Dyskinesia of a gall bladder
Dyskinesia of a gall bladder — the functional violation of a sokratimost of a muscular layer of a zhelchepuzyrny wall complicating bile evacuation. It is shown by biliarny pain, dyspepsia, an icteric syndrome, astenovegetativny frustration. It is diagnosed by means of a sonografiya, a dynamic stsintigrafiya, MRT of a gepatobiliarny zone, duodenal sounding, a retrograde holangiopankreatografiya. Apply miotropny spazmolitik, holeretik, holekinetik, tritsiklichesky antidepressants, NPVS in combination with a dietotherapy, physical therapy to treatment. At the complicated current and the expressed pain syndrome carry out a holetsistektomiya.
Dyskinesia of a gall bladder
Kinetic dysfunction of a gall bladder — the widespread gepatobiliarny disease revealed at 20,7% of adult women, 7,6% of men with the kept body without ultrasonography signs of its organic damage. Dyskinesia is diagnosed for 53-60% of children of preschool and school age with gastroenterologichesky pathology, boys are ill 3-4 times less often than girls. Pathology is often combined with dyskinesia of bilious channels. On observations of experts in the sphere of gastroenterology and hepatology, to a third of cases of bilious colic are caused by functional violations of sokratitelny activity of a zhelchepuzyrny wall. Patients of an asthenic constitution with signs of asteno-neurotic frustration enter into risk group.
Development of dyskinesia of a gall bladder is connected with primary or secondary violation of sokratitelny activity of a muscular cover of body. Extremely seldom motor and kinetic dysfunction is congenital, is caused by sokratitelny insolvency of gladkomyshechny fibers or violation of their sensitivity to neurohumoral influences. At most of patients dyskinesia has secondary character, is caused by such reasons as:
- Change of level of hormones. Oppression of motility of a bubble at pregnancy and reception of the combined oral contraceptives happens under the influence of the progestins weakening gladkomyshechny fibers. The Sokratimost of body also decreases because of increase in level of a somatostatin at somatostatinoma or reception of a pharmaceutical form of hormone.
- System diseases. The dysfunction caused by decrease in secretion of a holetsistokinin intestinal epiteliotsita arises at a tseliakiya. At a sklerodermiya, a myasthenia, an amiloidoza frustration is caused by morphological changes of a fibrous muscular layer. Zhelchepuzyrny dystonia is also noted at diabetes.
- Gepatobiliarny pathology. Inflammatory processes, change of composition of bile, irritation concrements can provoke dyskinesia at cholelithiasis, cholecystitis, a holangita. Diskoordination of reductions of a bubble is observed at a spasm of a sphincter of Oddi, increase in resistance in bilious channels.
An important role in development of frustration is played by the frequent stresses leading to an imbalance of parasympathetic and sympathetic stimulation, a diet error — the use of greasy food, irregular food, bystry having a snack high-calorie products. Gastritises, enterita, diseases of the operated stomach, other gastrointestinal diseases at which as a result of violation of digestion secretion of the factors influencing a tone and sokratitelny activity of a zhelchepuzyrny wall changes can be also complicated by dyskinesia.
Emergence of the clinical symptomatology characteristic of dyskinesia of a gall bladder is caused by bile evacuation violation. At the dicoordinated reduction of muscle fibers of a bottom and a neck, an insufficient sokratimost of a muscular layer the body stretches that leads to emergence of characteristic biliarny pain. The situation is aggravated with reduction of the threshold of painful sensitivity at communication of motor and kinetic frustration with the vegetative dysfunction caused by a stress. Periodically developing stagnation of bile provokes secondary inflammatory processes, , violation of intestinal digestion.
At systematization of clinical forms of motor dysfunction of a bubble consider an etiology of a disease and type of violations of sokratitelny activity. Such approach allows to develop optimum tactics of maintaining the patient. Taking into account an origin allocate primary forms of dyskinesia caused by congenital local violations of motility and an innervation, and secondary, arisen against the background of other diseases, special physiological states or as a result of the carried-out treatment. Depending on changes of a sokratimost of gladkomyshechny cages distinguish such options of frustration as:
- Hyper motor (hypertensive) dyskinesia. It is more often observed at children's and young age. It is caused by the strengthened reduction of a gall bladder leading to emergence of acute spastic pain and receipt of excess of bile in a 12-perstny gut.
- Hypomotor (hypotonic) dyskinesia. It is usually diagnosed for patients 40 years with neurotic frustration are more senior. Decrease in a tone of a zhelchepuzyrny wall with stagnation of bile and increase in volume of body is characteristic.
The main symptom of dyskinesia of a gall bladder — the biliarny pain disturbing the patient at least 3 months within half a year. At hypertensive option of dysfunction there is an expressed morbidity in the right podreberye with irradiation in a back and a shovel lasting no more than 30 minutes. The pain syndrome is often connected with experiences, stressful situations, in the most hard cases its intensity corresponds to degree of bilious colic — the sudden acute pain which is followed by nausea and vomiting which knocking over requires prescription of medicines.
Dull biliarny aches of various intensity which amplify at change of position of a body are characteristic of hypotonic option of a disease and can proceed within several days. The feeling of a raspiraniye and pressure in a projection of body is noted. Owing to stagnation of bile almost at a half of patients yellowness, decolouration a calla, urine darkening, a skin itch is observed. Dispepsichesky frustration are typical for dyskinesia: bitterness in a mouth, a meteorizm, an unstable chair. At the long course of a disease the general state is broken — weakness, emotional lability, sleeplessness is noted. Vegetative violations are often shown by perspiration, a palmar gipergidroz.
At violation of evacuation of contents of a gall bladder favorable conditions for sedimentation of insoluble particles with formation of microlitas are created. Further this state passes into cholelithiasis. A frequent complication of dyskinesia is chronic cholecystitis which develops as a result of accession of a secondary infection against the background of pathological changes of a wall of body. At stagnation of bile the syndrome of mechanical jaundice which is followed by intoxication of an organism and hepatic encephalopathy is formed. Owing to infectious defeat of bilious channels develops holangit. Insufficient intake of bile in intestines leads to emergence of syndromes of malabsorption and a maldigestiya.
Definition of a nosology is complicated as the disease belongs to a class functional and usually is not followed by organic pathology. Dyskinesia of a gall bladder is diagnosed by an exception of other diseases with a similar clinical picture. Diagnostic search assumes comprehensive examination of gepatobiliarny system of the patient. The most informative are:
- Ultrasonography of a gall bladder. Sonografiya reveals changes of volume of a bubble, existence of a giperekhogenny suspension. For assessment motor functions carry out the ultrasonic cholecystography – at dyskinesia after reception of a bile-expelling breakfast reduction of body less than for 40% is observed.
- Dynamic stsintigrafiya of gepatobiliarny system. The research with introduction to the patient of radiopharmaceutical is carried out for assessment of secretory function of a liver, extent of reduction of a bubble, passability of bile-excreting channels. Breakdown with holetsistokininy is supplemented.
- Duodenal sounding. By means of a consecutive fence of several portions of bile via the probe the nature of secretion and a rhythm of a zhelcheotdeleniye are specified. At hypomotor dyskinesia the increased amount of bile in portion In is observed, at a hyper motor form — reduced.
- Retrograde holangiopankreatografiya. The technique is applied to assessment of a condition of biliarny system, detection of concrements, expanded bile-excreting channels, visualization of a stenosis of BDS. Allows to differentiate functional frustration from organic pathology effectively.
- MRT of a liver and biliary tract. It is recommended as the specifying method at insufficient informational content of other tool researches. During layer-by-layer scanning with high resolution it is possible to visualize bilious channels and a bubble qualitatively.
Laboratory techniques have auxiliary value. In the general analysis of urine at a syndrome of mechanical jaundice increase in bilirubin and decrease in an urobilinogen is observed. In biochemical blood test slight increase of nuclear heating plant, alkaline phosphatase, cholesterol can be found, is more rare — direct bilirubin, lipoproteins. At a manometriya of a sphincter of Oddi at 60% of patients increase in pressure more than 40 mm of mercury is noted. Differential diagnosis of dyskinesia is carried out with inflammatory diseases of a biliarny path (cholecystitis, holangity), congenital anomalies of body (doubling, a hypoplasia, banners and excesses), striktura of a sphincter of Oddi, malignant new growths. Besides survey of the gastroenterologist consultations of the infectiologist, the hepatologist, the oncologist are recommended to the patient.
Treatment of dyskinesia of a gall bladder
Therapeutic tactics depends on type of motor dysfunction. Usually appoint the medicamentous therapy supplemented by correction of a diet and way of life. Frequent fractional food, normalization of weight, refusal of smoking, the dosed physical activities, an exception of stressful situations favorably affects the course of a disease. Taking into account features of violation of sokratitelny function are recommended:
- At hyper motor option of dyskinesia. For decrease in a tone of a muscular wall use miotropny spazmolitik, bile-expelling means with selective anti-spasmodic effect in relation to bilious channels, Oddi's sphincter. Exclude the products stimulating reduction of a muscular cover from a diet: hot and fat dishes, extractive substances, alcohol.
- At hypomotor option of dyskinesia. Purpose of prokinetik, holekinetik, natural and synthetic holeretik is shown. To improve bile outflow, enter rather weak proteinaceous broths, sour-milk molokoprodukta, eggs, vegetable oils into a diet. For prevention of locks increase quantity of the vegetable and other dishes stimulating motility of intestines.
In the presence of inflammatory process in addition apply nonsteroid resolvents. For knocking over of the expressed visceral giperalgeziya use tritsiklichesky antidepressants in small dosages. To patients with secondary forms of zhelchepuzyrny dysfunction etiopatogenetichesky treatment of the main disease under the recommended protocols is carried out. The pharmacotherapy is combined with physiotherapeutic techniques (prolonged tyubazhy, electrostimulation, pulse magnetotherapy), sanatorium treatment (reception of mineral waters, a peloidoterapiya). Holetsistektomiya will be seen off in exceptional cases at an intensive pain syndrome and the complicated course of dyskinesia.
Forecast and prevention
As complex treatment usually allows to reach permanent remission, the forecast is considered favorable. Complications arise in case of late diagnosis of a disease or in the presence at the patient of heavy interkurrentny pathology. For prevention of dyskinesia identification and elimination of diseases which break bile outflow, maintaining a healthy lifestyle (respect for the principles of the balanced food, performance of physical exercises, avoiding of stresses), maintenance of normal body weight is recommended earlier. Taking into account high efficiency of timely therapy at emergence of the first symptoms of pathology it is necessary to see a doctor as soon as possible.
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