Dyskinesia of biliary tract at children - the change of a tone and motility of bile-excreting system breaking full outflow of bile in a duodenum. Dyskinesia of biliary tract at children is shown by the pricking pains in the right podreberye, the dispeptichesky frustration connected with errors in food. For the purpose of diagnosis of dyskinesia of biliary tract at children ultrasonography of a gall bladder on an empty stomach and after reception of a bile-expelling breakfast, duodenal sounding is carried out, is more rare – the cholecystography, a gepatobilistsintigrafiya. Treatment of dyskinesia of biliary tract at children is carried out taking into account its type by means of a diet, pharmacotherapy, phytotherapy, physical therapy.
Dyskinesia of biliary tract at children
Dyskinesia of biliary tract at children – dysfunctional frustration of a biliarny path; the violation of a sokratimost of a gall bladder and bilious ways which is followed by disorder of function of a zhelcheotvedeniye. In structure of diseases of biliarny system at children of dyskinesia of biliary tract the first place belongs; it is followed by inflammatory diseases (cholecystitis, holangit), to anomaly of development of bilious ways and cholelithiasis. In children's gastroenterology dysfunctional frustration of bile-excreting system come to light at 70-90% of the children having diseases of the digestive system.
The reasons of dyskinesia of biliary tract at children
At children violation of regulation of consecutive reduction and relaxation of a gall bladder and sphincters from nervous and parakrinny systems is the cornerstone of dyskinesia of biliary tract. As a result of a diskoordination of activity of bile-excreting system the bile passage in intestines is broken that is followed by a complex of clinical manifestations.
At children of chest age of dyskinesia of biliary tract, as well as other functional disorders of a GIT, most often are a consequence of perinatal defeats of TsNS (a hypoxia, a patrimonial trauma, asphyxia etc.). Development of dyskinesia of biliary tract in children is promoted by anomalies of bilious channels and excesses of a gall bladder complicating normal outflow of bile; violations of the sfinkterny device; cytogene or hepatogenous diskholiya.
In pediatrics the association between developing of dyskinesia of biliary tract and the infectious diseases transferred the child – hepatitis A, salmonellosis, dysentery is traced. A certain role among the reasons of dyskinesia of biliary tract at children belongs to chronic diseases (to antritis, chronic tonsillitis, etc.), to a lyamblioz, an askaridoz, neuro to diathesis.
At children of advanced age the role of vegeto-vascular dystonia, neurosises, psychoemotional violations, hypodynamias, food errors in development of dyskinesia of biliary tract increases. As reduction and relaxation of a gall bladder happens under the influence of peptide hormones (a holetsistokinin, a gastrin, a sekretin, a glucagon, etc.), violation of their development at gastritis, a gastroduodenita, pancreatitis, an enterokolita can also lead to developing of dyskinesia of biliary tract at children.
Classification of dyskinesia of biliary tract at children
Depending on the nature of violations distinguish primary and secondary dyskinesia of biliary tract at children. Primary dysfunction is connected with disorder of neurohumoral regulation; secondary arises as a vistsero-visceral reflex and is a consequence of pathology of digestive organs.
According to the international classification, two forms of diskinetichesky frustration are allocated: dyskinesia of a gall bladder and puzyrny channel and spasm of a sphincter of Oddi.
Taking into account the nature of violations of a tone and motility of biliary tract and clinical manifestations dyskinesia at children can proceed on hypertensive-hyperkinetically, hypotonic - to the hypokinetic and mixed option. At hyper motor option release of bile happens quickly and often that is followed by a spastic condition of a gall bladder and sphincters. At a hypomotor form muscles of biliary tract are relaxed, bile is emitted slowly that results in its stagnation in a gall bladder. The mixed dyskinesia of biliary tract at children combines signs of hyper motor and hypomotor forms.
Symptoms of dyskinesia of biliary tract at children
As the main displays of dyskinesia of biliary tract at children serve the pain syndrome, a dispepsichesky syndrome and positive puzyrny symptoms. The nature of manifestations depends on a dysfunction form.
The current hypertensive - hyperkinetic dyskinesia of biliary tract at children is characterized pristupoobrazny (skhvatkoobrazny, pricking, cutting) by the pains in the right podreberye having short-term character (5-15 min.). At a palpation the area of a gall bladder is painful, positive puzyrny syndromes are defined. At a hypertensive form of dyskinesia of biliary tract the child often has a liquid chair, nausea, appetite loss, vomiting, bitterness in a mouth, the general weakness, a headache. As provocative factors of a pain and dispepsichesky syndrome physical activities, the use of fried or greasy food, negative emotions, as a rule, act. During the mezhpristupny periods health of children satisfactory; short spastic belly-aches can sometimes disturb them.
The hypotonic form of dyskinesia of biliary tract occurs at children seldom. In this case pain in a podreberye has the constant, aching, stupid character; sometimes there is only a raspiraniye and weight in this area. There can be dispepsichesky frustration: alternation of locks and ponos, loss of appetite, eructation air, meteorizm. Owing to a holestaz and restretching of a gall bladder at a palpation the increased and painless liver is defined.
Diagnosis of dyskinesia of biliary tract at children
Children with dyskinesia of biliary tract go the pediatrician for consultation to the children's gastroenterologist. For specification of the clinical diagnosis and definition like dyskinesia of biliary tract at children the complex of clinical, laboratory, tool trials is conducted.
At patients morbidity in a projection of a gall bladder and in epigastralny area decides on dyskinesia. The most significant in diagnosis of dyskinesia of biliary tract at children is ultrasonography of a gall bladder by means of which the form, the sizes, deformations of a gall bladder, a condition of channels, existence of stones is estimated. For definition of sokratitelny ability of a gall bladder and a condition of a sphincter of Oddi of ultrasonography of a gall bladder to the child repeats after reception of a provocative breakfast.
Duodenal sounding at children with dyskinesia of biliary tract allows to estimate the volume of portions of bile, its microscopic and biochemical structure. At a research of duodenal contents inflammation signs, tendency to formation of stones, lyambliya, etc. can be found.
In need of studying of morphology and function of bile-excreting system the oral or intravenous cholecystography (holetsistokholangiografiya), a radio nuclide holestsintigrafiya, a retrograde holangiopankreatografiya, MR-holangiografiya is carried out. For the purpose of an exception of other gastrointestinal diseases to the child gastroscopy, the analysis a calla on helminths, a koprogramma, on dysbacteriosis, biochemical blood test can be made.
Treatment of dyskinesia of biliary tract at children
Basis of productive treatment of children with dyskinesia of biliary tract dietary food with restriction of the use fat, fried, sharp, salty, sweets makes, aerated water. Food, enrichment of a diet by products with the high content of vegetable cellulose, vitamins A, In, With, bifido-and lactobacilli, the vegetable refined oils is recommended fractional (5-6 times a day). Regulation of the motive regime of the child, creation of a favorable emotional background is necessary. In all cases it is necessary to pay attention to therapy of the main disease.
To children with hyperkinetically - sedative medicines (phytocollecting, a valerian), spazmolitik for removal of painful attacks are appointed hypertensive type of dyskinesia of biliary tract (a papaverine, ). The basis of treatment of hypertensive-giyerkinetichesky dyskinesia of biliary tract at children is made by holeretik and holespazmolitik (, medicines of dry bile). Well the psychotherapy, acupuncture, physical therapy (paraffin applications, a diathermy, an induktotermiya, an electrophoresis from a spazmolitikama), massage cervical proved in therapy as dyskinesia of biliary tract at children zones.
At hypotonic - hypokinetic dyskinesia of biliary tract at children procedures of the stimulating character are appointed: physiotherapy exercises, hydrotherapy, massage. Bile-expelling medicines with holinokinetichesky effect (xylitol, sorbite, magnesium sulfate), vegetable infusions are applied (corn a rylets, a dogrose, a calendula); medical bile-expelling tyubazh are carried out. From physiotherapeutic methods galvanization, an electrophoresis with magnesium sulfate, Bernard's currents is used.
The forecast and prevention of dyskinesia of biliary tract at children
Timely diagnosis and adequate treatment of dyskinesia taking into account its type allows to normalize processes of a zhelcheotvedeniye and digestion, to warn an inflammation and an early kamneobrazovaniye in biliary tract at children. Long violation in work of bile-excreting system can lead to development of cholecystitis, a holangit, cholelithiasis, intestinal dysbiosis.
Children with dyskinesia of biliary tract need dispensary observation of the pediatrician, children's neurologist and gastroenterologist, ultrasonography control, carrying out courses of bile-expelling therapy twice a year, improving rest in specialized sanatoria. It is necessary to watch food and regime of the child, his emotional state.