Dyskinesia of biliary tract
Dyskinesia of biliary tract – a functional disease of biliarny system which cornerstone violation of motility of a gall bladder and bilious ways, and also process of a zhelcheotvedeniye is. Dyskinesia of biliary tract can develop on hyperkinetic or hypokinetic type; it is shown by pains in the right podreberye, nausea, dyspepsia, nevrozopodobny symptoms. Diagnostics includes ultrasonography of bile-excreting system, the cholecystography, a holangiografiya, duodenal sounding, a stsintigrafiya. Treatment of dyskinesia of biliary tract conservative: diet, reception of bile-expelling means and spazmolitik, sanatorium therapy, phytotherapy, girudoterapiya, physical therapy.
Dyskinesia of biliary tract
Motor and tonic dysfunction of a gall bladder and sphincters of bilious channels is the cornerstone of dyskinesia of biliary tract. At the same time depletion of a gall bladder and intake of bile in a duodenum is broken. Dyskinesia of biliary tract is the most widespread functional violation of gepatobiliarny system and serves as the leading reason of a holestaz, and also formation of stones in a gall bladder and channels.
Dyskinesia of biliary tract occurs primary at women. Are most subject to development of functional frustration of bile-excreting system of the person of young age (from 20 to 40 years) with the asthenic constitution and the lowered food.
Reasons of dyskinesia of biliary tract
Dyskinesia of biliary tract is considered in gastroenterology as the psychosomatic pathology developing against the background of the psychoinjuring situations. The anamnesis of patients with diskineziya of biliary tract often indicates family, professional and sexual difficulties. Quite often dyskinesia of biliary tract serves as display of the general neurosis or dientsefalny syndromes.
The significant role in development of dysfunction is assigned to violation of nervous regulation of work of a gall bladder, and also change of level of GITs hormones and endocrine glands (at a climax, insufficiency of function of adrenal glands, a single cyst and a polikistoza of ovaries, a hypothyroidism, a thyrotoxicosis, diabetes, obesity).
Except psychogenic and endocrine frustration, among etiologichesky factors consider the alimentary reasons: food allergy, irregular food, the use of low-quality food in combination with an inactive way of life.
Dyskinesia of biliary tract are often combined with other diseases of the digestive system: chronic gastritis, gastroduodenity, stomach ulcer, pancreatitis, enteritis, cholecystitis, holangity, cholelithiasis, postkholetsistektomichesky syndrome. Quite often dysfunctions of biliary tract accompany chronic inflammatory processes in an abdominal cavity and bodies of a small pelvis – salpingooforit, chronic appendicitis, etc. With the phenomena of dyskinesia of biliary tract helminthic and parasitic invasions of a GIT (helminthoses, ), dysbacteriosis, viral hepatitis B, intestinal infections (dysentery, salmonellosis) can proceed. As the factors contributing to development of dyskinesia of biliary tract allergic diseases - obstructive bronchitis, atopic dermatitis, allergic rhinitis can act.
Classification of diskineziya of biliary tract
On the etiologichesky mechanism distinguish primary and secondary dyskinesia of biliary tract. Primary dysfunction is caused by violation of neurohumoral regulation of activity of gepatobiliarny system owing to neurosises, vegetovascular dysfunction and dietary errors. Secondary dyskinesia of biliary tract develops on the mechanism of a vistsero-visceral reflex against the background of other diseases of the digestive system.
On the nature of violation of motor and tonic function of a gall bladder and sphincters distinguish dyskinesia of biliary tract, proceeding on hypertensive-hyperkinetically and hypotonic - to hypokinetic type. Hypertensive - hyperkinetic (spastic) dyskinesia of biliary tract develops at the raised tone of the parasympathetic autonomic nervous system; gipokineticheski-hypotonic (atonichesky) – at prevalence of a tone of sympathetic nervous system.
In both cases, as a result of inconsistency of work of a gall bladder and sphincters of bilious channels, intake of bile in a duodenum gleam is broken that leads to disorder of process of digestion. Depending on type of dyskinesia of biliary tract (hyperkinetic or hypokinetic) various clinical manifestations develop.
Symptoms of dyskinesia of biliary tract
At hypertensive - to hyperkinetic dyskinesia of biliary tract as the leading symptom serves the acute kolikoobrazny pain in the right podreberye irradiating in a right shoulder-blade and a shoulder. The painful attack, as a rule, develops after an error in a diet, excessive physical activity or a psychoemotional stress. The pain syndrome can be followed by nausea, sometimes vomiting, a lock or a diarrhea, a polyuria. Pain passes independently or is easily stopped by spazmolitika. Out of attacks the health satisfactory, is observed periodically arising, short pain of spastic character in the right podreberye, an epigastriya, okolopupochny area.
Quite often hypertensive dyskinesia of biliary tract is accompanied vasomotorial (tachycardia, hypotonia, a kardialgiya) and neurovegetative (irritability, perspiration, a sleep disorder, headaches) by manifestations. The stomach palpation during a painful attack reveals Kerr's symptom - the maximum morbidity in a projection of a gall bladder. The phenomena of intoxication and signs of inflammatory process in blood tests are absent.
The constant, not intensive, stupid, aching pain in the right podreberye, feeling of weight and stretching in this zone is characteristic of gipokineticheski-hypotonic dyskinesia of biliary tract. Against the background of strong emotions and meal dispepsichesky frustration - bitterness in a mouth, an eructation air, nausea, a loss of appetite, a meteorizm, a lock or a diarrhea develop. At a palpation of a stomach moderate morbidity in projections of a gall bladder, a positive symptom of Ortner is found. Except symptoms of disorder of digestion, at diskineziya of biliary tract nevrozopodobny manifestations are noted: tearfulness, irritability, differences of mood, increased fatigue.
Diagnosis of dyskinesia of biliary tract
As problem of diagnostics serves verification of a disease, definition like dyskinesia of biliary tract, an exception of the associated diseases supporting dysfunction. Ultrasonography of a gall bladder and biliary tract is directed to definition of a form, the sizes, deformations, congenital anomalies, concrements of bile-excreting system. For examination like dyskinesia of ultrasonography it is carried out on an empty stomach and after reception of the bile-expelling breakfast allowing to estimate sokratitelny function of a gall bladder.
Informative method of diagnosis of dyskinesia of biliary tract is carrying out fractional duodenal sounding with a research of duodenal contents. By means of sounding of a 12-perstny gut the tone, motility, reactivity, a condition of the sfinkterny device of extra hepatic bilious channels is defined. At hyperkinetic dyskinesia of biliary tract the level of a lipoproteidny complex and cholesterol in portion In decreases; at hypokinetic – raises.
Radiological inspection at dyskinesia of biliary tract includes the cholecystography and a holangiografiya. With their help the very tectonics and motility of biliary tract is estimated. In comprehensive examination the manometriya of a sphincter of Oddi, a holestsintigrafiya, MRT of a liver and biliary tract can be applied.
The koprogramma research, calla on dysbacteriosis and eggs of helminths is expedient.
Treatment of dyskinesia of biliary tract
Treatment of dyskinesia of bilious ways has to carry the complex orientation including normalization of the mode and character of food, the sanitation of the centers of an infection desensibilizing antiparasitic and antivermicular therapy, elimination of an intestinal dysbiosis and hypovitaminosis, elimination of symptoms of dysfunction. An important role in treatment of dyskinesia of biliary tract is played by a dietotherapy: an exception of reception of extractive products, refractory fats, confectionery, cold dishes, the products causing gas generation in intestines.
Much attention at dyskinesia of biliary tract is paid to correction of a condition of the autonomic nervous system. At hypertensive - hyperkinetic type of dysfunction sedative medicines (bromides, a valerian, a motherwort) are appointed; at hypotonic - hypokinetic - tonics (extracts of a levzea, eleuterokokk, tincture of a ginseng, magnolia vine, an araliya). At a lyamblioza or a helminthic invasion anti-parasitic and antigelmintny therapy is carried out.
Restoration of function of a bile production and zhelcheotvedeniye at different types of dyskinesia of biliary tract is also carried out differentially. At a giperkineziya holeretik (dry bile, cattle pancreas extract, , hydroxymethylniacinamide, ), low-mineralized mineral waters in the warmed-up look, spazmolitik (, a papaverine, ), phytocollecting (broths of a camomile, peppermint, a root of a glycyrrhiza, fennel fruits) are shown. From non-drug methods to patients with hypertensive - hyperkinetic dyskinesia of biliary tract recommends psychotherapy courses, acupunctures, girudoterapiya, applications of ozokerite and paraffin, a diathermy, induktotermiya, microwave therapy, an electrophoresis from a spazmolitikama, acupressure, massage of a vorotnikovy zone.
At hypotonic dyskinesia of biliary tract holekinetik (xylitol, magnesium sulfate, sorbite), highly mineralized waters of room temperature, phytotherapy (broths of flowers of an immortelle, leaves of a nettle, hips, a marjoram, a St. John's Wort) are appointed. At signs of an intra hepatic holestaz carrying out "blind" sounding is shown (tyubazhy). For increase in the general tone it is appointed LFK stimulating water procedures, the toning massage. From methods of physical therapy use a diadinamoterapiya, an electrophoresis from magnesium sulfate on area of a liver, ultrasound of low intensity, SMT-therapy, pulse currents of low frequency.
Observation of the gastroenterologist and neurologist, annual improving courses in balneological sanatoria is shown to patients with dyskinesia of biliary tract.
Forecast and prevention of dyskinesia of biliary tract
The course of dyskinesia of biliary tract a disease, chronic, however, at observance of a diet, healthy lifestyle, timely and correct treatment, can flow without aggravations. Otherwise development of complications from gepetobiliarny system is possible – kalkulezny cholecystitis and a holangit.
Prevention of primary dyskinesia of biliary tract demands respect for the principles of healthy food, timely correction of violations of the psychoemotional sphere; the prevention of secondary dyskinesia - elimination of the main disease.