initial volume: by 20-30% for 15 minutes and remains so for three to four hours.
The method is based on the intravenous administration of a contrast agent containing iodine, which accumulates in the gallbladder and its ducts.
Determination of the sphincter tone Oddi.
On the morning of the fasting patient in the radiology room on the table, Bilignost solution is injected intravenously over 15–20 minutes. And at the same time, a solution of morphine is introduced to artificially reduce the sphincter of Oddi. After 15-20 minutes, a snapshot is taken of the gallbladder and its extrahepatic ducts. Normally, the width of the common bile duct is 3-7 mm.
Interpretation of results
When the sphincter of Oddi is deficient, a contrast agent at 15–20 minutes after injection enters 12 PCs with a width of the common bile duct of 9 mm or more.
Conducted to study the bile ducts after the introduction of a contrast agent.
- Suspected severe narrowing of the bile duct
- Yellowness of the skin and mucous membranes caused by blockage of the bile duct with a stone or compression of its tumor
- Pronounced and prolonged pain syndrome
Basic techniques for the diagnosis of dyskinesia
- Percutaneous transhepatic cholangiography.
After local anesthesia using a superfine needle and under the control of X-ray television, the bile ducts are punctured through the skin, then a contrast agent is injected into them. Then take pictures.
During the procedure, if necessary, the bile ducts are drained.
- Retrograde endoscopic cholangiography. An endoscope (a flexible and long hose with a light source and a video camera at the insertion end) is inserted through the mouth and stomach into 12 PCs. Then a catheter is inserted into the lumen of the common bile duct and a contrast agent is injected, followed by X-rays.
If necessary, during the procedure, small stones are removed from the lumen of the common bile duct, and a tube is installed in it to facilitate the flow of bile.
The goal - the study of bile, as well as the function of the gallbladder and its ducts,
- Detection of bacteria and parasites contained in bile
- The study of the composition of bile
- Determination of patient predisposition to gallstone disease
- Evaluation of motility (motor function) of the biliary tract
On an empty stomach to the patient, through a cavity of a mouth and a stomach, the probe is entered into 12 PK. Then it is laid on the right side and receive bile portions:
- The first phase (“A” portion) is a mixture of pancreatic juice and 12 pc. It is collected from the moment of insertion of the probe to the introduction of a stimulant (magnesium sulfate solution). Normally, in 10-20 minutes, 15-20 ml of golden-yellow secretion is obtained.
- The second phase is the period from the moment of introduction of the stimulator (choleretic) until the next portion of bile appears (the phase of the closed sphincter of Oddi). Normally, the duration is from 3 to 6 minutes.
- The third phase is getting the contents of the cystic duct. Normally, about 3-5 ml of secretion is obtained in 3-5 minutes.
- The fourth phase (portion "B") - obtaining the contents of the gallbladder. The bile is thick dark brown. Normally, in 15-25 minutes, from 30 to 50 ml of bile is secreted.
- The fifth phase (portion “C”) is hepatic, during which light-yellow liquid bile is obtained from the intrahepatic bile ducts.
Interpretation of results
- In hypertensive dyskinesia, the selection of the portion “B” is accelerated and is accompanied by pain, and the second phase of the buried sphincter of Oddi lasts longer than 6 minutes. In the first phase, the selection of "A" portions intermittent and slow (lasts about 30 minutes), sometimes accompanied by a colicky pain in the right hypochondrium.
- In the hypotonic form, bile in portions “B” is secreted slowly, in large portions with long intervals between them. Repeated stimulation is often required.
- Microscopically examine the bile for the presence of parasites.
- From portions of bile produce seeding on microbiological environment to identify the microbial flora, as well as determining its sensitivity to antibiotics.
- Biochemical study "In" and "C" portions of bile:
- increase in bilirubin and cholesterol indicates bile stasis
- increased cholesterol and bile acids, as well as the detection of calcium bilirubinate crystals - a sign of the patient's tendency to stone formation
- increase in total protein and C-reactive protein indicates the presence of an inflammatory process in the gallbladder and its ducts
Mixed form of dyskinesia
Combines the signs of the hypotonic, hyperkinetic type. There is a malfunction of the muscles, resulting in initially stagnation of bile, followed by a maximum release into the intestine. It often develops in the presence of chronic diseases of the digestive tract, liver, hormonal disruptions, circulatory disorders.
They differ depending on the type of dyskinesia.
- Colic with sharp, burning pain under the right rib. Appear a few minutes after eating, at night.
- Persistent nausea. Increases after eating, as well as during prolonged fasting.
- Vomiting with bile, bitter taste.
- Loss of appetite, weight loss.
- Headache, dizziness, weakness, general malaise.
- Bloating, flatulence, discomfort in the stomach.
- Violation of the chair in the direction of diarrhea.
- High blood pressure.
- Excessive sweat.
Mixed type combines all the symptoms. There is a constant dull pain, aggravated after eating, against the backdrop of strong emotions.
In addition to the characteristic symptoms, there is a decrease in performance, a sharp change of mood, depressed state, sleep disturbance, chronic fatigue.
Often there is cholestatic syndrome:
- Enlarged liver
- Darkening of urine, fecal discoloration,
If there is any alarming symptom, you should seek help from a specialist. Early diagnosis of the problem will help to avoid serious consequences.
Dyskinesia of the bile ducts in gastroenterology is regarded as a psychosomatic disorder. The functions of the body are disturbed by stress, as a result of situations that traumatize the psyche. The primary diagnosis of the disease reveals the presence of such factors as an unfavorable psycho-emotional environment at home, at work, professional difficulties, sexual problems. Often, the symptoms appear on the background of general neurosis, depression, stress, shocks.
A significant role in the manifestation of dyskinesia assign hormonal background. Imbalance occurs as a result of natural transformations - puberty, pregnancy, menopause, age in men over 35 years of age, improper work of the endocrine system, the nervous system.
The following pathological conditions and diseases contribute to the development of dyskinesia:
- Lack of adrenal function,
- Thyroid enlargement,
- Polycystic ovary,
- Liver disease
- The inflection of the gallbladder,
- Inflammation of the abdominal organs,
- Peptic ulcer
- Parasitic diseases,
- Atopic dermatitis,
- Autoimmune pathology.
In addition, provoke the development of dyskinesia:
- Oily, spicy food,
- Sedentary lifestyle or excessive activity,
- Food allergies,
- Disrupted diet,
- Overeating, prolonged fasting
- Snacks at night,
- Sleep disturbance,
- Depletion of the nervous system
- Inflammation of the genitals.
In some cases, you can eliminate the influence of negative factors through proper nutrition, lifestyle, in others - requires special therapy.
Features of dyskinesia in a child
In children, the presence of a pathological process is associated with congenital anomalies, imperfections of the digestive system, nervous.With the deformation of the gallbladder there is frequent belching, regurgitation, bloating, flatulence.
In other situations, it is possible to determine the presence of dyskinesia by the following criteria:
- White bloom on the tongue
- Swollen tummy
- Pain on the right side under the rib,
- Cracks in the corners of the mouth,
- Yellowness of the skin, eyes,
- Poor appetite
- Reduction or rapid weight gain,
- Impaired stool
- Blood pressure change.
In older children, the symptoms are similar to adults, with the only difference being that painful symptoms are associated with certain events. As a rule, chronic diseases yet.
Dyskinesia develops as a result of:
- Hormonal rearrangements during puberty,
- Excessive physical activity
- Sedentary lifestyle,
- Early consumption of alcoholic beverages,
- Inadequate nutrition
- Violated mode
- The habit of eating at night,
- Love fast foods
- Nervous experiences, shocks,
- Unfavorable psycho-emotional setting.
The main methods of therapy are diet, rationing of sleep, rest, physical exertion, proper rest, massage. Use folk remedies, homeopathic medicines.
A person will have to pass blood, urine, feces for analysis. According to a blood test, the presence of an inflammatory process, antibodies to pathogens are determined, the functions of the endocrine system, pancreas, and liver are evaluated. A urine test is needed to evaluate the function of the excretory system. The feces gives the chance to reveal or disprove a parasitic infection, hepatitis, an intestinal dysbacteriosis. Laboratory tests only point to the pathological process, instrumental diagnostics are required to clarify the diagnosis.
Includes 2 methods - cholecystography, cholangiography. Evaluated the work of the ducts of the liver, gallbladder, traced the movement of bile. A person needs to drink a special substance immediately before the procedure. Dosage is adjusted individually. From the blood, the drug enters the ducts of the liver, gall, which allows you to see a clear picture of bladder motility.
The procedure requires additional preparation. During the day, diet food is prescribed, a few hours before the examination is allowed only to drink. Give up smoking, alcohol. Take ipodinate sodium tablets at bedtime. The whole procedure lasts half an hour, does not cause discomfort, pain.
- Intestinal obstruction
- Renal, cardiac, liver failure,
- Intestinal perforation,
- Allergy to the components of the x-ray substance.
As a result of the examination, specialists identify tumors, stones, polyps, bias, organ size, position.
In the presence of diseases of the digestive tract, gastroscopy is additionally prescribed.
Provides an integrated approach. The main goal is to ensure the full functioning of the gall bladder, to prevent complications.
- Correct lifestyle
- Homeopathic, folk remedies,
- Medical procedures.
In case of autoimmune disorders, hormonal agents are required, viral hepatitis is treated with antiviral agents, harmful microorganisms are eliminated, and helminths are eliminated with antiparasitic drugs and antibiotics. In each case requires an individual approach, but be sure to follow a diet, lead a healthy lifestyle.
Additional methods of therapy:
- Leech therapy,
The tube is carried out at home. The procedure activates the outflow of bile, improves the functioning of the liver, gallbladder. In the morning on an empty stomach drink 1 liter of non-carbonated mineral water.They go to bed on their left side, put a warm heating pad on their right side for 1-2 hours. They rise, do light exercises - torso, squatting. About cleansing the ducts says black stool with a pungent odor. The procedure is done 1 time per month, it is prohibited in case of gallstone disease.
Of great importance in dyskinesia play sedatives. In hypertensive-hyperkinetic type, tincture of valerian, motherwort, gloda, Nova Passit is prescribed. In case of hypotonic hyperkinetic disease, tonic preparations are prescribed - ginseng extract, echinacea, Eleutherococcus, Tonginal.
To eliminate the painful sensations, antispasmodics are prescribed - Papaverin, Drotaverin, No-Spa, Meverin. With strong biliary colic, combined agents are allowed, analgesics - Kombispazm, Spazmolgon, Analgin, Baralgin, Nise, Ketanov.
Treatment of hypotonic dyskinesia:
- Choleretic. Preparations to improve the flow of bile. Milk thistle, smoke extract, dogrose decoction.
- Prokinetics. To improve digestion. Normalizes gastrointestinal motility, increase the elasticity of the sphincter. The most common drugs are Domrid, Domperidone.
- Enzyme means. Accelerate the digestion of food, normalize acidity, stimulates the movement through the intestines, eliminate swelling, support the work of the pancreas. Mezim, Pancreatin, Colikid, Festal.
- Hepatoprotectors. Preparations for the restoration of liver cells, improve the work of the body. In addition, the means normalize the movement of bile, eliminate stagnant processes, improve the functioning of the gall bladder. Allohol, Milk Thistle, Holosas, Hepatosan, Artichoke, Karsil, Essentiale Forte.
- Sorbents. To remove toxins from the body, improve overall well-being. Activated carbon, Smekta, Enterol, Enterosgel.
Taking medication combined with folk remedies, diet, healthy lifestyle.
Treatment of hyperkinetic dyskinesia is carried out by the same drugs, except choleretics, which stimulate the flow of bile. Particular attention is paid to sedatives.
It is necessary to revise the diet regime. You should eat at least 6 times in small portions. After the meal should remain a slight feeling of hunger. The daily diet should include the first, second courses, fruit, dairy products. Exclude fried, spicy, salty foods, sweets. The last meal no later than 2 hours before bedtime, avoid snacking at night, overeating. Serve warm. This facilitates the work of the digestive tract, normalizes the flow of bile.
In the period of exacerbation, you must follow a strict diet, after relief to switch to a healthy diet. Proper diet allows you to get rid of the painful symptoms, prevents relapses. It is not recommended to eat foods containing chemical additives - flavors, flavor enhancers, preservatives. To limit the use of fast foods, products "to the beer."
It is prohibited in the period of exacerbation:
- Fried fish, meat,
- Rich broths,
- Preservation, sausages, smoked meats,
- Fresh bakery,
- Egg yolk.
- Carbonated drinks
- Dairy products,
- Any berries, fruits,
- Low-fat pork,
- Egg white,
- Still mineral water,
- Dried fruits and compote of them,
- Herbal decoctions,
- Bread stale,
- Premium pasta,
- Bakery products,
Meat in the first days of the diet fray, twist to a meat grinder. In the future, simply chew food.
The treatment is carried out with the help of herbs, seeds, vegetables, fruits. When choosing an effective medicine, one should take into account the type of dyskinesia, the properties of the components of the product.
- Mint, lemon balm. It has a pronounced sedative property, eliminates nausea, gagging, improves the functioning of the digestive tract. Mix in the same proportions, pour 1 hour. A spoonful of potion with a glass of boiling water, leave to infuse for 5 minutes. Drink as usual tea. It is recommended in the evening before bedtime in the morning.
- Chamomile. Universal remedy with a variety of useful properties - anti-inflammatory, healing, painkiller, antispasmodic, regenerating, diuretic, choleretic, sedative. Prepare similar to the previous tool. It is allowed to add a small amount of sugar, honey.
- Rosehip The decoction has a pronounced choleretic property. Strengthens the immune system, improves digestion, removes toxins, accelerates wound healing, reduces inflammation. Berries are poured with water, boiled on low heat for 5 minutes, let it brew for about an hour. Drink should be warm. Syrup has a powerful therapeutic effect, which is sold in a pharmacy - Holosas. Price about 80 rubles.
- Beet-carrot juice. It is necessary for the outflow of bile, improve digestion, eliminate stagnant processes. Helps to cope with constipation. It nourishes the body with nutrients, stimulates the renewal of liver cells. Juice is mixed in proportions of 1:10, where one share falls on beets. Let stand 15 minutes. Take a glass at a time. It is allowed to add a pumpkin, zucchini.
- Vegetable harvest. Increases blood pressure, eliminates stagnant processes, relieves spasm, eliminates inflammation, tones. Mixed in the same proportions devias, chamomile, calendula, root Althea. Pour 1 tbsp. Spoon the mixture with a glass of water. Boil for 5 minutes, insist 15. It is necessary to drink every 3 hours and 1 tbsp. Spoon all day.
- Oats Useful oatmeal, as well as prepare a decoction of the grains. Oats poured water, put on a small fire, boil an hour. Allow to cool, filter. Grains are used to prepare various dishes, drink a glass during the day. Improves overall health, removes toxins, eliminates stagnant processes, normalizes digestion.
When dyskinesia, it is recommended to eat pumpkin seeds, grapefruit, apricot, drink jelly, dried fruit compote, milk.
Prediction, possible complications
Dyskinesia of the bile ducts with congenital anomalies may not cause much inconvenience, if you lead a healthy lifestyle, stick to a diet. In other cases, the negative impact of adverse factors leads to the progression of the disease, complications. With stagnation, the risk of developing gallstone disease, pancreatitis increases. Irregular release of bile into the intestine causes inflammation of the duodenum, provokes an ulcer, gastritis, gastroduodenitis. In addition, there are problems with blood pressure, chronic fatigue, weakness, heaviness in the stomach.
- Peptic ulcer
- Atopic dermatitis.
With timely detection of the problem, the gallbladder and the digestive tract can be normalized to avoid the progression of pathology.
It should abandon bad habits, strengthen the immune system, give preference to proper nutrition, monitor the diet. Control weight, avoid nervous exhaustion. Be sure to engage in physical culture, do simple exercises, gymnastics. A sedentary lifestyle disrupts blood circulation, leads to stagnant processes, contributes to the accumulation of bile. Extreme motor activity stimulates the movement of bile, which is also not the norm.
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I almost always drink Allohol, I eat vegetables, fruits, cereal, berries, vegetables. Periodically do the tubage. I have a congenital anomaly - the presence of jumpers, narrowing of the lumen of the biliary tract.
When the right side starts to hurt, I undergo a course of therapy with the use of milk thistle. 1 spoonful of powder twice a day, 20 minutes after meals. Immediately it becomes easier.