Inflammation of the bile ducts. Cholecystitis is an inflammatory process. Classification and features of the clinical course

The digestive system is a whole complex consisting of internal organs performing important functions.

Frequent disruptions occur individual bodies, which has serious consequences.

Diseases of the gallbladder and biliary tract lead to poor digestion, disruption of the production and passage of bile, blockage of the ducts, forming tissue tumors.

Women are more prone to these disorders than men. The reasons may be cholelithiasis, dyskinesia, cholecystitis, acute cholangitis, cancerous neoplasms.

Each pathology is serious and must be treated immediately.

Organ functions

The gallbladder gradually stores bile produced by the liver. When eating, food enters the stomach cavity.

At this time, all the accumulated bile is ejected from the gallbladder, penetrates into the duodenum through the ducts.

Bile, getting into the intestines, digests and assimilates the incoming food. Any changes in this system can lead to global consequences.

What other functional properties does this organ have:

• It effectively neutralizes gastric juice.
• Activates the enzymatic ability of pancreatic and intestinal juices.
• Destroys pathogenic microorganisms in the intestinal cavity.
• Normalizes peristalsis and motor activity of the intestinal tube.
• Removes toxins and metabolic products of drugs from the patient's body.

The main causes and mechanism of formation of pathologies

All diseases of the gallbladder and biliary tract have their own causes of formation and mechanisms of development. What they can be:

• Infectious. Inflammatory processes can form in the cavity of the organ and on its mucous membranes due to the development pathogenic microorganisms, viruses, fungi, protozoa. Often the provoking factor is Escherichia coli, staphylococcus, streptococcus, proteus.
• Due to imbalances in the components of bile, its composition may change. This leads to the formation of stones and the development of gallstone disease. It provokes stagnation, leading to inflammation.
• Diseases can develop that can have a direct effect on the impulses necessary for the gallbladder to carry out the motor activity of the organ. This leads to violations of the patency of bile and the occurrence of its stagnation.
• Heredity, genetic predisposition, congenital pathology. Violations can develop as a result of the bending of the body.
• Tumor neoplasms. Often, the causes that prevent the outflow of bile through the ducts are polyps, cysts, or tumor malignant neoplasms.

Any of these violations can lead to serious deviations in the work of the body, so it is extremely important to detect pathology in time.

Symptoms of diseases

Reveal pathological condition common and characteristic symptoms. The appearance of the first signs should alert the patient and serve as a serious reason for contacting a doctor.

Diseases of the gallbladder and biliary tract in the early stages are manifested by weakness, malaise, fatigue. The efficiency decreases sharply, the general condition worsens.

The appearance of the first pain sensations may be at the moment when the disease has already flowed into severe stage. Therefore, it is extremely important to undergo a medical examination on time.

What signs may appear:

• Pain syndrome in the region of the right hypochondrium. Each disease is expressed by different phenomena of pain. Their nature and intensity may differ, depending on the diagnosis. If the presence of polyps does not cause any pain, then pain in gallstone disease will be one of the main signs of the disease.
• Often, pathological processes are accompanied by nausea, vomiting, vomiting may open, diarrhea may be replaced by constipation, increased gas formation, bloating and flatulence.
• In the oral cavity, patients feel a bitter taste and bad smell. It should be carefully examined by a doctor, since this phenomenon is characteristic of both diseases of the gallbladder and the liver.
• The tongue may take on a red or crimson hue.
• The patient's urine becomes dark color. This is one of obvious signs a disease called cholestasis. This phenomenon is explained by the accumulation and high concentration of urobilinogen in the urine.
• The patient's feces become discolored. These changes occur due to congestion of bile. Stercobilin, necessary for the natural staining of feces, does not enter the intestinal cavity, which leads to the corresponding consequences.
• Manifestation of icteric phenomena. Cholestasis is characterized by the absorption of bile into the blood, which leads to deposits of substances in the skin epithelium and mucous membranes. The patient notes yellowing of the eye sclera, mucous membranes of the oral cavity and the skin itself.

These signs are the main accompanying pathological processes. But sometimes they can be accompanied by a loss of appetite and an increase in body temperature.

Diseases

Each disease is presented in the form of pathological processes, in which unpleasant symptoms appear, the causes of which are various changes in the work of the body.

Any diseases should be detected in time and excluded by right methods therapy, so it is very important to consult a doctor in time when the first suspicious symptoms appear.

Cholecystitis

There are two forms of pathology: chronic and acute. Chronic is characterized by a violation of the flow of bile, in which the composition and density of this substance changes.

In the acute course of the disease, the walls of the organ become inflamed as a result of blockage of the bile ducts. The inflammatory process covers the entire bladder, develops as a result of gallstone disease.

Causes

The main cause of the development of the disease are calculi. They disrupt the patency of bile, provoke infection with the intestinal microflora.

Constant inflammation alters the walls of the gallbladder, leading to a chronic condition. There are other reasons too:

• Anatomical features of the body.
• Weakening of muscle tissue.
• congestion phenomena.
• Violation of the functional activity of the body.
• Weak secretion by the stomach.
• Injury to the gallbladder or liver.
• Long and exhausting diets, starvation.

Manifestations

At acute form patients experience paroxysmal pain in the right side of the abdomen, which increases significantly with a change in posture.

Pain may radiate to the neck and back. What other signs may be:

• Slight rise in body temperature.
• Raising a high temperature with suppuration, intoxication.
• There is nausea, vomiting, the patient is shivering, his pulse quickens.
• When the canal is blocked with a calculus, acute pain, icteric phenomena occur.
• Urine darkens stool discolor.

The chronic stage is manifested by the following symptoms:

• Nausea.
• discomfort phenomena.
• Dull pain in right side, especially after eating.
• In the absence of a calculus, there is a deterioration in the general condition, weakness, and malaise.
• Sleep disorders.

Postcholecystectomy syndrome

The disease is considered rare and is characterized by a complex of symptoms related to diseases of the gallbladder. They arise as a result of surgical intervention after excision of the organ or its ducts.

Causes

Main reasons:

• There are remains of stones in the channels.
• The opening connecting the ducts with the duodenum is narrowed.
• development of pancreatitis.
• The appearance of gastritis.
• Inflammatory process in the intestines.

Manifestations

The main symptoms are:

• Bitterness, nausea, bloating and flatulence, intestinal upset appear in the mouth.
• Pain in the right side of the abdomen, radiates to the right shoulder, collarbone.
• Paleness of the skin, weakness.

With exacerbation of concomitant diseases, an increase in body temperature, the appearance of icteric phenomena are possible.

Dyskinesia

The disease is characterized by impaired functional abilities of the bile ducts as a result of an unstable outflow of bile.

It can be intense or very weak. This process leads to serious violations in digestion.

Causes

The main reasons are:

• Low mobility, inactive lifestyle.
• Hormonal imbalances, hormonal imbalances.
• Violation of the microflora in the intestine.
• Overweight.
• Lack of vitamins.
• Stress, unstable psycho-emotional state.
• Strong physical stress.
• Eating disorder.

Manifestations

One of the common and main symptoms is pain. In the hyperkinetic form, its character may be different.

In many cases, the pain is paroxysmal in nature. More often appears after eating. The area of ​​its localization is the right hypochondrium.

Other signs:

• The occurrence of biliary colic.
• Colic is accompanied by severe short-term pain, numbness of the limbs.
• Pulse and heart rate increase.

The manifestation of the hypokinetic form:

• The occurrence of dull and aching pain.
• The appearance of heaviness and bursting in the right side.
• Bloating, flatulence.
• The nature of the pain is prolonged.
• The pain is reduced after eating and taking choleretic drugs.

Itching, skin rashes, loss of appetite may also appear.

Acute cholangitis

Inflammatory, more often infectious disease of the bile ducts is considered a consequence of prolonged cholecystitis, surgery or cholelithiasis.

The occurrence can occur due to stagnation of bile, the development of tumor neoplasms.

Causes

The main causes of the disease include stagnation of bile and infection.

In the first case, the process is formed as a result of blockage of the channels with calculi, tumor neoplasms, and helminthic invasions.

Prolonged dyskinesia can also cause the formation of congestion. Under such conditions, the composition of bile changes, there are ideal conditions for the development of infection.

Surgical intervention can also cause an ailment.

Manifestations

The main symptom of pathology is pain, which can give in right hand or disturb left side torso.

The pain syndrome is accompanied by accompanying signs:

• Arterial pressure drops sharply.
• Constant nausea with frequent vomiting, after which there is no relief.
• Itching on the skin.
• Muscle tissue in the right side of the abdomen is under tension.
• Raise body temperature up to 40 C.
• The patient is shivering, there is increased sweating.
• Weakness, poor health.

neoplasm

Tumors can be benign or malignant. Both options proceed without significant symptoms.

When the first signs appear, symptoms are noted that are often confused with cholecystitis.

Causes

The causes of tumor neoplasms can be concomitant diseases of the biliary system, digestive organs, hormonal disorders.

Often tumors are due to malnutrition, long-term use medicines with a wide range side effects, chronic depressive and stressful conditions.

Particular attention is paid to bad habits and bad ecology.

Manifestations

Benign tumor neoplasms do not disturb their owner for a long time. They rapidly increase in size without causing significant problems.

Reaching large sizes, they can manifest themselves in the form of pain, skin rashes or itching. Often there are icteric phenomena, covering not only the skin, but also the eye sclera.

Particular attention is paid to the general condition: the patient feels sick, he becomes ill, his sleep is disturbed, he becomes weak, an apathetic state occurs.

Malignant, which means cancer education presents with severe symptoms. The patient suffers from pain that is not amenable to medicinal painkillers.

The patient is constantly sick, he has repeated vomiting. due to decreased appetite or complete failure from food, he significantly loses body weight.

When diagnosing gallbladder on ultrasound ( ultrasound examination) shows an increase in its size.

Cholelithiasis

high levels of cholesterol and low level bile acids provoke the formation of stones, which gradually increase in size as harmful substances accumulate.

Stones block the ducts, disrupting the outflow of bile. The consequences are disruptions gastrointestinal tract, pain syndromes, spasmodic conditions, disorders of the intestinal microflora.

Causes

• Obesity, overweight.
• Diabetes.
• Improper diet, alcohol intake, fatty foods.

Manifestations

The patient feels severe pain, cramps and colic in the right side of the abdomen under the ribs. He is constantly exhausted by nausea, which is very often accompanied by vomiting.

Blockage of channels causes stagnation of bile. It gradually accumulates, penetrates into the walls of the bladder, and then into the blood. This leads to yellowing of the skin on the body, mucous membranes in the mouth and eyes.

There are cases when the stone is released from the gallbladder on its own, after which it passes through the channels and enters the cavity duodenum.

If the calculus is stuck in the ducts, it begins inflammatory process leading to acute cholecystitis.

This ailment is dangerous for its asymptomatic course, in which feelings of weakness, lethargy, and the development of complications are possible.

First signs pathological process should get the attention of the patient. He must certainly visit a doctor to find out the exact cause of pain in the right side of the abdomen and other unpleasant symptoms.

Some diseases can be asymptomatic, so they can develop rapidly, disturbing their owner only during the severe stage.

Help to identify a pathological condition will allow laboratory research blood, urine and feces. Just as relevant instrumental methods diagnostics.

Many diseases are easy to treat traditional method treatment with drugs. Sometimes only surgical intervention is required.

Any method of treatment is accompanied proper nutrition. Only right balanced diet will avoid many exacerbations and improve the functioning of the digestive system.

Refuse junk food. Instead they use healthy food. It's worth forgetting forever bad habits because they provoke painful conditions and aggravate them.

They follow a healthy lifestyle, follow all the recommendations of the attending physician. Only a specialist can supply correct diagnosis and name the reason for the appearance of unpleasant symptoms.

You can not delay the visit to the doctor. It's just as dangerous as self-medication.

Useful video

The gallbladder is hollow organ digestive system, the main function of which is to collect bile in itself and direct it, if necessary, to small intestine namely, in the duodenum.

Diseases of the gallbladder and biliary tract occupy a leading position in the structure of the pathology of the digestive tract. Moreover, the pathology of the gallbladder in women is more common than in men.

Given the prevalence of this problem, we propose to consider in this topic the most common diseases of the gallbladder, symptoms and treatment. certain types pathology. But first, we want to introduce you to the anatomy and functions of the gallbladder.

The gallbladder is a hollow, pear-shaped organ with more wide base and a narrow distal end that passes into the cystic bile duct. normal length this body is 80-140 mm, and the diameter is 30-50 mm.

IN gallbladder It is customary to distinguish three parts: the neck, body and bottom. This body is located on bottom surface liver in the fossa of the same name.

The wall of the gallbladder consists of three layers - serous, muscular and mucous. Slime layer has many longitudinal folds.

An unchanged gallbladder is not palpable through abdominal wall. The projection zone of this organ is located at the intersection point of the outer edge of the rectus abdominis muscle and the right costal arch, which is called the Kera point. In cases where the gallbladder is enlarged, it can be felt.

Gallbladder: functions

The gallbladder acts as a reservoir for storing bile. Liver cells produce bile, which is stored in the gallbladder. When a signal is received, bile enters the cystic duct, which flows into the common bile duct, and the latter opens into the duodenum.

In addition to the reservoir function, the organ has other purposes. So, in the gallbladder, mucus and acetylchocystokinin are produced, and also occurs reverse suction nutrients.

For a day at healthy people up to one liter of bile is formed. The maximum capacity of the gallbladder is 50 ml.

Bile is made up of water, bile acids, amino acids, phospholipids, cholesterol, bilirubin, proteins, mucus, certain vitamins, minerals, and drug metabolites that the patient is taking.

The following tasks are assigned to bile:

• neutralization of gastric juice;
• activation of the enzymatic ability of intestinal and pancreatic juice;
• neutralization of pathogenic microorganisms in the intestine;
• improvement motor function intestinal tube;
• elimination of toxins and drug metabolites from the body.

Diseases of the gallbladder: causes and mechanism of development

All causes of diseases of this organ can be divided into groups, namely:

Gallbladder: a brief description of diseases

• Cholelithiasis. This disease is more common in fair-haired women who have given birth over 40 years of age, who have excess weight or are obese. Stones are cholesterol, bilirubin brown and black, which can form in all parts of the biliary system. Rarely, only the gallbladder is affected. Cholelithiasis is a long-term chronic disease with periods of exacerbation and remission. IN acute period stones obturate the cystic duct, resulting in patients with acute pain with other unpleasant symptoms. This combination of symptoms is called hepatic colic.
• Chronic non-calculous cholecystitis. IN this case stones are absent, and inflammation of the mucous layer of the gallbladder causes an infectious agent, reflux of intestinal juice, diseases of the pancreas (pancreatitis), liver (hepatitis) or cholestasis.
• Biliary dyskinesia. This disease is characterized by the absence of organic changes in the gallbladder and ducts and occurs against the background of impaired innervation. Contribute to the development of dyskinesia chronic stress, excessive physical and mental load, neurasthenia. There are two types of dyskinesia - hyperkinetic, when the intestinal motility is too active, but chaotic, and hypokinetic, when the peristalsis of the bladder is weakened.
• Acute cholangitis, or inflammation of the bile ducts. Almost always to this disease lead other diseases of the liver and gallbladder (cholecystitis, cholelithiasis, hepatitis, postcholecystectomy syndrome, and others).
• Carcinoma. Malignant tumors in the gallbladder develop against the background chronic inflammation. This type of tumor is characterized by high malignancy and the appearance of screenings on early stages diseases.

What are the symptoms of gallbladder disease? Most diseases of the gallbladder have common symptoms.

Patients may experience the following symptoms:

• pain that is localized in the right hypochondrium. Moreover, the intensity of the pain syndrome in various diseases different. For example, polyps are completely painless, and calculous cholecystitis or cholelithiasis cause acute severe pain.
• dyspepsia, such as nausea, vomiting, bloating, diarrhea or constipation;
• bitterness in the mouth. In this case, it is necessary to conduct a thorough differential diagnosis, since this symptom may also accompany liver disease;
• redness of the tongue. This symptom commonly called "raspberry tongue";
• change in urine color. Due to cholestasis in the urine accumulates a large number of urobilinogen, which gives it the color of dark beer;
• discoloration of feces. As a result, stercobilin does not enter the feces, which gives the feces a natural brown color;
• jaundice. With cholestasis, bile begins to be reabsorbed into the blood, as a result of which bile acids and bilirubin are deposited in the skin and mucous membranes. The sclera and oral mucosa turn yellow first, and only then the skin.

The listed symptoms and signs are the main ones in diseases of the gallbladder. But depending on the nosological form and course of the disease, other symptoms may also be added, such as fever, general weakness, malaise, loss of appetite, and others.

Diagnosis and treatment of diseases of the gallbladder is carried out by a general practitioner, gastroenterologist, surgeon or hepatologist. First of all, if symptoms of diseases of this organ appear, you need to contact a general practitioner who, if necessary, will refer you to related specialists.

At objective examination the doctor must palpate the liver and gallbladder, with which you can determine pain points, that is, bladder symptoms, namely:

• Kera's symptom- pain on palpation of the gallbladder on inspiration;
• Georgievsky-Mussi symptom - appearance pain when pressing on a point that is located between the legs of the right sternocleidomastoid muscle;
• symptom of Ortner-Grekov- pain is provoked by tapping the edge of the palm on the right costal arch.

But complaints, anamnesis and objective data will not be enough for setting accurate diagnosis Therefore, patients are assigned the following additional studies:

• general blood analysis, which is used to determine blood changes characteristic of the inflammatory process in the body;
• general and biochemical analysis urine allows you to detect an increased level of urobilinogen;
• coprogram show violations of the digestive function;
• duodenal sounding. This method is performed using a thin rubber tube that is placed through the mouth into the duodenum to collect portions of bile.
• chemical analysis of bile used to study its composition.
• bile culture suggests the etiology of the disease;
• ultrasound examination of the abdominal organs. By using this method can be studied anatomical features gallbladder and identify organic changes, inflammation and the presence of stones.
• biopsy, performed with a thin needle under ultrasound guidance. The resulting material is examined under a microscope for the presence of cancer cells.
• cholangiography- This is an X-ray contrast study of the gallbladder and bile ducts;
• CT scan used mainly in gallbladder cancer to assess the prevalence of screenings.

Treatment of diseases of the gallbladder

All patients must be prescribed a diet, the principles of which we will discuss below.

Etiotropic treatment It consists in the use of drugs that are aimed at eliminating the cause. Indicated for cholecystitis antibiotic therapy, with stones, carcinoma or polyps of the gallbladder - surgery.

Pathogenetic treatment consists in the use of drugs that normalize the functioning of the gallbladder. For this purpose, antispasmodic, detoxifying, anti-inflammatory and enzymatic drugs can be used.

Symptomatic treatment involves the appointment of painkillers, choleretic, antipyretic and other drugs. For pain, drugs such as Ketonal, Baralgin, Drotaverin, Spasmolgon and others can be used.

Folk remedies will be an excellent addition to traditional therapeutic measures.

Even specialists often supplement the traditional therapy of gallbladder pathology with phytotherapy. To your attention the recipes of the most effective means and indications for their use.

Rosehip decoction: 3 tablespoons of rose hips are crushed in a mortar, 300 ml of boiling water is poured and boiled over low heat for 5 minutes. After that, remove from heat, let cool and filter through a fine sieve. Ready decoction is taken orally 100 ml three times a day 10 minutes before meals. This decoction has choleretic, analgesic and anti-inflammatory effects and is an analogue of the drug "Holosas". This medicine is used for non-calculous cholecystitis, cholangitis, hepatitis, biliary dyskinesia and other diseases in which the outflow of bile is slowed down.

Beetroot decoction: wash two medium beets, peel and cut into small pieces, then pour 10 glasses of water, bring to a boil and cook over low heat for about five hours. When the beets are ready, they rub them on a grater, transfer them to gauze and squeeze out the juice, which is combined with the broth. Take this medicine 60 ml half an hour before meals three times a day. With cholecystitis, the course of treatment is from 7 to 10 days.

Herbal collection: mix 1 tablespoon of herbs such as celandine, tansy (flowers), mint (leaves), calendula (flowers), wormwood, fennel seeds, dandelion (root), corn stigmas, immortelle (flowers). After that, 10 grams of the resulting collection is poured with two glasses of boiling water, covered with a lid and infused for 40 minutes. The finished infusion is filtered through a fine sieve and taken orally 100 ml 3 times a day before meals. This medicine has analgesic, choleretic and anti-inflammatory effects, so it is prescribed for cholangitis and cholecystitis.

Lingonberry leaf infusion: 10 grams of crushed lingonberry leaves are poured into 200 ml of boiling water, covered with a lid and infused for 40 minutes. The finished medicine is stored in the refrigerator and taken 30-40 ml 4-5 times a day before meals. An infusion of lingonberry leaves dissolves stones in the gallbladder and ducts. Olive oil has the same effect, which should be consumed in a dose of 15 ml before each meal.

Dietary nutrition for diseases of the gallbladder

In diseases of the gallbladder, diet is an indispensable component of treatment. All patients are assigned table number 5 according to Pevzner.

The diet for gallbladder pathology is as follows:

• eat fractionally, that is, in small portions 5-6 times a day;
• should be consumed enough liquids (at least 1.5 liters);
• during remission, it is recommended to reduce the proportion of fried, spicy and smoked foods in the diet;
• limit the proportion of fats in the diet, including plant origin;
• stop drinking alcohol and smoking;
• during exacerbation, it is forbidden to eat food and water. As the symptoms subside, food is resumed (50 ml vegetable puree soup, 100 ml unsweetened tea or fruit juice), gradually expanding the diet;
• exclude fresh bread and pastries from the menu, as well as ice cream, sweets, sweet soda and caffeinated drinks;
• the menu should be composed of soups-puree with vegetables, cereals, low-fat varieties meat, cereals, vegetable purees and stews, fruits, berries, vegetable salads, low-fat dairy products.

As a result, we can say that gallbladder diseases have similar symptoms, so make the correct diagnosis and prescribe effective treatment only a specialist can.

The bile produced in the liver enters the duodenum through ducts called the bile ducts. When the functioning of these ducts is disturbed, they speak of biliary dyskinesia. Almost 15% of patients who have any pathologies in the work of the gallbladder suffer from this particular disease.

Causes of biliary dyskinesia

Depending on the cause, primary and secondary form diseases.

The following factors can contribute to the occurrence of a primary dysmotility of the bile ducts:

• , depression and other mental disorders;
• malnutrition and violation of its regime ( bad chewing, dry food, constant use fatty foods and fast food, overeating, etc.);
• sedentary lifestyle (including in the elderly and bedridden patients);
• diseases, often congenital, accompanied by a decrease in muscle tone.

Secondary disorders of the functions of the bile ducts can occur for the following reasons:

• diseases of the liver and the gallbladder itself (,);
• chronic diseases organs of the digestive system (, etc.);
• intestinal infections ( typhoid fever, yersiniosis, brucellosis, cholera, etc.) and;
• hormonal disorders in the body;
• congenital anatomical disorders in the structure of the gallbladder and bile ducts.

Disease types

There are three types of this disease:

• hypertensive - more common at a young age and is associated with an increase in the contractile function of the gallbladder and its ducts;
• hypotonic - usually diagnosed in patients over 40 years of age, occurs as a result of a decrease in the motility of the organs of the gastrointestinal tract;
• mixed - at different times there are symptoms of both types of dyskinesia, their signs, although very similar, still have differences.

Symptoms of biliary dyskinesia

Pain. With hypotonic dyskinesia, dull It's a dull pain in the right hypochondrium is present almost constantly, subsides at night, increases after eating. In the hypertensive type of the disease, the pain syndrome is quite intense, gives to the right arm and shoulder blade, occurs as a result of eating fatty foods, physical activity, stressful situation lasts up to half an hour. And between attacks, patients may complain of severity and slight discomfort in the left hypochondrium, general well-being quite satisfactory.

A bitter taste in the mouth and a white or yellowish coating on the tongue. These symptoms are more characteristic of the hypotonic type of dyskinesia, but may also be present in hypertensive. Bitterness is more often felt after sleep, some time after a normal meal or physical activity, and may be present all the time.

Nausea and vomiting. This symptom is necessarily provoked by something, most often it appears when abundant reception fatty foods, overeating, or eating too fast. With biliary dyskinesia, vomiting undigested food with an admixture of bitter bile occurs at the peak of pain.

Chair disorders. With dyskinesia of the bile ducts, the flow of bile into the intestine is disrupted. With a hypotonic type of disorder, a lack of bile leads to a deterioration in intestinal motility, digestion of fats, as a result of which the passage of food bolus By digestive tract, there are also excessive formation of gases in the intestines. With a hypertensive type of dyskinesia, bile in the intestine may be sufficient, but it can be thrown out both during meals and into an empty intestine. As a result, peristalsis increases, water absorption slows down and occurs. Often this happens after an attack.

. With any type of biliary dyskinesia, digestion is disturbed, the absorption of nutrients worsens, and fat metabolism is especially affected. In addition, with a lack of bile, appetite decreases. With a long course of the disease, patients begin to slowly lose weight.

Treatment of biliary dyskinesia

If the disease is secondary, then first of all it is necessary to treat the disease that led to a disruption in the functioning of the gallbladder and ducts through which bile flows. Symptoms of dyskinesia can go away on their own with proper treatment of the underlying pathology.

The causes of primary biliary dyskinesia are also corrected. If the violations are of a psycho-emotional nature, then a psychotherapist's consultation and the appointment, and if necessary, antidepressants and tranquilizers, may be required.

Diet

For any type of dyskinesia, treatment must begin with a diet, usually the diet corresponds to table No. 5 according to Pevzner. Any fried, fatty, smoked, salty, sour food is excluded, whole milk, alcohol, as well as any other products that stimulate digestive processes. With hypertensive type of dyskinesia

and additionally excluded fresh fruit.

During the period of exacerbation, especially in the early days, it is better to cook food in a double boiler, additionally chop, eat 5-6 times a day in small portions of 200-300 g. After the symptoms disappear, a strict diet should be followed for several more months.

During the period of remission with biliary dyskinesia, the diet becomes less strict, but it is still not worth abusing fatty and fried foods.

For any diseases of the liver and gallbladder, it is recommended to adhere to the diet constantly.

Drugs for biliary dyskinesia

The appointment of drug therapy should be done by a doctor. If the diet for any type of disease is not fundamentally different, then drug therapy for hyper- and hypotonic types of dyskinesia has significant differences.

Antispasmodics are prescribed only for the hypertensive form of the disease. They are necessary to reduce the tone of the biliary tract and relax the sphincters that prevent the outflow of bile. Most often, drugs are prescribed, the active substance of which is drotaverine. Papaverine can also be used in the treatment of this disease; in its effect, it is several times inferior to drotaverine and is prescribed for mild attacks.

Cholagogue are widely used for biliary dyskinesia, but if the patient has concomitant cholelithiasis, they are contraindicated. These drugs increase the amount of bile discharge, increase the tone of the gallbladder, and reduce the tone of the ducts and sphincters that occur along the path of bile to the intestines. It is better to entrust the choice of the drug to the doctor, since the group of drugs is very large, and they contain different active ingredients.

For example, the drug Gepabene, containing extracts of milk thistle and fumes, is prescribed for hypertensive dyskinesia, and Hofitol, the main active ingredient of which is field artichoke extract, is more often recommended for hypotonic type of disease. Both drugs belong to the group of choleretic, but differently affect the body.

The autonomic nervous system has a direct effect on the regulation of the motility of the gallbladder and biliary tract, therefore, in the composition complex therapy means that tonic or relax it are included.

In hypertensive dyskinesia are prescribed sedatives of plant origin (infusion of valerian, motherwort, Persen, etc.), as well as drugs that inhibit excitation processes in the central nervous system(for example, ankylosing spondylitis). Hypotonic type of disease requires an appointment means tonic the autonomic nervous system(ginseng, eleutherococcus, Schisandra chinensis, etc.).

Mineral water

Treatment with mineral waters is carried out only during remission. For diseases of the liver and biliary tract, sulfate and bicarbonate-sodium waters are used (Smirnovskaya, Slavyanovskaya, Izhevskaya, Essentuki No. 4 and No. 17, Borjomi, etc.). Before starting such treatment, it is necessary to carefully study the composition and properties of mineral waters, since they all affect the digestive system as a whole, and as unwanted effect you can get diarrhea.

Physiotherapy

At increased tone bile ducts, electrophoresis with papaverine or platyfillin is prescribed, paraffin applications, magnetotherapy, coniferous baths.
In the hypotonic form of dyskinesia, electrophoresis with pilocarpine, diadynamic therapy and pulsed magnetotherapy are recommended.

Surgical treatment for biliary dyskinesia is not indicated.

Which doctor to contact

Treatment of biliary dyskinesia is done by a gastroenterologist. Additionally, you may need to consult a psychotherapist, surgeon, nutritionist, infectious disease specialist. The examination includes ultrasound of the hepatobiliary zone, duodenal sounding, sometimes cholecystography and cholangiography are necessary.

Biliary dyskinesia is not independent disease- This is a consequence of improper flow of bile into the duodenum for digestion. JVP is accompanied by aching, dull, sharp pains in the abdomen, an unpleasant odor from the oral cavity is considered an indirect sign. Treatment of pathology is aimed at correcting the underlying disease.

The main symptom of biliary dyskinesia is aching dull pain in the abdomen.

JVP - what is it?

Bile duct dyskinesia is a syndrome in which the normal physical activity biliary tract, the tone of the gallbladder decreases. Isolate organic and functional type disorders.

The syndrome is observed in 70% of cases of diseases of the gastrointestinal tract. Of these, 10% of cases are primary dysfunctions that are not associated with other disorders of the digestive system.

With DZHVP, the motor activity of the biliary tract is disturbed

Pathology according to ICD-10 was assigned the code K82.8 - diseases of the bile ducts of unspecified origin.

Types of biliary dyskinesia

There are 3 types of JVP:

1. hypokinetic(hypomotor, hypotonic). In this case, there is a decrease in the tone of the gallbladder, a decrease in the motor activity of the ducts.
2. hyperkinetic(hypertonic, hypermotor). It is dominated by spastic phenomena, increased contractility of the organ.
3. mixed. With a mixed form, there is both a change in tone and colicky pains.

Hypomotor type dysfunction

It is characterized by a lack of bile for the process of digestion of food. The production of the substance does not suffer, but at the time of release there is not a sufficient contraction of the gallbladder. This leads to the fact that food is not digested and not absorbed in full.

Dysfunction of the hypomotor type in the vast majority of cases develops in elderly people.

A patient with hypotonic dyskinesia is a person over the age of 40 years. The main cause of dysfunction of this type of pathology is stress, psychological disorders.

A typical symptom is a dull arching pain that spreads to the back and right shoulder blade. The pain syndrome can last for several days.

DZHVP on hypertonic type

More often it develops in women from 30 to 35 years old, adolescents and children. The attack develops suddenly in the form of colic. At the same time, the pressure in the gallbladder increases sharply, a spasm of the sphincters of Lutkens or Oddi is observed. The pain syndrome lasts no more than 20 minutes. Develops after eating, at night.

The emergence of JVP according to hypertonic type possible in children and adolescents

mixed form

It is characterized by the presence of signs of dysfunction in both hypokinetic and hypermotor types.

Causes of JVP

There are 2 types of biliary dyskinesia. The classification is based on the causes that caused a violation of the release of bile.

Causes of the primary syndrome:

1. stress factors- acute or chronic nervous strain both at work and in personal life. It provokes inconsistency in the work of the sphincters of the gallbladder.
2. Errors in the diet- disregard for the rules healthy eating, infrequent meals. This leads to a violation of the production of digestive enzymes, hormones. Over time, dyskinesia develops.
3. Diseases allergic nature V chronic form . The presence of an allergen leads to irritation of the sphincters, which provokes inconsistency in their activity.

Causes of secondary dysfunction:

1. Gastrointestinal diseases - gastritis, enteritis, ulcers, cell death of the mucous membranes of the stomach and duodenum.
2. Chronic inflammation in the reproductive area, cystic changes in the ovaries, kidney disease.
3. Liver pathologies - hepatitis, cholangitis, the presence of stones in the gallbladder.
4. Salmonellosis in history.
5. Other bacterial and viral diseases of the gastrointestinal tract.
6. Worm infestations.
7. Congenital malformations of the structure of the gallbladder - bends, constrictions.
8. Endocrine pathologies, menopause in women.

Symptoms of gallbladder dysfunction

The symptomatology of the pathological process depends on the type of dysfunction.

Table: Signs of JVP depending on the type of disease

An increase in temperature with dysfunction of the bile ducts is not observed. Its presence indicates the beginning of the inflammatory process, bacterial damage.

Which doctor should I contact?

In case of violation of the digestive system, consult a gastroenterologist

The treatment of dysfunction of the digestive system is engaged in:

According to indications, consultations are possible.

Diagnostics

The task of the doctor at the stage of examining the patient is to determine the type of pathology, identify the causes of dyskinesia and exclude other diseases, including tumor genesis.

The survey includes:

1. Inspection and questioning patient, palpation of the abdomen.
2. ultrasound- to determine the size of the organ, exclude developmental anomalies, tumors, assess the contractile activity of the gallbladder.
3. General blood analysis- at increase in ROE one can judge the inflammatory process, an increase in eosinophils and leukocytes - possibly a helminthic invasion.
4. Biochemistry of blood- there may be an increase in bilirubin and cholesterol, the appearance of C-reactive protein.
5. Cholecystography- X-ray of the digestive tract using contrast agent. As a contrast, iodine preparations are used orally or infusionally.
6. Cholangiography- according to indications - x-ray examination of the bile ducts after the introduction of a contrast agent. The drug is administered percutaneously by puncture method. At the same time, the doctor conducts drainage of the ducts. Manipulation is performed under local anesthesia.
7. Endoscopic cholangiography- according to indications - through the oral cavity with the help of an endoscope, a camera is passed into the gallbladder. Contrast is introduced, pictures are taken. At the same time, stones can be removed.
8. duodenal sounding- according to indications - a study of the composition of bile, an assessment of the motor activity of the bile ducts.

Cholecystography using a contrast agent allows you to get complete picture about the state of the gastrointestinal tract

The method of examination of the patient is determined by the doctor. It may change depending on the symptoms and as the results of the study become available.

Treatment of biliary dyskinesia

Treatment of gallbladder motility disorders is carried out in a complex manner in both adults and children, and also depends on the type of dysfunction.

Patient management includes:

• mode;
• normalization of nutrition;
• drug therapy;
• physiotherapy;
• sanatorium treatment - if possible.

Physiotherapy is prescribed for gallbladder motility disorders

In addition, it is necessary to normalize psycho-emotional state, sleep.

Medications

Drug treatment is long and depends on the type of bile duct motility disorder.

In the treatment of hypomotor dysfunction

Choleretics - Hofitol, Cholenzim, Allohol - they all contain either bile or bile acids, digestive enzymes, plant extracts.

The active components of the drugs enhance the contractile activity of the gallbladder, improve the digestion of food. Against the background of the reception increases the production of bile.

Taking Hofitol enhances the contractile activity of the gallbladder

Individual dosages are selected by the doctor. The duration of treatment is from 20 days to 2 months.

The drugs are well tolerated. Against the background of the reception, diarrhea may develop, various allergic reactions. In this case, drug tactics are reviewed.

This group of drugs is not prescribed in the presence of:

• nephritis, hepatitis in the acute period;
• obstruction of the bile ducts;
• the presence of stones;
• individual sensitivity.

Tonics for plant-based normalizing the state of the nervous system:

• extract from ginseng root.

Take Eleutherococcus tincture to stabilize the nervous activity of the body

The drugs stimulate the higher nervous activity, reduce fatigue, improve the body's adaptation to various stimuli.

Dosages depend on the age and condition of the patient and can range from 15 to 30 drops per 1 dose. Main side effect tincture is insomnia. Therefore, it is undesirable to take them in the evening.

Contraindications to the appointment:

• childhood;
• pregnancy, lactation;
• individual intolerance;
• insomnia in history;
• period of menstruation.

Tubazhi - with mineral water, sorbitol, magnesia - only during remission and in agreement with the doctor.

The procedure is aimed at improving the outflow of bile.

Tubazh help maintain the outflow of bile during the remission of the disease

You should take 100-200 ml of water or sugars dissolved in it, magnesium sulfate and lie on your right side on a heating pad for 40 minutes. It is forbidden for cholelithiasis, a history of ulcers, inflammation in the liver.

In the treatment of hypermotor dysfunction

Cholekinetics - relax the bile ducts, but increase the tone of the bladder itself, relieve spasms, reduce the level of lipids in the blood.

• Oxaphenamide;

Gepabene is prescribed to relax the bile ducts and relieve spasms

Both the one and the other drug are taken 1 capsule 3 times a day. From side effects only episodic cases of diarrhea have been observed. Medicines are not prescribed for inflammatory processes in the liver in the acute period.

Antispasmodics - No-shpa, Papaverine - to relax smooth muscles. This relieves pain during an attack.

No-shpa will help remove pain during an attack

Additionally shown sedatives doctor's choice.

Folk remedies

Phytotherapy belongs to folk methods treatment. But at the same time they use medicinal herbs used in official medicine. The duration of treatment with phytocollections is from 2 to 3 weeks.

Decoction of immortelle flowers

Use immortelle flowers to make a medicinal decoction

It will take 60 g of vegetable raw materials and 1 liter of boiling water. Fill and wrap. Let it brew until the broth has completely cooled. Take 100 ml half an hour before meals 3 times a day.

Corn silk

Brew corn silk to make a medicinal infusion

Requires 4 tbsp. l. pour 1 liter of boiling water. Wrap and leave to cool. Take 1 tablespoon 3 times a day.

Chamomile tea

Replace regular tea with chamomile tea to improve the digestive tract

Take 1 tbsp. l. chamomile flowers and pour 1 cup of boiling water. Insist 5 minutes. Take 1 glass of tea 3 times a day.

Liquorice root

Boil licorice root for an effective remedy for FAD

You will need 2 teaspoons of chopped vegetable raw materials. Pour a glass of boiling water and simmer over low heat for 15 minutes. Strain and top up with water to a full glass. Take 100 ml 3 times a day before meals.

Mint tea

Accept Mint tea 3 times a day before meals

Need 2 tbsp. l. pour 1 cup boiling water. Insist 30 minutes. Take 100 ml 3 times a day before meals. The course of treatment is 4 weeks.

Diet for JVP

Diet is an essential component of the treatment of bile duct dysfunction. In the first few days, pureed soups, cereals, vegetable puree. Starvation is not shown.

sample menu

Nutrition should be fractional: during the day, make 5-6 meals.

When following a diet, it is important to split the food - divide the daily norm of food into 5-6 meals

First day:

1. Breakfast - vegetable salad, rice milk porridge, tea, bread and butter.
2. The second breakfast is an apple, baked or 250 ml of fruit juice.
3. Dinner - vegetable soup, baked chicken breast, braised cabbage, compote.
4. Snack - biscuit cookies, dried fruit compote.
5. Dinner - millet porridge, boiled beef, boiled beetroot salad with vegetable oil, tea.
6. At night - a glass of fermented milk product.

Second day menu:

1. Breakfast - oatmeal on the water, a glass of fermented baked milk.
2. The second breakfast is fruit puree.
3. Lunch - vegetable soup, pasta, steamed meat casserole, green tea, bread.
4. Snack - cottage cheese with raisins and dried apricots, sour cream.
5. Dinner - vegetable salad, steam omelet, tea.
6. At night - a glass of yogurt.

Features of treatment in children

According to medical statistics, 90% of children diagnosed with dyskinesia had episodes inflammatory diseases gastrointestinal tract, helminthic invasions. At a more adult age, the development of this dysfunction is promoted by vegetovascular dystonia. Girls are diagnosed with this disorder more often than boys.

A feature of the treatment of this condition in children is that diet therapy comes first. A specialized diet is not provided, it is enough to follow the recommendations for proper nutrition.

They include minimizing fast food, nuts, snacks, mineral water. In addition, nutrition is shown at the request of the child, according to appetite. Do not strictly adhere to regime moments.

Snacks with various goodies - nuts, sweets, buns - under strict prohibition. The best choice in this case are fruits.

Drug therapy is represented by drugs for the normalization of microflora, antispasmodics for pain, sedatives plant-based, choleretic. Additionally, massages, electrophoresis with antispasmodics, a course of exercise therapy are shown.

Adequate motor activity should be present at all stages of treatment. Mandatory walks to fresh air and positive emotions.

Features of treatment during pregnancy

In the early stages, a violation of the outflow of bile is the main cause of the development severe forms toxicosis. This manifests itself in the form of bouts of nausea, vomiting, lack of appetite, weight loss.

In this case best solution there will be a hospitalization of a woman in gynecological department hospital.

Pregnant women with DVP require hospitalization and constant control doctors

A feature of the treatment of pregnant women with a diagnosis of JVP is that many drugs are prohibited during the gestational period. The main tactic of managing the patient is to follow the principles rational nutrition, food according to appetite. It is forbidden to "eat for two" as grandmothers recommend.

Permissible drug treatment- This is the reception of phytocollections. For example, decoctions corn silk, dill, mint. Antispasmodics are allowed.

Self-administration of herbal remedies during gestation is inappropriate. Treatment is carried out only under the supervision of a gynecologist.

DZHVP is not an indication for termination of pregnancy, for caesarean section. Dysfunction does not affect the course of natural childbirth.

Possible Complications

JWP is not normal state for the body. Treatment should be carried out in full. Otherwise the following complications may develop:

• cholecystitis - an inflammatory process involving the gallbladder;
• the appearance of stones in the gallbladder;
• acute and chronic pancreatitis;
• duodenitis is an inflammatory process in the duodenum.

duodenitis and cholecystitis frequent complication at improper treatment JWP

Prevention

The best prevention of gallbladder dysfunction is the timely treatment of gastrointestinal diseases, helminthic invasions, pathologies of the nervous system. Normalization of nutrition, adequate physical activity, good rest for all categories of patients.

JVP is not a sentence, but the state of the body needs to be brought back to normal. Be sure to identify true reason dysfunction and follow the recommendations of a gastroenterologist.

- This functional disease biliary system, which is based on a violation of the motility of the gallbladder and biliary tract, as well as the process of bile excretion. Pathology can develop according to the hyperkinetic or hypokinetic type; manifested by pain in the right hypochondrium, nausea, dyspepsia, neurosis-like symptoms. Diagnosis includes ultrasound of the biliary system, cholecystography, cholangiography, duodenal sounding, scintigraphy. Treatment is conservative: diet, intake choleretic agents and antispasmodics, spa therapy, herbal medicine, hirudotherapy, physiotherapy.

General information

The basis of biliary dyskinesia is motor-tonic dysfunction of the gallbladder and sphincters of the bile ducts. This disrupts the emptying of the gallbladder and the flow of bile into the duodenum. Dyskinesia is the most common functional disorder of the hepatobiliary system and is the leading cause of cholestasis, as well as the formation of stones in the gallbladder and ducts. Pathology occurs predominantly in women. most susceptible to development functional disorders biliary system of a young person (from 20 to 40 years old) with an asthenic constitution and reduced nutrition.

Causes

By etiological mechanism distinguish between primary and secondary biliary dyskinesia. Primary dysfunction is caused by a violation of the neurohumoral regulation of the activity of the hepatobiliary system due to neurosis, vegetative-vascular dysfunction and dietary errors. Secondary dyskinesia develops according to the mechanism of the viscero-visceral reflex against the background of other diseases of the digestive system.

According to the nature of the violation of the motor-tonic function of the gallbladder and sphincters, dyskinesias are distinguished, proceeding according to the hypertonic-hyperkinetic and hypotonic-hypokinetic type. Hypertonic-hyperkinetic (spastic) dyskinesia develops with increased tone of the parasympathetic autonomic nervous system; hypokinetic-hypotonic (atonic) - with the predominance of the tone of the sympathetic nervous system.

In both cases, as a result of the inconsistency of the work of the gallbladder and the sphincters of the bile ducts, the flow of bile into the lumen of the duodenum is disrupted, which leads to a breakdown in the digestive process. Depending on the type of dyskinesia (hyperkinetic or hypokinetic), various clinical manifestations develop.

Symptoms of dyskinesia

In the hypertensive-hyperkinetic variant of the pathology, the leading symptom is acute colicky pain in the right hypochondrium, radiating to the right shoulder blade and shoulder. A pain attack, as a rule, develops after an error in diet, excessive physical activity or psycho-emotional stress. The pain syndrome may be accompanied by nausea, sometimes vomiting, constipation or diarrhea, polyuria. The pain goes away on its own or is easily stopped by antispasmodics.

Outside the attacks, the state of health is satisfactory, there are intermittent, short-term pain sensations of a spastic nature in the right hypochondrium, epigastrium, and umbilical region. Often, hypertensive dyskinesia is accompanied by vasomotor (tachycardia, hypotension, cardialgia) and neurovegetative (irritability, sweating, sleep disturbance, headaches) manifestations. Palpation of the abdomen during a pain attack reveals Ker's symptom - maximum pain in the projection of the gallbladder. The phenomena of intoxication and signs of the inflammatory process in the blood tests are absent.

Hypokinetic-hypotonic dyskinesia is characterized by constant, non-intense, dull, aching pain in the right hypochondrium, a feeling of heaviness and stretching in this area. Against the background of strong emotions and eating, develop dyspeptic disorders- bitterness in the mouth, belching with air, nausea, loss of appetite, flatulence, constipation or diarrhea. Palpation of the abdomen reveals moderate soreness in the projection of the gallbladder, positive symptom Ortner. Neurosis-like manifestations are noted: tearfulness, irritability, mood swings, fatigue.

Diagnostics

The task of diagnosis is to verify the disease, determine the type of biliary dyskinesia, exclude concomitant diseases that support dysfunction. Ultrasound of the gallbladder and biliary tract is aimed at determining the shape, size, deformation, congenital anomalies, stones of the biliary system. To determine the type of dyskinesia, ultrasound is performed on an empty stomach and after taking a choleretic breakfast, which allows assessing the contractile function of the gallbladder.

An informative diagnostic method is fractional duodenal sounding with the study of duodenal contents. By probing the duodenum, the tone, motility, reactivity, and the state of the sphincter apparatus of the extrahepatic bile ducts are determined. With hyperkinetic dyskinesia of the biliary tract, the level of the lipoprotein complex and cholesterol in portion B decreases; with hypokinetic - increases.

X-ray examination includes cholecystography and cholangiography. With their help, the architectonics and motility of the biliary tract are assessed. IN comprehensive examination sphincter of Oddi manometry, cholescintigraphy, MRI of the liver and biliary tract can be used. It is advisable to study the coprogram, feces for dysbacteriosis and helminth eggs.

Treatment of biliary dyskinesia

Restoration of the function of bile formation and bile excretion in case of different types dyskinesia is also differentiated. With hyperkinesia, choleretics are indicated (dry bile, cattle pancreas extract, flamin, hydroxymethylnicotinamide, oxafenamide), weakly mineralized mineral water heated, antispasmodics (drotaverine, papaverine, platifillin), herbal teas (decoctions of chamomile, peppermint, licorice root, dill fruits).

From non-drug methods patients with hypertensive-hyperkinetic biliary dyskinesia are recommended courses of psychotherapy, acupuncture, hirudotherapy, applications of ozocerite and paraffin, diathermy, inductothermy, microwave therapy, electrophoresis with antispasmodics, acupressure, massage of the collar zone.

In the hypotonic variant, cholekinetics are prescribed (xylitol, magnesium sulfate, sorbitol), highly mineralized waters room temperature, herbal medicine (decoctions of immortelle flowers, nettle leaves, rose hips, oregano, St. John's wort). With signs of intrahepatic cholestasis, "blind" probing (tubage) is indicated. To increase the general tone, exercise therapy is prescribed, stimulating water procedures, toning massage.

Of the methods of physiotherapy, diadynamic therapy, electrophoresis with magnesium sulfate on the liver area, low-intensity ultrasound, SMT therapy, low-frequency pulsed currents are used. Patients with biliary dyskinesia are shown to be monitored by a gastroenterologist and neurologist, annual health courses in balneological sanatoriums.

Forecast and prevention

The course of the pathology is chronic, however, if the diet is followed, healthy lifestyle life, timely and proper treatment, the disease can proceed without exacerbations. Otherwise, it is possible to develop complications from the hepetobiliary system - calculous cholecystitis and cholangitis. Prevention of primary dyskinesia requires adherence to the principles of healthy eating, timely correction of disorders of the psycho-emotional sphere; prevention of secondary dyskinesia - elimination of the underlying disease.