Poor gallbladder contraction. Causes of changes in the size of the gallbladder. The reasons for the appearance of such pathologies

Bile is produced when a food bolus enters the lumen of the duodenum. Bile is produced by the liver, stored in the gallbladder, and, if necessary, enters the digestive tract through the bile ducts. There is a disease associated with impaired motility of these pathways and leading to the appearance of many unpleasant symptoms. The pathological process called dyskinesia of the gallbladder.

About the disease

In the course of statistical studies, it was noted that dyskinesia biliary tract affects just over a tenth of the world's population. In the vast majority of cases, these are women. reproductive age having an asthenic physique. It is assumed that gender differences in incidence are associated with the production of hormones and metabolic processes in the female body.

What is gallbladder dyskinesia? traditional medicine I started to study this disease relatively recently. It was first officially documented in 1903 by two surgeons operating on a patient who suffered from intense pain in the right hypochondrium. At first, the doctors thought about the exacerbation of cholelithiasis, but during surgical intervention no gallstones were found.

Since ancient times it has been assumed that there is a direct relationship between diseases of the gallbladder and psycho-emotional state patient. If a person is constantly exposed to stress, experiences negative emotions, is in a state of nervous tension, then there is a high probability that he will have problems with the biliary system.

By the appearance and behavior of a person, one can assume the type of dyskinesia that prevails in him. If the patient is irritable, prone to aggression, and pain syndrome predominates, then this is, as a rule, a hyperkinetic type, due to an increased tone of the muscular wall of the gallbladder. If the patient complains of bitterness in the mouth, general weakness, depression, then this indicates a hypotonic type associated with impaired bile flow. It must be said that these criteria are conditional and are not taken into account during the diagnosis by a doctor, due to their low specificity.

Anatomy

The gallbladder is one of the organs of the digestive system, located in the region of the right hypochondrium. In length, it can reach about 14 cm, and up to 5 cm in diameter. The volume of the bladder is approximately 1 ml, but with congestion associated with cholelithiasis, a tumor, or congenital obstruction of the ducts, the capacity of the gallbladder may increase. At healthy people gallbladder shaped like a pear. In some diseases or congenital malformations, it may change, become spindle-shaped, become bifurcated, or contain internal adhesions.

Anatomically, it is divided into three parts: bottom, body, neck. The bile ducts connect directly to the cervix and then exit into the lumen of the duodenum. The structure that limits the duct from the digestive tract is the sphincter of Oddi. This formation is a muscular ring that prevents the reflux of gastric juice into the biliary tract.

The wall of the gallbladder consists of three membranes:

• Outer or connective tissue sheath. Limits the gallbladder from other organs of the abdominal cavity, contains blood vessels that feed other layers.
• Muscular layer. It mainly consists of circular muscle fibers. The shell is necessary for the implementation of muscle contraction and expulsion of bile into the lumen of the biliary tract. At the neck of the bladder, circular fibers form the sphincter of Lutkens, which prevents premature bile secretion.
• The mucous membrane (inner layer) is formed by epithelial cells that perform an excretory function.

Many mechanisms are involved in the processes of bile secretion. Biggest impact on development functional dyskinesia has an autonomic nervous system. Normally, with activation of the parasympathetic nervous system there is a contraction of the muscular wall of the gallbladder and relaxation of the sphincter of Oddi. In severe psychoemotional disorders, there is a disruption in the work of the vagus nerve, which manifests itself in the form of disorganization of the muscular elements of the biliary system.

The intestinal mucosa produces a number of biologically active substances that affect the functioning of the gallbladder. Cholecystokinin is a neuropeptide hormone synthesized by the epithelial cells of the duodenum. Normally, its release occurs when food enters the gastrointestinal tract. In the pathology of the duodenum, there may be a violation of the production of this hormone, which manifests itself in the form of inhibition of the motility of the gallbladder.

Some neuropeptides, also synthesized by the intestinal mucosa, can prevent the contraction of the muscular layer of the gallbladder. All of the above factors are closely related to each other. If one of these components is damaged, disorganization occurs in the work of the muscular apparatus, which is manifested either by congestion or biliary colic.

Bile

Bile is a yellowish-brown liquid produced by the liver and is essential for normal digestion. The main functions of bile include the inactivation of gastric pepsin and the emulsification of fats. Pepsin is an enzyme synthesized by the epithelium of the stomach. At the stage of gastric digestion, pepsin plays an important role in the breakdown of protein compounds. When it enters the duodenum, it interacts with bile acid and is eliminated. If this does not happen, then pepsin will break down the protein compounds of the pancreas and thereby prevent further processing of the food bolus.

Emulsification of fats, i.e., the breakdown of complex lipid molecules into simpler components, allows for better absorption of fatty acids. In addition, bile improves the motility of the digestive tract, stimulates the synthesis of intestinal hormones and prevents attachment pathogenic bacteria on the mucous membrane of the digestive tract. Bile also has an excretory function. It contains bilirubin and cholesterol - fat-soluble compounds that cannot be excreted by the kidneys. About 2/3 of the cholesterol is excreted in the feces, and the rest is taken back into the blood.

Bile is indirectly involved in the activation of trypsin, a pancreatic enzyme that breaks down protein.

Etiologically, biliary dyskinesia can be divided into two types - primary and secondary.

• In the first case, the pathology is associated with functional disorders, manifested in the form of motor disorders. On the biochemical level there is a disorder of neurohumoral reactions and neurotransmitters. Experts note that the leading cause of this disorder is the long-term influence of stress factors.
• Secondary dyskinesia is caused by any organic pathology that occurs in the organs of the digestive system. Most often it is gastritis, duodenitis, hepatitis, cholecystitis or inflammatory processes in the abdominal organs. Slightly more than 60% of all cases of dyskinesia are organic pathologies.

The main function of the gallbladder is the accumulation and concentration of bile, as well as its release into the digestive tract when food is received. Bile itself is synthesized by hepatocytes in a continuous mode.

Clinically, two forms of dyskinesia are distinguished, according to hyper- and hypomotor type.

• With dyskinesia of the hypermotor type, the increased tone of the vagus nerve plays a leading role in the pathogenesis. As a rule, these are young women, asthenic physique, suffering from emotional lability. With this form of dysfunction, there is an increase in the motor activity of the gallbladder. In this case, there is an increase in tone in the sphincters of Lutkens and Oddi. What does this lead to? The muscular layer of the gallbladder begins to actively contract in order to squeeze bile out of itself. At the same time, the sphincters that restrict the flow of bile are strongly compressed. As a result, this condition will manifest itself as biliary colic, similar to the one that occurs during an exacerbation of gallstone disease.
• The hypomotor type of dyskinesia occurs when the sensitivity of the gallbladder to the influence of neurohumoral stimuli decreases. This condition is also seen in increased concentration estrogen in the blood chronic diseases duodenal ulcer, leading to mucosal atrophy and decreased production of cholecystokinin.

Causes of dyskinesia

As mentioned above, there are primary and secondary causes of biliary dyskinesia. Moreover, for each subtype of the disease there are specific causes.

Primary dyskinesia

The pathological process is due to functional dysfunction, which cannot be fixed using instrumental research methods. With a long course of the disease, there is Great chance development of organic disorders in the biliary tract and gallbladder.

Causes of primary biliary dyskinesia:

• Chronic stress leads to disruption of the vagus nerve. The parasympathetic nervous system directly regulates the sequence of relaxation and contraction of the muscular structures of the gallbladder and the sphincter of Oddi. Prolonged psycho-emotional overstrain leads to a violation of the coordination of sphincters.
• Diet error. Frequent use fatty foods leads to suppression of the synthesis of intestinal hormones that affect the secretion of bile and the tone of the muscle structures of the biliary tract. For correction given state It is recommended to abandon the systematic use of fried, smoked and spicy foods.
• All muscles in the human body are interconnected. If a person leads a sedentary lifestyle, has an asthenic physique, eats poorly, then the muscle layer of his organs will be weakened. When food enters the duodenum, the gallbladder will not be able to contract as needed, so bile stasis occurs.
• Allergic reactions. Allergens contained in environment, when ingested, can have a negative effect on the intestinal mucosa. As a result, the muscular apparatus of the intestine is irritant effect, which leads to a violation of the relationship between relaxation and contraction of muscle elements.

Secondary dyskinesia

Occurs with organic pathologies of the gallbladder, duodenum, biliary tract and other organs of the gastrointestinal tract. Common causes of secondary biliary dyskinesia:

• inflammation of the stomach and thin department intestines. With a prolonged inflammatory process, atrophy of the mucous membrane of the organs occurs. Subsequently, this leads to a decrease in the production of biologically active substances that affect the motility of the gallbladder and biliary tract. At hyperacidity stomach increases the synthesis of pepsin, which does not have time to inactivate in the duodenum. Against the background of increased acidity, the sphincter of Oddi begins to contract and prevent the flow of bile into the intestinal lumen.
• Chronic inflammation of other abdominal organs. As a rule, it is pyelonephritis, solaritis, and in women, adnexitis or ovarian cyst. With the development pathological reactions this kind of reflex changes occur in the gallbladder and biliary tract.
• Inflammation of the liver and bile ducts. With these diseases, the infection spreads to the wall of the gallbladder. At the same time, the properties of bile change, which leads to the development of cholelithiasis. A formed large gallstone can lead to a mechanical violation of the outflow of bile.
• Infectious diseases of the biliary tract (dysentery, salmonellosis, etc.). Toxins released pathogenic microorganisms in the course of their life, disrupt the transmission of impulses from the nervous apparatus to the muscular elements of the biliary system. In this case, the relationship between the contraction of the muscular wall of the gallbladder and the sphincter of Oddi disappears.

Symptoms

Depending on the type of motility, the symptoms of gallbladder dyskinesia will vary.

Hypotonic type of dyskinesia:

• The pain syndrome will be permanent, dull arching character. The pain is localized in the right hypochondrium, does not radiate and intensifies after eating. There is pain when the gallbladder is stretched due to a violation of the discharge of bile.
• Belching appears after eating or in the inter-food interval.
• Nausea. With gastroduodenal reflux, vomiting of bile may occur.
• Bitterness in the mouth. As a rule, with diseases of the hepato-biliary system, all organs of the gastrointestinal tract suffer. Very often, patients have a reflux of bile into the stomach, and then into the esophagus and oral cavity. In this case, a sick person will notice bitterness in the mouth that appears in the morning or after physical exertion.

Indirect signs of JVP, what is it? These signs manifest themselves in the form of mental and emotional disorders. Patients experience depression, emotional lability, increased fatigue, general weakness and sleep disturbance. Men may experience erectile dysfunction and women have menstrual disorders.

• The pain in this case will be intense, colicky in nature, have a clear localization in the right hypochondrium, occur against the background of psycho-emotional overstrain or an error in the diet. The duration of the pain attack is about 30 minutes. During the day, there may be several such attacks. In some cases, the pain radiates to the back, under the shoulder blade or right arm. During the period of remission, there is no pain, but there is a constant heaviness in the projection of the gallbladder.
• Decreased appetite. Bile is a kind of stimulant of appetite and intestinal motility. With a hypertensive type of dyskinesia, bile does not enter the duodenum, as a result, biologically active substances that cause an increase in petite are not isolated.
• Weight loss. On the one hand, the reason for this condition is the previous paragraph, on the other hand, due to the stagnation of bile, the breakdown of nutrients does not occur, so they are not absorbed in the intestines, but pass through.
• Nausea and vomiting. A rare occurrence for hypermotor dyskinesia. Usually seen during an attack biliary colic.
• Diarrhea. Disorder of the chair occurs either during a painful attack, or after eating. Bile acids, when released into the lumen of the small intestine, inhibit the absorption of fluid and increase the secretion of water and trace elements. In this case, there is an increase in fecal masses in volume and acceleration of intestinal motility.

There are also mixed forms of dyskinesia, which are characterized by signs of a combination of symptoms from different forms gallbladder dysfunction.

Treatment

How to treat dyskinesia of the gallbladder? The principles of drug treatment are to prescribe drugs that improve the outflow of bile, eliminate bacterial infection, normalizing the work of the nervous system and the digestive tract. Depending on the type of dyskinesia, appropriate therapy is selected.

• Choleritics are a group of drugs prescribed to improve the production and separation of bile. They are based on bile acids. Due to this effect, the motility of the biliary tract is stimulated, as well as the normalization of digestion and the breakdown of nutrients. The most common drugs are (Allohol, Cholenzym and Holiver).
• Eleutherococcus extract and / or ginseng tincture are prescribed to increase the tone of the vagus nerve. Data medicines normalize arterial pressure, increase metabolism and resistance to physical stress.
• Tubeless tubes are substances that stimulate the secretion of bile. In this case, bile departs from the gallbladder and from the intrahepatic ducts. Tubages are often used when carrying out duodenal sounding.

Treatment of hypertensive form of gallbladder dyskinesia:

• Cholekinetics are drugs used to increase the tone of the muscular wall of the gallbladder. In addition, drugs from the group of cholekinetics have a relaxing effect on the sphincters of Oddi and Lutkens. Due to their effect on the body, the intensity of the pain attack decreases, the rheological properties bile, the concentration of cholesterol in the blood decreases. Some drugs like Hepabene also have a hepatoprotective effect, protecting liver cells from the effects of toxins.
• Antispasmodics - pharmacological preparations prescribed to reduce the tone of the sphincters. One of these drugs, Odeston, is similar to cholecystokinin in its effect on the body. With regular use of this medicine, there is an increase in bile production, relaxation of natural barriers and a decrease in pressure in the biliary tract.
• To normalize the work of the vagus nerve, apply sedatives like motherwort or valerian tincture.

Prevention

To prevent biliary dyskinesia, you must follow a few simple recommendations.

• You have to deal with stress. Severe psycho-emotional overstrain leads to a disorder of the parasympathetic nervous system. If possible, avoid stressful situations, do not accumulate irritation and anger in yourself. In the presence of severe depression, it is recommended to seek the help of a professional.
• Diet in biliary dyskinesia plays a big role in the treatment of this disease. The first step is to stop eating fast foods, convenience foods and other poor quality foods. The diet for JVP should include foods rich in vitamins, nutrients and beneficial trace elements.
• For patients with impaired motility of the biliary tract, it is indicated spa treatment. In such places, complex healing activities are carried out aimed at relaxing and eliminating signs of the disease. With biliary dyskinesia, sanatorium treatment is indicated for mineral waters Oh.

But perhaps it is more correct to treat not the consequence, but the cause?

for acquaintance, contraindications are possible, consultation with the doctor is MANDATORY! Do not engage in self-diagnosis and self-treatment!

Really helpful article! Most importantly, the causes of the disease are named! My bile stagnates and a thick sediment is visible on ultrasound! I drink allahol and odeston! The doctor recommended to use Ursosan at night! I have been drinking Ursosan constantly for 3 years! Can Ursosan harm the body if you drink it for more than 2 years constantly, without a break?

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Why is the contraction of the gallbladder disturbed?

The contraction of the gallbladder allows this organ to push the bile produced by the liver into the digestive organs when food enters there. Bile is responsible for the breakdown of hard-to-digest fats and contributes to the normal digestive process. That is why the good contractility of this important body digestive system is the main indicator of its normal functioning.

Alas, gastroenterologists often encounter such a pathology as a violation of the motility of this organ and bile ducts, in which the contractile function of the gallbladder deviates from the norm.

This disease is called dyskinesia, which is a very common disease of this organ. According to medical statistics, women suffer from gallbladder dyskinesia ten times more often than men.

Functions of the gallbladder

The gallbladder forms the so-called biliary system with the liver. It is located directly below it and is small cavity(reservoir) oval bag-shaped up to 70 cubic centimeters. The length of this organ in adults can reach up to 14 centimeters.

The main functions of the gallbladder:

• accumulation of bile produced around the clock by the liver;
• bringing it to the required consistency;
• delivery of this hepatic secretion to the duodenum when food enters the gastrointestinal tract.

Bile is a biological fluid involved in the breakdown of heavy animal fats and the release of essential nutrients from the products entering the body.

The liver is responsible for the production of this fluid, from where it then enters the gallbladder through the common bile duct. There it accumulates, acquires the necessary consistency and, if necessary, is thrown into the digestive tract. Such a release occurs a short time after food enters the gastrointestinal tract.

What is dyskinesia and its types

Dyskinesia of the gallbladder is a disease (usually of a non-infectious nature), in which there is a violation of the motor (in other words, evacuation) function of this internal organ. This interferes with the normal filling of the bladder with bile, and also disrupts its contractile function.

Women are much more likely to get this disease, and this is due to the specifics of their hormonal background and general structure. female body. Often, gallbladder dyskinesia develops during pregnancy.

If we talk about the share of dyskinesia in the total number of diseases of the biliary system, then it is about 12 percent. This pathology is a functional disorder, and does not cause morphological changes in this internal organ.

Such disorders of the motility of the gallbladder are primary and secondary.

In addition, experts distinguish the following types of this pathology:

• hypotonic;
• hypertonic;
• hypokinetic;
• hyperkinetic dyskinesia.

Hypotension is a decrease in the level of contractility of the gallbladder. This type of this pathology is characterized by difficult biliary excretion and difficulties with the accumulation of bile.

Conversely, hypertension is characterized by a sharp increase muscle tone. Such an increase in contractility also disrupts normal bile secretion, since the resulting spasms of the muscles of the walls of this organ lead to chaotic work of the sphincters.

The reasons for the appearance of such pathologies

The reasons that cause it functional impairment normal functioning of the gallbladder, quite a lot. Dyskinesia in the primary form, as a rule, occurs as a result of congenital features development of this internal organ. The secondary form of this pathology is mainly provoked by various concomitant diseases.

The main factors provoking primary dyskinesia of the gallbladder:

• doubling of the bile ducts and the bladder itself;
• congenital scars and constrictions in this organ;
• violation of the normal functioning of smooth muscle cells;
• decreased sensitivity of receptors to mediators;
• improper and unbalanced diet;
• dysfunction of the nervous system;
• hormonal disruptions.

The process of bile secretion is monitored by the nervous and endocrine system human body. Increased activity vagus nerve leads to increased contractility of the gallbladder. This pathology occurs due to a malfunction in the autonomic nervous system. Also, such dyskinesia can be provoked by violations of the production of hormones such as gastrin, secretin, cholecystokinin, and so on.

Hypotonic dyskinesia, in which contractility, on the contrary, decreases, as a rule, occurs as a result of the action of neuropeptides on this internal organ.

Both hypotension and hypertension of the gallbladder can be provoked by improper and irrational nutrition. If food intake does not occur regularly, at different times, if a person practices dry food and snacks on the go, as well as in the case of constant consumption of fatty, fried, spicy or simply low-quality foods, this is a sure way to the appearance of such gallbladder motility disorders. Such violations can also lead to various diets for the purpose of losing weight and fasting, in which there are long breaks between meals.

Dyskinesias can also develop as a result of constant stressful condition, as the consequences of various kinds of allergic diseases (for example, asthma) and as a result of sedentary seated image life. People with asthenic physique are more susceptible to this pathology.

In children, as a rule, dyskinesia is either a consequence of congenital weakness muscular system(primary form), or this disease occurs against the background of concomitant diseases (secondary form). In both children and adult patients, gallbladder motility disorders can be triggered by pancreatitis, cholelithiasis, dysentery, salmonellosis, peptic ulcer, gastritis, enterocolitis, and various atrophies of the digestive mucosa.

The main risk factors for this disease in female patients are various pathological changes in the pelvic organs (for example, salpingitis or adnexitis).

The clinical picture of this disease of the gallbladder depends on the type of pathology manifested.

Violation of the motility of this internal organ of the hypomotor type is accompanied by the appearance of the following symptoms:

• constant dull pain in the right hypochondrium;
• flatulence;
• constant belching;
• bad breath after belching;
• feeling of bitterness in the mouth;
• nausea;
• periodic vomiting;
• bloating;
• loss of appetite;
• stool disorders (alternating constipation and diarrhea);
• decrease in heart rate (bradycardia);
• lowering blood pressure;
• weight gain (common in chronic form hypotension of the gallbladder);
• increased sweating;
• hypersalivation.

The majority of patients with this type of dyskinesia complain of a constant dull pain syndrome. pain different intensity are present almost constantly, their character can be dull, compressive or pressing, the intensity of pain increases during movement and decreases at rest. All this is connected with an increase in the value of pressure in the abdominal cavity and a violation of the normal bile outflow. Such pains, as a rule, do not have a clear localization and are classified as "spilled". Basically, food intake does not affect the intensity or appearance of pain in these cases.

For dyskinesia very characteristic symptom is an eructation of air, which provokes a disturbed function of the nervous system, forcing more swallowing movements.

With the hypokinetic course of this pathology, patients often experience nausea caused by irritation of the receptors. digestive organs and excitation of the nerve center responsible for vomiting. As a rule, the patient begins to feel sick after taking too much fatty foods, as well as after overeating or in cases of too rapid absorption of food.

Another characteristic symptom of a deterioration in the muscle tone of the gallbladder is a feeling of bitterness in the oral cavity (especially in the morning and immediately after eating). The reason for this phenomenon is the entry of bile into the stomach, which is then thrown into the esophagus (which never happens during normal functioning of the gallbladder).

Since hypokinetic dyskinesia of the gallbladder provokes the development of fermentation and putrefaction processes in the digestive system caused by a deficiency of bile that breaks down food, this course of the disease is often accompanied by bloating.

Enzymes such as bile acids are responsible for a good appetite in the human body. In the event of a violation of the process of bile outflow, a deficiency of these substances occurs, and the appetite deteriorates sharply.

Constipation and diarrhea with hypokinetic dyskinesia are quite rare. Their manifestation is caused by decreased intestinal motility, as well as disturbances in the normal course digestive process associated with the normal processing of fats, proteins and carbohydrates.

With the stagnation of bile in the gallbladder, the so-called cholestatic syndrome occurs. It is characterized by:

• itching of the skin;
• change in their color (jaundice);
• yellowing of the eye sclera;
• dark urine;
• lighter (yellow-green) color of feces.

Symptoms

Hypermotor (or hyperkinetic) dyskinesia of the gallbladder is distinguished by some characteristic features.

This form of the disease is characterized by the following clinical picture:

1. the occurrence of intense pain syndrome, similar to hepatic colic;
2. a significant deterioration in the general well-being of the patient;
3. weight loss;
4. loss of appetite;
5. liquid stool;
6. nausea;
7. vomit;
8. cardiopalmus;
9. yellowing of the skin;
10. high blood pressure;
11. general weakness;
12. constant malaise;
13. appearance in the tongue of plaque.

The most common and unpleasant symptom of hypertensive dyskinesia of this internal organ is a pain syndrome, which is characterized by the following symptoms:

• duration - up to 30 minutes;
• sharp character;
• occurs in the form of seizures;
• localized in the right hypochondrium;
• provoked by physical overstrain or stressful condition;
• given to the right hand and right shoulder blade.

The patient quickly loses his appetite, begins to eat poorly, which causes a sharp decline body weight. In addition, weight loss is also affected by insufficient digestion of nutrients contained in food, caused by a deficiency of bile. The subcutaneous fat layer in such patients becomes thinner.

Also, with this type of dyskinesia, the functioning of the autonomic nervous system is disrupted, which is manifested by mood swings, irritability, and sleep disorders.

The appearance of a yellowish or greenish coating on the tongue can occur with both forms of dyskinesia. In some cases, patients have complained about changes in taste sensitivity. In addition, stagnant processes in the gallbladder negatively affect sexual function the patient, and in women with this pathology, in some cases, the menstrual cycle was disturbed.

Diagnosis of this pathology

Despite a fairly characteristic clinical picture, external symptoms alone are not enough to accurately diagnose gallbladder dyskinesia.

To determine the causes that provoked the dysmotility of this organ, laboratory and instrumental studies of the gallbladder itself, its ducts and other organs of the digestive system are prescribed.

Such surveys include:

1. ultrasound examination of the gallbladder, as well as the pancreas and liver;
2. general blood analysis;
3. blood test for biochemistry;
4. Analysis of urine;
5. coprogram (analysis of feces);
6. layuoratornoe examination of feces for the presence of helminth eggs in it;
7. cholangiography;
8. cholecystography;
9. examination of bile (microscopic);
10. duodenal sounding, after which the analysis of gastric juice is performed.

Laboratory studies in the diagnosis of gallbladder dyskinesia make it possible to identify the following negative changes:

• increased erythrocyte sedimentation rate (ESR);
• increase in the level of leukocytes;
• an increase in the level of bilirubin;
• increase in cholesterol C-reactive protein and bile acids;
• an increase in the level of amylase (typical for cases of concomitant inflammation of the pancreas).

Also, liver tests are required to make this diagnosis.

Also, to clarify this diagnosis, such instrumental diagnostic techniques as cholangiography and cholecystography are used.

Retrograde cholangiopancreatography is also mandatory. To exclude stenosis of the sphincter of Oddi, a manometry procedure is performed.

For the purpose of excluding possible pathologies duodenum and stomach, a special examination called fibroesophagogastroduodenoscopy is performed.

Method of treatment of this disease

As a rule, the treatment of this pathology is carried out by conservative methods - with the help of medicines. The choice of drug is based on the type of organ motility disorder. With hypotension of the gallbladder are used:

• drugs that normalize the level of contractility (prokinetics) (for example, Cerucal or Domperidone);
• to improve bile flow, drugs are used, which are called choleretics (Holenzim or Allochol);
• to increase the tone of this organ while reducing the tone of the bile ducts, cholekinetic drugs are used.

In addition, to normalize the work of the autonomic nervous system, the doctor may prescribe sorbitol, magnesium sulfate or eleutherococcus extract. In the hyperkinetic course of this pathology, as a rule, cholekinetics and antispasmodics are used.

Antispasmodics relieve pain. Most known drugs this group are No-shpa, Duspatalin, Odeston, Papaverin and Drotaverin. In especially severe cases, it is possible to prescribe narcotic painkillers.

Physiotherapy methods are often used to treat patients with this pathology.

The increased tone of the gallbladder helps to normalize electrophoresis with drugs such as Platifillin and Papaverine. If the tone is lowered, then electrophoresis with Pilocarpine is used.

For any pathologies of the biliary system, patients must necessarily follow a diet called " treatment table No. 5".

The duration of the course of drug therapy for dyskinesia of this organ is several weeks and, as a rule, does without surgery.

Types of gallbladder dyskinesia - hypomotor, hypermotor, signs and treatment

Dyskinesia of the gallbladder is a pathology of the tone and functioning of the organ and the ducts extending from it. This violation consists in the improper excretion of bile into the duodenum 12, as a result of which problems with intestinal digestion develop.

General description of the disease

Gastrointestinal dyskinesia ranks eighth in prevalence among diseases this body. It develops in people and adults, and childhood. It appears more often in women than in men.

The reason for this is the processes of the body of women. The category of people most susceptible to this disease includes adolescents and young girls with an asthenic physique.

For a complete cure of dyskinesia, it is necessary timely treatment and the right diet.

Organ structure

The gallbladder is located on the right side of the ribs. In length, it reaches 6-14 cm, and in width - 3-5 cm. Its capacity is equal to ml, but in case of stagnation it can increase. The shape is oblong. It consists of several parts - the bottom, body and neck, from which comes the cystic duct, which connects to the hepatic duct.

The role of the gallbladder is:

• in the accumulation and storage of bile produced by the liver;
• in its excretion into the duodenum.

At this process bubble contraction occurs. In addition, at this moment, the sphincter relaxes, thereby contributing to the promotion of bile.

This process depends on:

• intestinal hormones;
• departments of the nervous system for sympathetic and parasympathetic purposes;
• cholecystokinin-pancreozymin;
• secretin;
• glucagon;
• motilin;
• gastrin;
• neurotensin;
• vasointestinal polypeptide;
• neuropeptides.

These components act on the muscles of the bladder when eating and reduce it, which leads to an increase in pressure. Then the sphincter relaxes and passes bile into the ducts and duodenum 12.

With inconsistency in the activity of the departments of the nervous system and other pathological disorders, outflow disorders occur.

Bile plays an important role in the system intestinal digestion. She is capable of:

• improve appetite;
• normalize the absorption of fat-soluble vitamins;
• accelerate the breakdown and absorption of lipids;
• remove pepsin from the intestine;
• safely influence the production of mucus and intestinal hormones;
• activate enzymes that are required for the digestion of protein foods;
• act antibacterial;
• activate the work of the intestines.

Reasons for the development of pathology

Dyskinesia of the gallbladder is of primary and secondary type. Their difference lies in the causes of the development of the disease and the timing of its occurrence. initial symptoms primary dyskinesia are dysfunctions that can be detected by ultrasound or x-rays. Typically, such disorders are associated with congenital pathologies in the development of the ducts.

With the progression of the disease, the structure of the entire biliary system changes.

The causes of dyskinesia of the gallbladder and ducts of the primary type are the following:

• the use of fatty foods;
• snacks in a hurry;
• eating too often;
• poor chewing of food;
• irregular meals;
• stress and psychosomatic disorders;
• allergic reactions;
• sedentary lifestyle, weak muscles from birth, low weight;
• hereditary predisposition in a child if the parents also have this disease.

Dyskinesia of the gallbladder of the secondary type is a deformation with signs of pathologies in the structure of the organ and biliary tract as a result of existing diseases. You can detect these changes during medical examinations.

Secondary dyskinesia can develop against the background of the following factors:

• diseases of the digestive system (atrophy of the mucous surface of the gastrointestinal tract, gastritis, duodenitis, enteritis, duodenal ulcer, lack of bile and colitis);
• problems with the biliary system (cholelithiasis, hepatitis infection, cholangitis and cholecystitis);
• chronic inflammation in the pelvis or peritoneum (ovarian cyst, pyelonephritis and solaritis);
• helminth infections (giardiasis and opisthorchiasis);
• congenital pathological change in the structure of this organ;
• diseases arising from endocrine disorders (overweight, hypothyroidism, insufficient production of testosterone or estrogen).

Types of disease

Dyskinesia of the gallbladder can be of several types, differing in the ability of the walls of the organ to contract:

• Hypermotor (hypertonic). It develops with increased tone bubble and paths extending from it. It occurs in people with a parasympathetic nervous system that enhances the tone of the organ. Children and teenagers are most affected.
• Hypomotor form (hypotonic), appearing with reduced tone. The most susceptible people are over 40 years old, in whom the sympathetic system dominates.
• Hyperkinetic form (hyperkinesia) with active bile outflow;
• Hypokinetic form (hypokinesia) with a slow outflow of the secreted substance.

Symptoms

Signs of dyskinesia of the gallbladder depend on the type of dysfunction of the organ and the bile ducts.

Symptoms of the hypomotor type of the disease include:

• aching pain in the right hypochondrium, which may intensify after eating;
• bloating;
• bitter taste in the mouth due to morning time, after eating food and physical exertion;
• belching;
• flatulence;
• nausea and vomiting with an admixture of bile;
• constipation or diarrhea;
• loss of appetite;
• excess body weight;
• disorders of the nervous system (flushing of the face, increased salivation and sweating, lowering blood pressure and decreased heart rate).

With hypermotor dyskinesia, the patient has the following symptoms:

• acute pain in the right hypochondrium, radiating to the region of the heart (occurs after stress, physical activity and malnutrition)
• weight loss
• loss of appetite;
• nausea and vomiting with attacks of biliary colic;
• disorders of the autonomic nervous system (pain in the head, increased blood pressure, tachycardia, weakness, worsening sleep, fatigue, sweating and a constant feeling of irritation);
• diarrhea.

These two forms of dyskinesia also have common features:

• darkening of the color of urine;
• colorless stool;
• yellow tint of the skin and eye sclera;
• deterioration in taste;
• white or yellow coating on the tongue.

With mixed dyskinesia, a combination of symptoms of these forms is possible.

Diagnostic methods

Diagnosis of gallbladder dyskinesia consists of several procedures. First of all, the patient is examined by a doctor and anamnesis is taken.

• Ultrasound of the bladder after a morning meal;
• Ultrasound of the abdominal cavity to determine the size of the gallbladder, the presence of abnormal changes and stones;
• Fibroesophagogastroduodenoscopy, which allows to determine the state of the mucous surface of the digestive tract;
• Duodenal sounding, which examines the bile and the functioning of the gallbladder and biliary tract;
• Infusion cholecystography, in which a substance with iodine is injected;
• Oral cholecystography, which assesses the size of the gallbladder and the presence of possible anomalies;
• Cholangiography, which allows you to examine the ducts of the bile system using an endoscope and a contrast agent

Therapy

The use of medicines

For the treatment of biliary tract disease according to the hypotonic type, such medical preparations how:

• choleretics (Cholecin, Holiver, Allochol, Flamin, Holosas and Cholenzim);
• means with a tonic effect (Eleutherococcus extract and tincture of ginseng);
• probeless tubage (Xylitol, Sorbitol and magnesium sulfate).

For the treatment of hypertensive dyskinesia, the following drugs are used:

• antispasmodics (No-shpa, Papaverine, Gimecromon, Duspatalin and Drotaverine);
• cholekinetics (Gepabene, Oxafenamide);
• drugs with sedative properties (sodium bromide, motherwort, valerian, potassium bromide).

Physiotherapy

In the treatment of hypotonic dyskinesia, physiotherapy procedures such as amplipulse therapy and electrophoresis using pilocarpine are also used, and for hypertonic dyskinesia, laser procedures and electrophoresis using platyfillin and papaverine are also used.

In some cases, other procedures are also prescribed:

• massage, including acupressure, which is able to normalize the functioning of the gallbladder;
• acupuncture (acupuncture);
• hirudotherapy (treatment with leeches).

Also, in some cases, treatment of diseases that caused the development of dyskinesia (infections, helminthic invasion, ulcer and gallstone disease). For maximum effect therapy, it is necessary to observe the correct daily regimen, combining work and rest.

When dyskinesia is detected, the patient needs:

• go to bed before 23:00;
• daily sleep from 8 hours;
• adhere to the correct diet;
• take regular walks in the fresh air;
• combine mental and physical stress.

Important! In some cases, patients try to fight dyskinesia folk remedies, but you must first consult with your doctor.

Proper nutrition

For the maximum effect of the treatment of this disease, compliance with special diet, which must be followed for 3-12 months. It is prescribed to improve the functioning of the liver, the digestive system and the pathways designed to remove bile.

This diet involves the exclusion of certain foods:

• alcohol;
• fatty meat, broth on meat;
• fried and fatty meals, smoked meats;
• sour and spicy food;
• radish, onion, sorrel and garlic;
• marinade;
• fatty fish;
• seasonings;
• milk, cream;
• legumes;
• chocolate;
• pastries, rye flour bread;
• soda, coffee and cocoa.

It is necessary to eat in small portions several times a day, i.e. fractionally. During an exacerbation, the first time should be consumed only liquid or chopped dishes in a meat grinder. After elimination acute symptoms you can switch to steamed, boiled and baked dishes. It is recommended to reduce salt intake to avoid swelling.

With such a diet, the following foods are allowed:

• vegetable-based broths;
• lean meat and fish;
• cereals;
• butter;
• yolk from a boiled chicken egg;
• dried bread;
• vegetables;
• kefir, fermented baked milk;
• juices;
• caramel and honey;
• fruit.

The development of the disease in children

Children with gallbladder dyskinesia may experience abdominal pain, problems with stools, and decreased appetite. It can even develop in early childhood. The onset of the disease may be asymptomatic.

Note! If a child has at least suspicion of dyskinesia of the gallbladder, then his parents should immediately consult a doctor.

Treatment can be carried out both on an outpatient basis and inpatient, depending on the condition of the child. The disease can run long time, but with strict adherence to medical prescriptions, a positive result will still be achieved.

When it hurts on the left, a person involuntarily understands that it rather disturbs the heart, above the navel - problems with the stomach, lower abdomen - the genitourinary system is worried. The most common pathology of the right side is problems with the liver or biliary system. Almost every fifth sees a diagnosis with the words - the gallbladder is reduced. But not everyone understands what this means. The purpose of the article is to provide the reader with complete, and most importantly, understandable information on this issue.

Almost every fifth sees a diagnosis with the words - the gallbladder is reduced

Bile is the secretion of the liver. It is formed in the gallbladder. If you imagine this organ as a slightly inflated balloon, then when you press it, the tail relaxes and air comes out through the hole. Our organ works in a similar way: when it contracts, the sphincter of Oddi opens and the yellow solution that enters the duodenum begins to activate the processes of processing the food we have taken. Hypermotor form of dyskinesia is a pathology in which hollow organ with bile is reduced, that is, the ball is constantly in a deflated state, which means that the procedure for supplying a yellow substance becomes uncontrollable.

In an adult, this part of the liver is in the form of an elongated pear, 5-14 cm long and 3-5 cm wide. The shape may vary due to deformation, the most unusual are hourglass and boomerang kinks. The size of the organ depends on the amount of yellow secretion inside. If a normal functioning keeps its volume within 30-80 ml, then with a delay of bile it changes. The mucous membrane is covered with furrows and folds, which at the neck of the bile storage reservoir form the Lyutkens-Martynov sphincter. He, as a fuse, is responsible for the timely supply of bitter liquid.

Hormones, neuropeptides trigger the synthesis of a yellow-green fluid for the functioning of important processes in the gallbladder:

• starting the intestines, disinfecting its mucosa;
• activation of the decomposition of fats: glycerin and acids;
• assimilation of the necessary elements;
• conducting a safe digestion system.

Biliary dysfunction provokes other process disorders. When the gallbladder is contracted, problems with digestion of food, like a domino principle, are superimposed on each other.

Causes and symptoms of pathology

Most people are used to enduring pain, believing that it will soon pass without a trace. But something these discomfort provokes. There is a list of symptoms with which the body tries to convey to a person the seriousness of the situation, which makes going to a medical institution urgent.

Among them are the following signs:

Diarrhea indicates problems with the gallbladder

1. Belching. Due to the disorder, the patient takes more sips for eating, so the excess air needs to go somewhere.
2. Unpleasant taste in the mouth. Failure of the ducts that bring excess secretion to the throat and mouth.
3. Yellowness of the skin.
4. Urine is dark in color, feces become light.
5. Flatulence provokes a deficiency of a yellow-green solution. In simple words for the perfect chemical reaction there are not enough necessary elements, the result is more gas is released.
6. Diarrhea. This secretion helps to absorb the vital important elements. Its deficiency irritates the walls of the mucosa, so the digested food moves quickly, not having time to digest.
7. Plaque on the tongue occurs due to improper transport of unabsorbed nutrients into the oral cavity.
8. Vomiting reflex. Failure of the gastrointestinal tract causes a violation of the diaphragm.

There are only two reasons why the gallbladder is contracted. Congenital abnormalities are considered the primary hypermotor form of dyskinesia of the gallbladder and biliary tract, the secondary is the presence of a disease that is directly related to digestion.

So the sources of the first group include:

• allergy,
• narrow or blocked ducts
• the presence of barriers
• doubling of the pear-shaped sac,
• stress,
• wrong lifestyle,
• lack of body weight.

The most common sources of secondary dyskinesia are:

Diabetes mellitus may be a source of a secondary form of dyskinesia

1. Disorders of the thyroid gland, provoking the production of an insufficient amount of the hormone.
2. Inflammation of the duodenum.
3. The presence of cholecystitis of the gallbladder reduces the tone of the ducts, which is also an explanation why the piriform sac is reduced.
4. Gastritis, ulcers.
5. Stones in the kidneys.
6. Myotonia.
7. Dystrophy.
8. Viral hepatitis.
9. Infection with worms.

It doesn’t matter if a deficiency or an excess of a bitter solution provokes an ailment. After all, a delay in secretion can provoke gallstone disease. Starvation, obesity, high cholesterol contribute to the formation of stones. For the prevention of gallstone disease, it is necessary to drink beetroot juice diluted with water on an empty stomach. From all these pathologies, thickening of the walls of the gallbladder occurs.

Recognition of the disease and ultrasound results

It is important to follow the doctor's recommendations: do an ultrasound scan, take tests strictly on an empty stomach. After all, if you take medicine in the evening or have a hearty dinner, then the body will still process food and the pear-shaped sac will automatically contract to supply a yellow-green liquid. Such negligence may affect the reliability of the research results.

Since inflammation is always accompanied by an increase in the level of erythrocytes and leukocytes, a complete blood count in the diagnosis of gall disease is indispensable. At the conclusion of the biochemical analysis, the level of bilirubin will be visible. An increase in concentration indicates a delay in the yellow substance.

Mandatory and final measure in the diagnosis is ultrasound examination. In this case, the doctor will make sure that the right treatment is chosen. You need to understand that the thickening of the walls of the gallbladder occurs as a result of some kind of disease.

Causes and signs of illness in children

Most often, newborns and women suffer from this pathology. In children, this is due to dysregulation of motor skills. In addition to these primary sources, there may be such factors:

Diagnosis of dyskinesia in children is problematic

• congenital abnormalities in the development of the gallbladder;
• worms;
• sedentary lifestyle;
• malnutrition;
• pancreatitis;
• hepatitis.

Diagnosis of dyskinesia in newborns and preschool children is problematic. Their pathology outwardly manifests itself only in the form of pain in the abdomen and heaviness under the right rib. Which greatly complicates the task of the doctor.

Therapy Methods

When the causes of biliary dysfunction are clarified by the doctor, the treatment of the patient begins. To normalize the action of secretion, it is necessary to increase the activity of the reduced part of the liver, to lower the tone of the ducts. For this, cholekinetics are accepted:

• Oxaphenamide (1-2 capsules before meals, the course is two weeks).
• Gepabene (1 tablet with meals, three times a day, for at least 3 weeks).

Treatment of the disease is closely related to the reduction of pain, relaxation of the tone of the sphincters. Therefore, antispasmodics are used for a short course:

• Hymecromon.
• Papaverine, Drotaverine, No-shpa.

At the same time, drinking water of low mineralization is additionally prescribed. These are Essentuki 2, 4 and rest in a sanatorium. They take care of the pear-shaped sac with bile and intestines, everyone knows about medicines and doctors of a narrow specialty work - hepatologists.

Prevention and diet

The purpose of the diet is to reduce the load on the liver. It is recommended to eat food often, in small portions, steamed. When the pain intensifies, it is advisable to eat food in a liquid state.

With a reduction in the biliary system, the following are excluded from the diet:

With a reduction in the biliary system, sweets are excluded from the diet

1. Absolutely all sausages.
2. Beef, pork.
3. Eggs.
4. Fresh vegetables, fruits and berries.

The following products have a beneficial effect on the body:

• low-fat kefir, yogurt,
• bird, fish,
• oil,
• vegetable soup,
• tea, coffee with milk.

Interesting fact: drinking coffee in the morning helps to forget about stones in the gallbladder.

Video

Gallbladder.

The gallbladder is fully consistent with its name - it is a reservoir of bile produced by the liver. This is a small hollow organ (8 to 12 cm long) located under the liver and connected to it by the bile duct. The gallbladder is also connected to the duodenum. Bile, produced by the liver and stored in the gallbladder, is needed by the body to digest fats.

Video about the structure and functions of the gallbladder

Signs of pathology of the gallbladder

A sign of various serious illnesses biliary tract are severe paroxysmal pain in the right hypochondrium. Most often, this indicates gallstone disease, when the stone gets stuck in the biliary tract and interferes with the outflow of bile, as a result of which the muscles of the gallbladder and ducts begin to contract intensively, which is the cause of pain. Pain can also be caused by the movement of the stone through the biliary tract.

Attention: in the presence of stones in the gallbladder and its ducts, visceral therapy is contraindicated!

But there may be other causes of pain in the right hypochondrium - for example, biliary dyskinesia, that is, a violation of their motor function, and in this case, visceral therapy can just provide very effective help. The cause of pain can also be inflammation of the bile ducts and the wall of the gallbladder. In any case, if there are such pains, before starting treatment, you need to undergo an examination and clarify the diagnosis. Acute biliary colic, of course, is also a contraindication to visceral therapy- however, in this state, this type of treatment is impossible: the pain is so strong that it does not even allow you to touch the area of ​​​​the gallbladder.

The following signs also speak of certain violations of the gallbladder function: yellowing of the sclera of the eyes and facial skin; yellow coating on the tongue, nausea, dryness and bitterness in the mouth, pain when pressing on the right hypochondrium, indigestion, sometimes a feeling of a lump in the throat and difficulty swallowing. But since the body is whole unified system, in which the organs are interconnected, then the pathology of the gallbladder can be manifested by other symptoms, which at first glance may seem very unexpected: for example, headaches and pain in the knee and hip joints. There is nothing surprising in this, since the pathology of the gallbladder leads to congestion in it, which is the cause of general poisoning of the body. The consequence of such autointoxication is just headaches, mainly of the migraine type, that is, localized in temporal areas. Pathologies of the gallbladder also lead to metabolic disorders in the body as a whole, which provokes diseases and destruction of the joints. Therefore, a crunch in the knee and hip joints, pain during movement and load may also indicate pathologies of the gallbladder. It is no coincidence that in traditional medicine any treatment always began with the therapy of the gallbladder, and it was this organ that was assigned almost the leading role in the healing process.

What causes diseases and disorders of the gallbladder? All the same stresses, negative emotions, anxiety, worries. There is nothing supernatural here, the mechanism of the impact of negative emotions on the gallbladder is very simple. As a result of stressful situations due to muscle tension, functions decrease internal organs. In particular, there are interruptions in the outflow of bile from the gallbladder, which leads to congestion. As we already know, for the normal functioning of the body it is very important that the gallbladder does not lose its ability to contract - after all, only by contracting can it “transport” bile into the duodenum. As a result of stress, leading to chronic tension, the gallbladder gradually loses its ability to contract. Because of this, not only digestion is disturbed - after all, the right amount of bile does not enter the duodenum, but bile stagnation occurs, leading to its thickening. And this, in turn, leads to the formation of sand and stones and to the fact that excessively concentrated bile corrodes the mucous membrane of the gallbladder and causes inflammation. Contribute to diseases of the gallbladder are also factors such as excessive consumption of fatty foods and improper mode of physical activity.

Returning the normal tone to the gallbladder, making it actively contract again - this means restoring its health and, as a result, improving the entire body. Visceral therapy copes with this task. It is only important to take into account that in addition to stones in the bile ducts and acute biliary colic, contraindications to visceral therapy are also conditions with elevated body temperature, acute period hepatitis, fresh trauma of the right hypochondrium, pathologies such as congenital atony, constriction of the gallbladder, kink of the duct.

Each person can independently adjust the work of his gallbladder and get rid of all kinds of related ailments and disorders of the work of other organs as well. But before proceeding with the actual implementation of the visceral therapy technique, one must remember the need to normalize one's emotional state. AT bad mood treatment is better not to start - there will be no result! Therefore, to begin with, we will take care of our emotional comfort. Create the desired emotional state, as described above. This is essential for the success of the treatment. Choose a time when no one will bother you, put aside all the worries of the day, remember something good, and most importantly - create a stable positive attitude towards yourself. Remember the well-known truth: a person is what he thinks about himself. If we think well of ourselves, everything is fine in our lives and it is easier for us to maintain health. It is always easier for an optimist with positive self-esteem to be healthy than for a dull pessimist who is always dissatisfied with himself and the world. For the success of healing by the method of visceral therapy, the ability to relax is especially important, and this is possible only when we are calm, do not worry about anything, put aside all our worries and stay in good mood. Create a pleasant atmosphere, turn on music that you like - let it be calm enough, but at the same time rhythmic, so that you can work in rhythm with the music.

So, are you ready? The procedure is performed on an empty stomach. Lie on your back with a positive attitude, listen to some music, then concentrate on the gallbladder area. It does not matter if you cannot imagine in detail what this organ looks like - imagine it as best you can. Mentally wish him well. Now you need to clench the right hand into a fist and press it on the area of ​​\u200b\u200bthe right hypochondrium, helping yourself with the palm of your left hand (pressing from above or from the side with the palm of your left hand on the fist of your right). First, this is done lying on your back, then sitting.

You need to press smoothly, slowly, gradually, until a lung appears. pain sensation. Once slight pain appears, you need to pause to stop further pressure, but do not weaken the already existing pressure of the fist on the right side. When the pain subsides slightly or disappears, you need to move your fist a little lower and press again until the pain appears. Where pain zones are found, the fist is held in a pressed position until the pain subsides. This is done until you push through the entire area of ​​\u200b\u200bthe right hypochondrium, anesthetizing all problem areas.

Depending on the state of health, this procedure is carried out from one to three times a day, 30-40 minutes before meals.

What is happening? With daily pushing, the chronic spasm of the gallbladder is removed, it relaxes, its contractile function is restored, and venous congestion is eliminated. As a result, it becomes possible to free the gallbladder from thickened bile, as well as sand and small stones, calculi, from which stones can subsequently form. Bile is renewed, due to which inflammation is reduced. After a few days, the normal functioning of the gallbladder is restored. Improving at the same time general well-being- headaches and pains in the knees disappear, digestion is normalized. Treatment can be considered complete when, with pressure, pain in the right hypochondrium no longer occurs. There are cases when such a seemingly simple treatment made it possible to avoid surgery to remove the gallbladder! Truly, all diseases are caused by stagnation, from a lack of movement in organs and tissues, and they can be cured only by restoring the necessary motor functions to them. In fact, everything ingenious is simple ...

Phytotherapy for diseases of the gallbladder

Visceral therapy can be supplemented with phytotherapy methods, which very often give a positive effect when other treatments fail.

As a choleretic agent, an infusion of cinquefoil root is used. Pour two tablespoons of crushed cinquefoil root with two glasses (400 ml) of boiling water and infuse in a thermos for three hours. Strain and drink 3-4 times a day for half a cup before meals.

A decoction of dandelion roots will help dissolve stones in the gallbladder. Two tablespoons of dry crushed dandelion roots should be poured with 0.5 liters of boiled water, brought to a boil and boiled over low heat for 10 minutes, then let it brew for two hours, strain and drink half a glass 3-4 times a day for half an hour before meals .

Strawberries also contribute to the dissolution of gallstones and their expulsion from the gallbladder - in the summer, during the season, for three weeks, you need to eat 3-5 full glasses of berries daily.

Physical education for the gallbladder

To improve the functioning of the gallbladder, the best yoga exercise is called the “Bending to the Legs Pose”. This posture helps to restore the normal movement of bile, remove stagnation and even get rid of stones at the initial stage of their formation. The pose is performed like this.

You need to lie on your back, legs together, stretch your arms behind your head. Inhale and raise the upper body to a sitting position, straight arms raised up, then, while exhaling, continuing to move, lean forward to your knees, trying to reach your hands thumbs legs without bending the knees. Pull your toes towards you. We must try to bend as low as possible to the knees in order to take hold of the big toes with our hands, and put our head between the knees. You need to strive to ensure that the elbows touch the floor on either side of the legs.

Most likely, it will not be possible to complete this exercise the first time. Do not try to master it right away - it may take more than one day. Gradually, this exercise will get better and better. By the way, it helps to eliminate fat deposits on the stomach - and as the stomach shrinks, it will become easier and easier for you to bend down to your knees. Yes, and the spine will return its flexibility, which will also make it easy to perform the exercise over time.

Traditional medicine recommends sleeping on the stomach with pain in the gallbladder area, placing an ordinary ball of thread under it. The ball can be replaced with a small soft ball. A ball or ball will put pressure on the gallbladder and thereby facilitate the outflow of bile. It is at night, during sleep, that this method works especially effectively, since in sleep the body relaxes as much as possible, muscle tension disappears, internal organs rest and in this state it is easier to restore their functions. An indicator of the effectiveness of this method is when pain disappears by morning when pressing on the gallbladder area, even if it was in the evening.

This is a functional violation of the contractility of the muscular layer of the gallbladder wall, which makes it difficult for the evacuation of bile. Manifested by biliary pain, dyspepsia, icteric syndrome, asthenovegetative disorders. It is diagnosed using sonography, dynamic scintigraphy, MRI of the hepatobiliary zone, duodenal sounding, retrograde cholangiopancreatography. For treatment, myotropic antispasmodics, choleretics, cholekinetics, tricyclic antidepressants, NSAIDs are used in combination with diet therapy, physiotherapy. With a complicated course and pronounced pain syndrome perform cholecystectomy.

The reasons

The development of gallbladder dyskinesia is associated with a primary or secondary violation of the contractile activity of the muscular membrane of the organ. Extremely rarely, motor-kinetic dysfunction is congenital, due to contractile failure of smooth muscle fibers or a violation of their sensitivity to neurohumoral influences. In most patients, dyskinesia is secondary, caused by such reasons as:

• Change in hormone levels. Inhibition of bladder motility during pregnancy and taking combined oral contraceptives occurs under the influence of progestins, relaxing smooth muscle fibers. The contractility of the organ is also reduced due to an increase in the level of somatostatin in somatostatinomas or taking a pharmaceutical form of the hormone.
• Systemic diseases. Dysfunction caused by decreased secretion of cholecystokinin by intestinal epithelial cells occurs in celiac disease. With scleroderma, myasthenia gravis, amyloidosis, the disorder is due to morphological changes in the fibromuscular layer. Gallbladder dystonia is also noted in diabetes mellitus.
• Hepatobiliary pathology. Dyskinesia can be provoked by inflammatory processes, changes in the composition of bile, irritation with calculi in cholelithiasis, cholecystitis, cholangitis. Discoordination of bladder contractions is observed with spasm of the sphincter of Oddi, an increase in resistance in the bile ducts.

An important role in the development of the disorder is played by frequent stress, leading to an imbalance of parasympathetic and sympathetic stimulation, diet errors - eating fatty foods, irregular meals, quick snacks with high-calorie foods. Dyskinesia can also be complicated by gastritis, enteritis, diseases of the operated stomach, and other gastrointestinal diseases, in which, as a result of indigestion, the secretion of factors affecting the tone and contractile activity of the gallbladder wall changes.

Pathogenesis

emergence clinical symptoms, characteristic of gallbladder dyskinesia, is due to a violation of the evacuation of bile. With discoordinated contraction of the muscle fibers of the bottom and neck, insufficient contractility of the muscle layer, the organ is stretched, which leads to the appearance of characteristic biliary pain. The situation is aggravated by a decrease in the threshold of pain sensitivity due to the association of a motor-kinetic disorder with autonomic dysfunction caused by stress. Periodically developing stagnation of bile provokes secondary inflammatory processes, cholelithiasis, intestinal digestion.

Classification

When systematizing clinical forms motor dysfunction of the bladder take into account the etiology of the disease and the type of violations of contractile activity. This approach allows you to develop optimal tactics for managing the patient. Taking into account the origin, primary forms of dyskinesia are distinguished, caused by congenital local dysmotility and innervation, and secondary, arising against the background of other diseases, special physiological conditions or as a result of treatment. Depending on changes in the contractility of smooth muscle cells, such variants of the disorder are distinguished as:

• Hypermotor (hypertonic) dyskinesia. It is more often observed in childhood and young age. It is caused by increased contraction of the gallbladder, leading to the appearance of acute spastic pain and the flow of excess bile into the duodenum.
• Hypomotor (hypotonic) dyskinesia. Usually diagnosed in patients over 40 years of age neurotic disorders. A decrease in the tone of the gallbladder wall with stagnation of bile and an increase in the volume of the organ is characteristic.

Symptoms

The main symptom of gallbladder dyskinesia is biliary pain, which disturbs the patient for at least 3 months within six months. In the hypertensive variant of dysfunction, severe pain occurs in the right hypochondrium with irradiation to the back and shoulder blade, lasting no more than 30 minutes. The pain syndrome is often associated with experiences, stressful situations, in the most severe cases, its intensity corresponds to the degree of biliary colic - sudden acute pain, accompanied by nausea and vomiting, for the relief of which medications are required.

The hypotonic variant of the disease is characterized by dull biliary pains of varying intensity, which increase with a change in body position and can last for several days. There is a feeling of fullness and pressure in the projection of the organ. Due to stagnation of bile, almost half of patients experience jaundice, discoloration of feces, darkening of urine, and skin itching. For dyskinesia, dyspeptic disorders are typical: bitterness in the mouth, flatulence, unstable stool. With a long course of the disease, the general state- there is weakness, emotional lability, insomnia. Autonomic disorders are often manifested by sweating, palmar hyperhidrosis.

Complications

In case of violation of the evacuation of the contents of the gallbladder, favorable conditions for the deposition of insoluble particles with the formation of microlites. In the future, this condition turns into cholelithiasis. A common complication of dyskinesia is chronic cholecystitis, which appears as a result of the addition secondary infection on the background pathological changes organ walls. With stagnation of bile, obstructive jaundice syndrome is formed, accompanied by intoxication of the body and hepatic encephalopathy. As a result of an infectious lesion of the bile ducts, cholangitis develops. Insufficient flow of bile into the intestine leads to the occurrence of malabsorption and maldigestion syndromes.

Diagnostics

The definition of nosology is difficult, since the disease belongs to the functional class and is usually not accompanied by organic pathology. Gallbladder dyskinesia is diagnosed by excluding other diseases with a similar clinical picture. Diagnostic search involves a comprehensive examination of the patient's hepatobiliary system. The most informative are:

• Ultrasound of the gallbladder. Sonography reveals changes in the volume of the bladder, the presence of a hyperechoic suspension. To assess the motor-evacuation function, ultrasonic cholecystography is performed - with dyskinesia after taking a choleretic breakfast, a reduction in the organ by less than 40% is observed.
• Dynamic scintigraphy of the hepatobiliary system. A study with the introduction of a radiopharmaceutical to the patient is performed to assess the excretory function of the liver, the degree of contraction of the bladder, the patency of the bile ducts. Complemented by a test with cholecystokinin.
• duodenal sounding. With the help of sequential sampling of several portions of bile through the probe, the nature of secretion and the rhythm of bile secretion are specified. With hypomotor dyskinesia, an increased amount of bile in portion B is observed, with a hypermotor form - a reduced one.
• Retrograde cholangiopancreatography. The technique is used to assess the state of the biliary system, detect calculi, dilated bile ducts, and visualize stenosis of the obstructive duct. Allows you to effectively differentiate functional disorders from organic pathology.
• MRI of the liver and biliary tract. It is recommended as a clarifying method in case of insufficient information content of others. instrumental research. During layer-by-layer scanning with high resolution it is possible to qualitatively visualize the bile ducts and bladder.

Laboratory techniques are of auxiliary importance. In the general analysis of urine in the syndrome obstructive jaundice there is an increase in bilirubin and a decrease in urobilinogen. AT biochemical analysis blood may show a slight increase in AST, alkaline phosphatase, cholesterol, less often - direct bilirubin, lipoproteins. With manometry of the sphincter of Oddi, 60% of patients have an increase in pressure of more than 40 mm Hg. Art. Differential Diagnosis dyskinesia is carried out with inflammatory diseases biliary tract (cholecystitis, cholangitis), congenital anomalies of the organ (doubling, hypoplasia, constrictions and kinks), strictures of the sphincter of Oddi, malignant neoplasms. In addition to examining a gastroenterologist, the patient is recommended to consult an infectious disease specialist, a hepatologist, and an oncologist.

Treatment of dyskinesia of the gallbladder

Therapeutic tactics depend on the type of motor dysfunction. Usually prescribed drug therapy supplemented by dietary and lifestyle modifications. The course of the disease is favorably affected by frequent fractional meals, normalization of weight, smoking cessation, dosed physical activity, and the elimination of stressful situations. Taking into account the peculiarities of violation of the contractile function, it is recommended:

• With hypermotor dyskinesia. To reduce the tone of the muscle wall, myotropic antispasmodics are used, choleretic agents with a selective anti-spasmodic effect in relation to bile ducts, sphincter of Oddi. Foods that stimulate muscle contraction are excluded from the diet: spicy and fatty foods, extractives, alcohol.
• With hypomotor dyskinesia. The appointment of prokinetics, cholekinetics, natural and synthetic choleretics is shown. To improve the outflow of bile, weak protein broths, fermented milk products, eggs, and vegetable oils are introduced into the diet. To prevent constipation, increase the amount of vegetable and other dishes that stimulate intestinal motility.

In the presence of inflammatory process non-steroidal anti-inflammatory drugs are also used. To stop severe visceral hyperalgesia, tricyclic antidepressants are used in small dosages. Patients with secondary forms of gallbladder dysfunction undergo etiopathogenetic treatment of the underlying disease according to the recommended protocols. Pharmacotherapy is combined with physiotherapeutic methods (prolonged tubage, electrical stimulation, pulsed magnetotherapy), spa treatment(reception of mineral waters, pelotherapy). Cholecystectomy is performed in exceptional cases with intense pain syndrome and complicated course of dyskinesia.

Forecast and prevention

Since complex treatment usually achieves stable remission, the prognosis is considered favorable. Complications arise in the case of late diagnosis of the disease or if the patient has a severe intercurrent pathology. For the prevention of dyskinesia, it is recommended to identify and eliminate diseases that interfere with the outflow of bile, maintain a healthy lifestyle (observance of the principles balanced nutrition, performance exercise, avoiding stress), maintaining normal weight body. Given the high efficiency of timely therapy, when the first signs of pathology appear, it is necessary to consult a doctor as soon as possible.

Dyskinesia of the gallbladder is a disorder characterized by abnormal motility of the biliary system. In patients, there is a strong or, on the contrary, insufficient contraction of the gallbladder. As a result, an insufficient amount of bile enters the duodenum, which leads to a breakdown in the entire digestive process.

Women are diagnosed with this disease 10 times more often than men.

Disease symptoms.

Pain under right rib. In the hyperkinetic variant of dyskinesia (in this case, the contractile motility of the biliary system is increased), acute pain is felt, it is paroxysmal, short-term, it can hurt in the right shoulder blade or shoulder. The pain usually appears after exercise or emotional stress eating fatty foods. Also note the tendency to frequent diarrhea, with a strong spasm of the gallbladder, the temperature may rise to 38 - 39 C, vomiting of bile.

With the hypokinetic variant of dyskinesia (in this case, the contractile motility of the biliary system is reduced), the pain will be dull, aching, it almost does not stop, subsiding only for a while, it is characteristic as if bursting in the right hypochondrium. But at some point usually after shaking or fatty foods) the gallbladder contracts and throws out everything that has accumulated. At this time, vomiting of bile, a rise in temperature, diarrhea and spastic pains in the right side are again possible.
The color of the stool is light not only with insufficient formation of bile, but also with its insufficient removal.

Attacks of biliary colic - strong pain in the right hypochondrium, appearing unexpectedly, a frequent heartbeat is characteristic, even a feeling of cardiac arrest, fear, numbness of the extremities.
Cholestatic syndrome includes a complex of symptoms that appear due to insufficient flow of bile into the duodenum. It develops much less often than previous cases. Signs of cholestatic syndrome:

• jaundice (skin, mucous membranes becomes yellow;
• lighter stool;
• darker than usual urine;
• hepatomegaly (enlarged liver);
• itching of the skin;

dyspepsia (disorders of the digestive process):

• lack of appetite;
• vomiting and nausea ;
• dryness and bitterness in the mouth in the morning (more common in case of hyperkinetic dyskinesia - that is, when the contractile activity of the biliary tract is increased);

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• increased fatigue;
• irritability;
• hyperhidrosis (excessive sweating);
• recurrent headaches.
• Decreased sexual activity.

Treatment is prescribed after an accurate diagnosis

There are two types of dyskinesia: hypomotor and hypermotor. Let's look at what it is more specifically:

1. hyperkinetic (hypermotor) dyskinesia of the biliary tract - increased motility of the biliary tract - the contraction of the bladder is too strong and throws all the bile into the duodenum, it is always in a spasmodic state, for this reason it is not able to accumulate right amount bile. At the same time, "extra" bile in the duodenum causes rather strong peristalsis and can be thrown into the stomach and esophagus and into the pancreatic ducts. It is most often diagnosed in young people.
2. hypokinetic (hypomotor) DZHVP - the contraction of the biliary system is weakened, the bladder itself tends to accumulate bile, and it releases a very small, insufficient amount into the duodenum. This type of dyskinesia is more susceptible to people who are over 40, and patients suffering from neuroses.

Diagnostics

To make a correct diagnosis, the doctor will prescribe additional examinations:
Blood analysis. Usually, at the time of exacerbation, the level of alkaline phosphatase is increased, etc.
Ultrasound of the gallbladder of the liver to see the work of the entire biliary system, to detect stones, if any.

Duodenal sounding - a gastric tube collects bile for analysis. At the same time, a medical problem is also solved here - the bile ducts are washed if bile stagnation is detected.
Tests using special preparations. The patient is injected medicinal substance(for example, secretin), which enhances the production of bile. If there is a disease, then the bile will not have time to enter the intestines, but will remain in the gallbladder and ducts. It is noted by an increase in the ducts and the volume of the bladder itself, which is diagnosed by ultrasound.

X-ray - cholecystography.

It is especially important not to distinguish biliary dyskinesia from other equally dangerous diseases that are similar in symptoms!

Treatment

With hypomotor JVP, it is necessary to improve the motility of the biliary tract. Mostly used choleretic drugs. In this case, antispasmodics are prescribed more often, which help to relax the biliary tract and reduce pain. It is better for such patients to learn the so-called rule of three Zh., the essence of which is simple - to remove fried, fatty and egg yolks from the diet. It is better to add more magnesium-fortified foods to the menu, because. This mineral helps to reduce spasm. The list of these products includes millet, buckwheat, whole grain flour bread, greens.
Depending on the time and cause of the appearance, doctors note the primary and secondary types of biliary dyskinesia.

The first type of dyskinesia is associated with congenital malformations (deficiencies) in the development of the biliary system.

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The second type of dyskinesia - appears during life, is associated with various acquired diseases (for example, pancreatitis, duodenitis, gastritis or peptic ulcer).

Causes of the disease

Dyskinesia of the gallbladder is a common pathology, and there are many reasons leading to it.
Heredity (pathology is transmitted from parents to children).
Sedentary lifestyle, sedentary work.

Anatomical features, such as deformations of the gallbladder and kinks of the organ, due to which the normal contraction bile secretion.

• Worms and Giardia.
• Intestinal infections.
• Significant physical activity.

But not always everything is to blame for problems in the digestive organs. Often, diseases such as diabetes mellitus, problems with thyroid gland and even chronic ENT infection.

Of no small importance is the emotional mood of the patient: the work of the internal organs directly depends on the state of the nervous system, often with frequent neurosis, stress. depression occur violations.

Problems with the removal of bile are not uncommon in women who use hormonal contraceptives.
One of the main risk factors is eating errors. Excess fatty, spicy food on the menu, overeating, eating disorders increase the risk of this pathology.

Biliary dyskinesia is a common occurrence in children. As in the case of adults, as a result of dyskinesia, the entire digestive system fails. This disease is not primary, but is the result of a long process in children's body which was not found in time. Children with this pathology have complaints of attacks of pain in the right side, often radiating to the right shoulder blade. Moreover, a number of symptoms are described that disturb children from time to time. These signs are caused by errors in nutrition, a violation of the entire lifestyle, daily routine, neuro-emotional physical activity, etc. In the case of children, as well as with adults, a properly selected individual diet plays a primary role. Which can not only improve the general condition of the child, but also can completely get rid of pain symptoms.