Dyskinesia of the gallbladder
The content of the article:
- Forms of the disease
- Causes and risk factors
- Symptoms of gallbladder dyskinesia
- Dyskinesia of the gallbladder in children
- Diagnostics
-
Treatment of gallbladder dyskinesia
- Diet for gallbladder dyskinesia
- Treatment of gallbladder dyskinesia with mineral water
- Drug treatment for gallbladder dyskinesia
- Tubages for gallbladder dyskinesia
- Physiotherapy for biliary dyskinesia
- Potential consequences and complications
- Forecast
- Prevention
Dyskinesia of the gallbladder (dysfunction of the gallbladder) is a functional disorder in which the contractile function of the gallbladder is disrupted, as a result of which the flow of bile into the duodenal lumen ceases to meet the needs of the digestive process, i.e., bile is supplied either in insufficient quantities or in excessive.
With dyskinesia, no pathological changes in the gallbladder and bile ducts are observed. Thus, this disorder is not an independent disease, but is regarded as a functional disorder.
Gallbladder dyskinesia is often observed in the practice of gastroenterologists and therapists. Among all diseases of the biliary tract, it accounts for about 15%. In women, it occurs 10 times more often than in men, affecting mainly young people suffering from neurosis and / or asthenic syndrome. According to statistics, in 30% of cases, attacks of biliary colic are caused not by organic changes in the hepatobiliary system, but by dyskinesia of the gallbladder and ducts.
Forms of the disease
Depending on the cause, gallbladder dyskinesia is divided into two types:
- primary - due to congenital anomalies in the development of the bile ducts and / or gallbladder;
- secondary - develops as a complication of a number of diseases and hormonal disorders.
Depending on the peculiarities of the muscle tone of the walls of the gallbladder, the following forms of dyskinesia are distinguished:
- hypermotor (hyperkinetic) - characterized by increased contraction of the walls of the gallbladder, as a result of which an excessive amount of bile enters the duodenum, which is characteristic of young people;
- hypomotor (hypokinetic) - the tone of the walls of the gallbladder is reduced, which causes insufficient flow of bile into the duodenum. It is usually observed in people over 40 years old and suffering from neuroses.
Causes and risk factors
The causes of primary gallbladder dyskinesia are congenital anomalies:
- doubling of the gallbladder;
- narrowing of the gallbladder cavity;
- the presence of a septum in the gallbladder.
Source: yogatherapia.ru
Secondary dyskinesia of the gallbladder is caused by:
- gastritis, gastroduodenitis;
- peptic ulcer of the stomach and duodenum;
- cholangitis, cholecystitis;
- pancreatitis;
- viral hepatitis;
- cholelithiasis;
- hypothyroidism;
- stress, neurosis;
- vagotonia;
- condition after surgery on the abdominal organs;
- severe course of some diseases (dystrophy, myotonia, diabetes mellitus).
There are a number of factors that increase the risk of developing biliary dyskinesia. These include:
- genetic predisposition;
- insufficient intake of plastic substances, minerals and vitamins with food;
- irrational and unhealthy nutrition (poor chewing, frequent consumption of fatty foods, snacks on the go, dry food);
- helminthiasis;
- intestinal infections;
- changes in hormonal balance (premenstrual syndrome, obesity, hormone-active tumors, hormonal therapy, pregnancy and the postpartum period);
- inflammatory diseases of the abdominal cavity and small pelvis (appendicitis, solar syndrome, pyelonephritis, adnexitis);
- vegetative vascular dystonia;
- asthenic physique;
- hypodynamia;
- physical or mental stress;
- chest osteochondrosis;
- chronic diseases of an allergic nature (allergic rhinitis, urticaria, bronchial asthma);
- muscle weakness.
Symptoms of gallbladder dyskinesia
A number of common syndromes are inherent in all forms of dyskinesia:
- dyspeptic;
- painful;
- asthenovegetative;
- cholestatic.
Their severity differs in different patients.
Insufficient flow of bile into the duodenum leads to the development of cholestatic syndrome. It manifests itself in the following symptoms:
- icteric staining of the skin and mucous membranes;
- dark urine;
- lighter color of feces;
- itchy skin;
- hepatomegaly (enlargement of the liver).
Source: traffic-moscow.ru
Cholestatic syndrome develops in about every second patient with gallbladder dyskinesia.
The development of dyspeptic syndrome is associated with digestive disorders due to an inadequate amount of bile entering the intestines. Its signs:
- belching with air;
- decreased appetite;
- bad breath;
- nausea and vomiting;
- plaque on the tongue is white or yellowish;
- bloating;
- constipation (with a hypermotor form) or diarrhea (with a hypomotor form);
- dryness and bitterness in the mouth.
Dyskinesia of the gallbladder in almost all patients is accompanied by the development of asthenovegetative syndrome, manifested by the following symptoms:
- irritability, mood lability;
- general weakness, rapid fatigue;
- sleep disorders;
- excessive sweating (hyperhidrosis);
- low blood pressure;
- tachycardia attacks;
- headaches;
- decreased libido.
Another symptom of gallbladder dyskinesia is pain, the severity of which differs in hyperkinetic and hypokinetic forms of dysfunction.
With hyperkinetic dyskinesia of the gallbladder, pain is localized in the area of the right hypochondrium and may radiate to the right clavicle, scapula and / or arm. The pain is paroxysmal, acute, sharp. Painful attacks occur repeatedly during the day, but last no more than 30 minutes. Their development can be provoked by errors in nutrition, physical or mental overload. After the end of the attack, a feeling of heaviness remains in the right hypochondrium.
Intensive contraction of the walls of the gallbladder with hyperkinetic dyskinesia against the background of closed sphincters leads to the development of biliary colic. It begins suddenly with a sharp pain, accompanied by fear of death, tachycardia, numbness of the upper limbs.
With hypokinetic dyskinesia of the gallbladder, pain is localized in the epigastrium and right hypochondrium, and can spread to the right side of the back. It has a bursting, dull, aching character and lasts for several days.
Dyskinesia of the gallbladder in children
According to medical statistics, gallbladder dyskinesia occupies a leading place in the structure of the general incidence of the biliary system in children. About 80-90% of children registered with a gastroenterologist suffer from this functional disorder.
Dyskinesia of the gallbladder in children develops under the influence of the same reasons as in adults, but is more often associated with disorders of the neurohumoral regulation of the muscle tone of the walls of the gallbladder. Such disorders are usually observed against the background of neurocirculatory dystonia, therefore this condition is considered the main cause of gallbladder dyskinesia in pediatric practice.
The main clinical manifestation of gallbladder dyskinesia in children is the development of the right hypochondrium syndrome. It is characterized by severity and pain localized in this area. The nature of the pain is determined by the form of the disease. In the hypokinetic form, the pain is provoked by diet disorders and is dull in nature, continuing for a fairly long time (up to several weeks). The hyperkinetic form is manifested by an acute painful attack, the development of which can be provoked by strong psycho-emotional overload.
Children usually do not have any other signs of gallbladder dyskinesia.
Diagnostics
The diagnosis is made on the basis of characteristic clinical symptoms, physical examination data, laboratory and instrumental examination.
With dyskinesia of the gallbladder, the following laboratory tests are performed:
- general blood analysis;
- general urine analysis;
- biochemical blood test (the activity of aspartate aminotransferase, alanine aminotransferase, gamma-glutamyl transpeptidase, alkaline phosphatase, the level of magnesium, calcium, sodium, potassium, bilirubin, total protein and its fractions, uric acid, creatinine is determined);
- lipid profile;
- analysis of feces for helminth eggs.
The methods of instrumental diagnostics are also used:
- Ultrasound of the liver and gallbladder with a test breakfast - allows you to assess the size of the gallbladder, the state of its walls, contents, and also determine the form (hypomotor or hypermotor) dyskinesia;
- duodenal intubation - introduction of a probe into the duodenum, through which portions of bile are taken and sent for laboratory analysis;
- FEGDS (fibroesophagogastroduodenoscopy) - performed in cases where there is an assumption that gallbladder dyskinesia has arisen as a complication of a disease of the esophagus, stomach or duodenum;
- oral cholecystography - the patient is given a contrast solution to drink, and then an X-ray of the gallbladder is performed. This allows you to evaluate its shape and size, identify possible structural anomalies, determine the form of dyskinesia;
- intravenous cholecystography - the method is similar to oral cholecystography and differs only in that the contrast agent is administered intravenously;
- ERCP (endoscopic retrograde cholangiopancreatigraphy) is a method that combines X-ray examination and endoscopy; allows you to identify stones in the gallbladder, to determine the form of dyskinesia;
- hepatobiliary scintigraphy - the patient is injected intravenously with technetium isotope, which accumulates well in the gallbladder and bile ducts, after which the liver is scanned.
Source: traffic-moscow.ru
Treatment of gallbladder dyskinesia
Therapy for gallbladder dyskinesia is aimed at improving the outflow of bile from it. For this purpose, it is recommended:
- normalization of the work and rest regime;
- reception of mineral waters;
- adherence to a diet;
- drug treatment (choleretic, antispasmodics, enzymes, tranquilizers);
- carrying out tyubazh;
- physiotherapy (paraffin baths, diadynamic currents, electrophoresis);
- massage;
- Spa treatment.
Diet for gallbladder dyskinesia
Diet therapy plays a primary role in the complex treatment of gallbladder dyskinesia. Patients are prescribed a diet of table No. 5 according to Pevzner (modification is determined by the form of pathology and the characteristics of its clinical course). Food should be taken frequently, at least 5 times a day in small portions. All meals and drinks should be warm, as too hot or cold food temperatures can provoke a pain attack. When preparing dishes, dietary methods of heat treatment are used: baking, boiling, steaming. Exclude from the diet:
- fried, fatty and spicy foods;
- pickles and marinades;
- fatty meats and fish;
- cocoa and chocolate;
- confectionery, baked goods;
- alcohol;
- strong tea and coffee, carbonated drinks;
- vegetables irritating the gastrointestinal tract mucosa (sorrel, radish, onion, garlic);
- products that stimulate the processes of gas formation in the intestine (rye bread, cabbage, legumes);
- fresh milk.
The diet for biliary dyskinesia allows the use of the following products:
- dried bread from second grade flour;
- low-fat varieties of meat, poultry, fish;
- fermented milk products (cottage cheese, kefir, yogurt, natural yogurt, fermented baked milk);
- boiled or fresh vegetables, except for those on the list of prohibited foods;
- any cereals in the form of a dressing for soup or porridge;
- vegetable oil;
- butter (no more than 20 g per day);
- weak broths;
- coffee or tea with milk;
- honey.
The diet must be followed for a long time, at least 6 months, which allows you to achieve a stable remission. It is advisable for patients with gallbladder dyskinesia to adhere to the stated principles of dietary intake throughout their lives.
Treatment of gallbladder dyskinesia with mineral water
Mineral water for dyskinesia of the gallbladder is recommended to be drunk warm 3 times a day, half an hour before meals, one glass. With a hypokinetic form, mineral water with a high degree of mineralization is shown (Mashuk, Borzhomi, Batalinskaya, Essentuki No. 17). With hypokinetic, on the contrary, water with low mineralization is prescribed (Smirnovskaya, Narzan, Lipetskaya, Karachinskaya, Darasun). The duration of the course of mineral water therapy is 3-6 months.
Drug treatment for gallbladder dyskinesia
Medicines for the treatment of biliary dyskinesia are prescribed by a gastroenterologist, depending on the form of the disease. In the treatment of hyperkinetic dyskinesia of the gallbladder, the following are used:
- choleretic drugs belonging to the group of cholekinetics (Gepabene, Holosas, Flamin, Mannitol, Sorbitol, Oxafenamide) - improve the outflow of bile;
- cholespasmolytics (Drotaverin, Papaverin, No-shpa) - relieve pain;
- sedatives (Novopassit, motherwort or valerian tincture).
Source: myslide.ru
With a hypokinetic form of gallbladder dyskinesia, the following are prescribed:
- choleretic drugs belonging to the group of choleretics (Allochol, Cholenzym, Tanacehol, Lyobil);
- myotropic antispasmodics (Odeston, Duspatalin);
- enzyme preparations (Penzital, Creon, Mezim) - used for severe dyspeptic syndrome (flatulence, constipation or diarrhea, bitterness in the mouth);
- tonics (tincture of eleutherococcus, ginseng).
Tubages for gallbladder dyskinesia
Conducting tubeless tubazh is indicated only for hypokinetic dyskinesia of the gallbladder in remission. Before the procedure, the patient drinks 200 ml of a 10% solution of magnesium sulfate, 2 slightly beaten egg yolks, a glass of freshly squeezed beet juice or mineral water without gas, for example, Essentuki No. 17, and then lies down on his right side, placing a heating pad under it. The procedure takes 30-40 minutes. Tubages are repeated 6-8 times with a frequency of once every 7-10 days.
Physiotherapy for biliary dyskinesia
Physiotherapy is actively used in the complex treatment of gallbladder dyskinesia and contributes to the rapid relief of the main symptoms of the disease. With a hyperkinetic form of pathology, the following are used:
- Microwave therapy;
- inductothermy;
- electrophoresis with 0.1% papaverine hydrochloride solution, 10% magnesia solution or 5% novocaine solution;
- applications of ozokerite or paraffin;
- Charcot shower.
Patients with hypokinetic dyskinesia of the gallbladder are recommended:
- faradization of the gallbladder;
- UHF;
- diadynamic currents.
Potential consequences and complications
In the absence of treatment, gallbladder dyskinesia may be complicated by the development of cholangitis, calculous cholecystitis, and intestinal dysbiosis.
Source: med-explorer.ru
Forecast
The forecast is favorable. Although the pathology is chronic in nature, however, correct and timely treatment, maintaining a healthy lifestyle and adhering to a diet help prevent exacerbations.
Prevention
Prevention of gallbladder dyskinesia includes the following measures:
- timely detection and treatment of diseases that can provoke violations of the outflow of bile into the duodenum;
- adherence to the principles of healthy eating;
- normalization of body weight;
- maintaining an active lifestyle (playing sports, daily walks in the fresh air);
- avoidance of physical and mental overwork.
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Elena Minkina Doctor anesthesiologist-resuscitator About the author
Education: graduated from the Tashkent State Medical Institute, specializing in general medicine in 1991. Repeatedly passed refresher courses.
Work experience: anesthesiologist-resuscitator of the city maternity complex, resuscitator of the hemodialysis department.
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
