Treatment of dyskinesia of the gallbladder and biliary tract. Biliary dyskinesia: symptoms in adults and children, necessary treatment. Pain in hypertensive biliary dyskinesia

Inna Lavrenko

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Dyskinesia of the bile ducts - impaired functioning bile ducts and gallbladder, due to which the liquid enters the intestines in uneven volumes and at the wrong time.

Bile is an important substance that is directly involved in the breakdown of products, stimulates the intestines, and has an irritating effect. Bile passes through the ducts thanks to the muscles. Until they contract normally, there can be no problems in the work of the biliary tract and bladder.

In that situation, when the musculature of the gallbladder ceases to cope with its duties, it accumulates in the bladder, stretching it. As a result, characteristic clinical symptoms occur.

Disease classification

AT medical practice It is customary to single out the most important indicators of the biliary tract - the work of sphincters, muscle tone, and excretion of bile through the passages. Taking into account all this, there are several types of the disease according to:

hypotonic sign ( functionality sphincter decrease).
hypertonic character (here, on the contrary, the state rises);
hypokinetic type (slows down the flow of bile).

Clinical picture of JVP

The signs of this condition will depend entirely on the movement of bile and muscle tone. With dyskinesia, the following symptoms come to the fore:

in the right abdomen, the patient feels painful attacks (this becomes especially noticeable during exercise);
diarrhea;
after taking a sweet or nervous disorder, a burning sensation appears in the intestines;
vomiting along with bile;
a white coating appears on the tongue;
the person loses his appetite;
headache.

The first type of the disease is accompanied by the following symptoms:

The mixed view is characterized by:

heaviness and acute pain;
constipation, which is replaced by diarrhea;
sudden jumps in body weight;
belching appears, and an unpleasant aftertaste in the mouth;
general fatigue.

It is important to realize that the disease can manifest itself not only as a similar clinical component, but also the general condition of the patient may suffer. Approximately every second person diagnosed with biliary dyskinesia first goes to a dermatologist for help, as everything points to developing dermatitis.

These symptoms on the skin indicate problems with the gastrointestinal tract. Along with this, patients constantly feel itching, which is accompanied by peeling, as well as dryness of the skin. In some situations, bubbles filled with water appear.

In the presence of cholangitis, bulbitis or infection, there may be an increase in temperature. Usually, in this condition, a person begins to feel discomfort in the right hypochondrium. Their occurrence is associated with a complete disregard for prescribed diets, nervous experiences and physical overload.

Features of the course of JVP in babies

Many pathologies of the gastrointestinal tract begin to form in childhood. The main reason for the development of the disease in children is the impaired functioning of the central nervous system. non-compliance balanced diet and regime - the most important moment that can lead to an unpleasant pathology. Other reasons also include:

inactive lifestyle;
smoking in a passive form (for example, one of the relatives may suffer from this addiction);
the presence of dyes or flavors in the diet (abuse of carbonated drinks);
the formation of the biliary tract is impaired.

Most often, such a deviation from the norm occurs in children in a hidden mode. Primary Symptoms may appear unexpectedly. Usually, children who have been diagnosed with this diagnosis are passive, they have little interest in what is happening around them. High fatigue can lead to the fact that the child will begin to study worse. The pain that appears in the right area of the abdomen becomes an important bell that determines the JVP.

Attacks can manifest themselves during rapid movement, and as soon as the bile leaves, the pain subsides. Brown-colored diarrhea is also common.

If biliary dyskinesia is not treated and left as is, then during puberty all this can cause the most serious changes in all organs associated with the gastrointestinal region.

How to get rid of this condition?

Treatment must be carried out without fail, otherwise everything can end quite badly. First, the doctor directs the patient to diagnostic examination liver and gallbladder. If the assumptions about the initial diagnosis are confirmed, then the patient is discharged drug therapy and a special diet.

Of the drugs, it is better to give preference herbal remedies. For example, Sirin, helps to improve motor function bile duct, completely eliminates the clinical picture, improves the condition of bile.

If the reception lasts a long time, then the kinetic abilities are regenerated, and the formation of stones is no longer a problem. Herbal preparations have positive action at the expense great content active ingredients, as well as due to purity.

Organization of good nutrition

It is a decisive element in therapeutic measures. In some situations, in order to cope with the problem, these measures are enough, and the need for medicines disappears. The task of therapeutic nutrition for dyskinesia is to ensure the improvement of the bile outflow, the proper functioning of the liver, the normalization of all appointments of the ducts and other organs.

It becomes a prerequisite good nutrition, a person's diet should contain required amount carbohydrates, protein foods. It is important to limit the amount of incoming fats.

Menu Features

With tract dyskinesia, eating should be moderate: portions are small, but frequent. You can not overload the body with food, it is also necessary to eat at the same time so that the organs get used to the systematic production of bile.

With this option, the waste of bile returns to normal, the incoming food is digested much more efficiently. Frequent meals will not allow bile to accumulate, which prevents too much contraction of the muscles of the walls of the bladder.

Product cleansing

People with JVP need to eat boiled or baked foods. Stewing is also considered acceptable, but in no case should you fry food due to the fact that this action kills polyunsaturated fatty acids. With this method of processing, harmful components appear that increase the load on the organs.

Temperature

Biliary dyskinesia does not imply strict restrictive measures. Food should not be consumed cold, because all this can lead to unwanted spasm of the ducts.

Fluid and salt intake

It is worth reducing the amount of incoming salt or completely removing it, because an excess leads to the accumulation of excess fluid in the body, which is already excreted with incredible difficulty. Drink more purified water. This will thin the bile, prevent the formation of solids, promote excretion harmful substances and bad cholesterol.

Alcoholic drinks

It is best to get rid of this destructive habit. Alcohol causes muscle spasm which leads to unwanted bile retention. Among other things, ethanol is broken down in the liver, and too high indicators of such a substance load the diseased organ and contribute to the appearance of pathologies associated with the liver.

Alimentary fiber

Fiber with dietary fiber must be present in the patient's menu. This substance normalizes the process of separation of cholesterol and bile. Fiber, due to its properties, causes softening stool and stimulates intestinal peristalsis, which prevents constipation from happening.

Products prohibited for consumption

Therapeutic nutrition refers to the restriction of those foods that increase contractility and stimulates bile secretion. Food that leads to stagnation and thickening of bile should also be under lock and key. Components that lead to irritation of the mucous membrane covering the stomach are excluded.

Eliminate foods that contain purines from your diet essential oils. All these components make bile viscous, disrupting its removal and leading to the appearance of stones. Refractory fats also fall under the ban, making it difficult for the absorption and breakdown of substances that benefit the body.

Approved Products

The diet for JVP should be saturated with animals and vegetable fats, carbohydrates, proteins. These components are actively involved in the decomposition of amino acids and fight toxins. The diet should be filled with those products, which include lipotropic components, because they stop the crystallization of bile and increase the outflow.

It is better to stop your choice on. Food should be enriched with various vitamins, so eat fresh fruits and vegetables.

Products allowed for consumption:

vegetable soups;
Dietary meats;
Vegetables containing starch
Pomegranate, bananas and apples. From others it is best to prepare mousse;
Fresh vegetable salads are extremely healthy (they are flavored with vegetable oil).

Such nutrition evacuates bile, leads to a normal state not only digestion, but also stool. Among other things, correct organized diet excludes complications and attacks of a painful condition. Body mass returns to its previous state, appearance and the emotional component of the patient improves.

If principles organized meals when this condition is ignored, this can lead to the following complications:

Chronic stage of cholecystitis;
a phenomenon such as the formation of stones can be observed;
The body feels an urgent need for vitamins.

Massage for JVP

With such a pathology, massage on your own has a positive result: intestinal motility normalizes, bile is excreted faster, the functionality of the stomach and pancreas is activated.

If the symptoms of the disease are exacerbated, then such actions can not be carried out. Patients are massaged with gentle movements, smoothly, so as not to cause trouble in the end.

Execution technique

The patient should lie horizontally right hand lies on the lower abdomen, and the left is placed on the navel. Gently press the palm on the stomach, while the hands move towards each other. The position of the limbs is sometimes changed. Can be put left hand on the navel, cover it with the other, and then begin to make rotational movements.

Alternative therapy options

There are some herbs that do an excellent job with this ailment - sage, mint, St. John's wort and others. We take 50 grams of crushed elecampane and marshmallow roots, 10 grams of chamomile and the same amount of calendula flowers. All ingredients are thoroughly mixed and poured with water, boil for five minutes over low heat. We insist and persevere. It is necessary to use such a decoction half an hour before a meal for two weeks.

You can also take 30 grams of plantain leaves, a small amount of sage and mint, rose hips, cumin, raspberry leaves. Five hundred milliliters are poured into this collection boiled water closed and left alone for several days. After we pass everything through cheesecloth to separate small particles, and take it warm before eating.

Preventive actions

To prevent the onset of a painful condition, be sure to watch your own diet. Exclude spicy sauces, marinades, carbonated drinks and fast food from the menu. Eat fruits, vegetables, drink juices made from natural ingredients. Such nutrition not only normalizes the work of digestion, but also benefits the body.

Extremely important point considered to be an emotional human state, therefore it is necessary to treat all disorders of the central nervous system try not to give in negative emotions. The mode of sleep and work should be normalized, go in for sports and drink less alcohol.

Remember that if any symptoms appear that indicate a disease, you should not leave everything as it is or start self-medication. Go to a competent specialist who will conduct all the necessary studies and prescribe the appropriate treatment.

Digestion is a complex of biochemical reactions combined with a mechanical effect on the food bolus. Many organs of the gastrointestinal tract produce own secret necessary at a certain stage of digestion. Bile is secreted upon ingestion food bolus into the lumen twelve duodenal ulcer. Bile is produced by the liver and stored in 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. This pathological process is called gallbladder dyskinesia.

The structure of the bile ducts

About the disease

In the course of statistical studies, it was noted that slightly more than a tenth of the entire population of the Earth suffers from biliary dyskinesia. In the vast majority of cases, these are women. reproductive age having an asthenic physique. It is assumed that gender differences in morbidity are associated with the production of hormones and metabolic processes in the female body.

Treatment

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

Hypotonic dyskinesia:

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).
To improve tone vagus nerve Eleutherococcus extract and / or ginseng tincture are prescribed. These drugs normalize blood 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.

Allochol in tablet form

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.
– 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.

Packing Odeston

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.
D plays an important 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 with mineral waters is indicated.

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Functional disorders of the tone and motility of the gallbladder, bile ducts and their sphincters, manifested by a violation of the outflow of bile into the duodenum, accompanied by the appearance of pain in the right hypochondrium. At the same time, there are no organic changes in these organs.

Medical practice indicates that women are more susceptible to the occurrence of dyskinesias. There is evidence that biliary dyskinesia in women occurs 10 times more often than in men. It is noted that the incidence of hyperkinetic dyskinesia is more often observed in young people, and hypokinetic dyskinesia is typical for those who are already forty years old, and it also develops in people who suffer from mental instability.

gallbladder dysfunction

gallbladder dysfunction- this is a violation of the contractility of the gallbladder, which is accompanied by pain such as biliary colic and is often combined with a violation of the emptying of the gallbladder. Gallbladder dyskinesia does not pose a threat to life, but significantly reduces comfort. In addition, it creates the conditions for the development of more serious violations. For example, with prolonged dyskinesia, gallstone disease and other diseases of the gastrointestinal tract can develop.

Sphincter of Oddi dysfunction

Sphincter of Oddi dysfunction- this is a violation of its contractility Sphincter of Oddi, regulates the portioned flow of bile and pancreatic juice into the duodenum. Dysfunction of the sphincter of Oddi may be a primary, but more often a secondary disease, may accompany peptic ulcer, cholecystitis, cholelithiasis, postcholecystectomy syndrome and much more.

Types of biliary dyskinesia

Biliary dyskinesia with inadequate supply of bile is called hypokinesia;
with excess bile hyperkinesia bile ducts.

Causes of biliary dyskinesia

The causes of biliary dyskinesia in each case are ambiguous. But, as a rule, a person "earns on his own", thanks to his eating habits, which are formed in childhood, in adolescence.

Dyskinesia is almost always diagnosed as secondary disease. It manifests itself in humans as a consequence of some factors leading to disruption of the biliary tract.

With hypermotor dyskinesia, a person feels cramping, sometimes very sharp pains in the right hypochondrium, bitterness in the mouth, upset stool. With hypomotor dyskinesia - drawing pains, heaviness in the right hypochondrium, nausea, constipation. As a rule, these discomfort appear after eating, but can also be associated directly with food intake.

So, the disease occurs in people who have suffered at one time acute viral hepatitis, neurocirculatory dysfunction.

Biliary dyskinesia in children and adults is considered as a disease psychosomatic nature, which can be provoked by mental trauma, as well as severe stress.

It has been proven that the motor activity of the gallbladder directly depends on stress and strong negative emotions: in this case, it slows down significantly, and stagnation of bile occurs in the gallbladder.

Very often, when studying the case histories of such patients, it turns out that they once had psychological problems varied nature.

In addition, the trigger for the development of dyskinesia of the gallbladder can be impaired nervous regulation of the gallbladder, menopause, and insufficiency of the function of the endocrine glands.

There is also the possibility of joining dyskinesia to cholelithiasis, cholecystitis. In patients with peptic ulcer, appendicitis, a reflex occurrence of hyperkinetic dyskinesia occurs. This form disease also threatens those who eat irregularly, consume too much too often spicy dishes that irritate the mucous membrane.

The main symptoms of biliary dyskinesia appear depending on which factor provoked the development of dyskinesia. As a rule, most people suffering from this disease complain of a complex of symptoms of nervosa. That's too much high level fatigue, bouts of tearfulness and irritability, palpitations, sweating, recurrent headaches. In this case, patients feel pain in the right hypochondrium.

If it's about hypertensive dyskinesia, then such pain is distinguished by paroxysmal character. In this case, the pain is quite acute, but lasts a short period of time. Pain may radiate to right shoulder or spatula. Especially often such attacks occur after the use fatty foods, strong tension, both physical and emotional. Very often, patients with hypertensive dyskinesia note a manifestation of bitterness in the mouth, which most often happens in the morning.

If the patient is suffering from symptoms hypotonic dyskinesia, then such a state is characterized by a dull and It's a dull pain, in which there is also a feeling of fullness in the region of the right hypochondrium. Such pain constantly worries the patient, while his appetite noticeably decreases, the person often feels sick, and belching appears. The rise in body temperature is not observed, a clinical blood test also does not indicate the presence of abnormalities.

In addition, symptoms of biliary dyskinesia in men may include a decrease in sexual activity. At the same time, menstruation may be disrupted in women.

Common signs of dyskinesia are depression, emotional as well as physical weakness. During an attack of biliary colic, the patient may experience a sensation strong heartbeat or a feeling of cardiac arrest. He may be accompanied by a feeling of fear, numbness of the limbs.

The disease continues for a long period, with severe exacerbations periodically observed, which provoke stress and other elementary disorders. After the attacks, there is a periodic relief of the condition.

After a certain time, dyskinesia can provoke inflammation in the gallbladder and ducts, as well as cause the formation gallstones.

Treatment of biliary dyskinesia

Treatment is complex and includes:

From the very first days of treatment, the state of the autonomic nervous system is corrected. With hypertensive and hyperkinetic type of biliary dyskinesia, sedatives are prescribed: bromides, infusion of valerian, motherwort.

With hypotonic and hypokinetic type of biliary dyskinesia, tonic preparations are used: extract of eleutherococcus, leuzea, tincture of ginseng, aralia, magnolia vine.

Antibacterial therapy for this pathology is not indicated. When prescribing chemotherapy drugs for other concomitant disease it is necessary to take into account the possible adverse effects of these drugs on the function of the biliary system.

If giardiasis or other helminthic invasion necessarily carry out anthelmintic therapy.

A special role belongs choleretic agents. According to their mechanism of action, they are divided into:

choleretics(increase the formation of bile);
cholekinetics(contribute to the release of bile from the bladder into the intestinal lumen).

Choleretics include:

allochol, cholenzym, cholecin, lyobil and other drugs with bile acids;
nikodin, oxafenamide, tsikvalon (synthetic preparations);
immortelle, corn silk, tansy, wild rose, cholagol, olimetin (preparations plant origin);
valerian preparations, mineral water (increased bile secretion due to the water component).

Cholekinetics include:

magnesium sulfate, sorbitol, xylitol, berberine bisulfate (increase the tone of the gallbladder and reduce the tone of the biliary tract);
antispasmodics, eufillin (relaxes the sphincters of the biliary system).

The choice of drugs to restore the functions of bile formation and bile secretion depends on the type of dyskinesia.

With hypertensive type of biliary dyskinesia use oxafenamide, nikodin, mineral water weak mineralization (Slavyanovskaya, Smirnovskaya, Essentuki 4, 20, Narzan in hot or heated form 5-6 times a day). For herbal medicine, chamomile flowers, peppermint, licorice root, valerian root, motherwort grass, dill fruits are used.

With hypotonic type of biliary dyskinesia prescribe flamin, cholecystokinin, magnesium sulfate, pancreozymin; mineral waters of high mineralization (Essentuki 17, Arzni and others, room temperature or lightly warmed 30-60 minutes before meals, depending on the secretion of the stomach). Phytotherapy: corn stigmas, immortelle flowers, chamomile, nettle leaves, rose hips, St. John's wort, oregano.

With hyperkinetic type of biliary dyskinesia use antispasmodics in a short course, potassium and magnesium preparations, mineral waters of weak mineralization in a heated form 5-6 times a day. Phytotherapy: chamomile flowers, peppermint, licorice root, valerian root, motherwort herb, dill fruit.

With hypokinetic type of biliary dyskinesia recommend sorbitol, xylitol, cholecystokinin, pancreozymin, magnesium sulfate, mineral waters of high salinity at room temperature or slightly warmed up 30-60 minutes before meals. Phytotherapy as in the hypotonic type.

With intrahepatic cholestasis Tubage is carried out (tubeless drainage of the biliary system, or "blind" probing) 1-2 times a week. Assign tonic drugs, choleretics and cholekinets. At increased activity choleretic patients do not prescribe the liver enzyme ALT.

Treatment of children with biliary dyskinesia

Treatment of children with biliary dyskinesia is carried out until the complete elimination of bile stasis and signs of impaired bile flow. With severe pain, it is advisable to treat the child in a hospital for 10-14 days, and then in a local sanatorium.

Timely diagnosis of biliary tract dysfunction and proper treatment children, depending on the type of identified violations, helps to prevent the formation in the future inflammatory diseases gallbladder, liver, pancreas and prevents early stone formation in the gallbladder and kidneys.

Complications of biliary dyskinesia

Over time, the gallbladder and ducts may develop inflammatory process or gallstone disease.

The diagnosis of biliary dyskinesia is understood as a whole complex of certain pathological disorders biliary system, resulting from malfunctions of the motor function of the gallbladder and its ducts. At the same time, there are no organic type changes. With such pathological condition there is an excessive or deficient contraction of the gallbladder.

Description of the disease

More susceptible to dyskinesia female part population in whom the disease is diagnosed 10 times more often. The disease is characterized by the lack of bile flow into the duodenum in the required amount, which causes pain in the region of the right hypochondrium.

The reasons

There are several reasons that can cause biliary dyskinesia. Some of them may be in the impaired functioning of the hepatic organ and the pathways that excrete bile. As a result of malnutrition, inflammation of the regulatory system, which consists of the liver and gallbladder, develops, which provokes a violation of the motility of the biliary tract.

Abuse of alcohol, fatty and spicy food negatively affects normal metabolic processes. Thus, the load on the liver increases, which negatively affects the functioning of the liver and other digestive organs.

A stress factor plays a direct role in the development of biliary dyskinesia. Nervous disorders lead to spasm of the gallbladder and its ducts, resulting in an excessive release of bile into the duodenum. Excess bile enters the pancreas, thereby blocking the movement of pancreatic fluid, which has a corrosive effect on the organ, which provokes the occurrence of pancreatitis, followed by a complication in the form of diabetes mellitus.

Dyskinesia is presented in two varieties:

Hypokinetic type. AT this case the gallbladder is in a relaxed state, which leads to its poor contraction, stretching and increase in volume, resulting in bile stasis, as well as pathological change its composition, which is dangerous by the formation of stones in the gallbladder. This type of dyskinesia is much more common.
Hyperkinetic type. The gall organ is located in constant tone, sharply reacting to food entering the lumen of the duodenum with sharp contractions, while under the influence of strong pressure throwing out an excessive amount of bile.

Symptoms

In accordance with the detected type, the signs of biliary dyskinesia are distinguished:

1. Mixed:

pain syndrome and heaviness in the right side;
stool disorders, when constipation alternates with loose stools;
loss of appetite;
painful sensations;
unstable body weight;
belching, leaving a bitter taste in the mouth;
general malaise.

2. Hypokinetic form:

soreness of a aching nature, localized in the right hypochondrium;
feeling of heaviness in the abdomen;
persistent nausea;
gag reflexes.

3. Hyperkinetic form:

soreness of an acute nature, which makes itself felt in episodes in the right hypochondrium and radiates to the dorsal and sewing regions. Basically, the duration of such pain is about half an hour, and their occurrence is caused by eating;
persistent nausea;
gag reflex with bile;
poor appetite;
general weakness, accompanied by pain in the head.

In biliary dyskinesia, symptoms significantly reduce the quality of life, worsening general well-being. Often, patients with biliary dyskinesia turn to a dermatologist with symptoms of dermatitis. However skin rashes also indicate problems with the functioning of the digestive tract. Indirect signs may appear in:

skin itchy sensations;
dryness and flaking of the skin.

There may be blistering rashes containing a water base.

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Diagnostics

In order to detect biliary dyskinesia, laboratory and instrumental research. However, the latest diagnostic methods are more informative:

1. Ultrasound

An ultrasound examination of the gallbladder for an adult and a child is performed with a choleretic breakfast. First, at the end of the diet lasting three days, a conventional ultrasound of the peritoneal cavity is performed, through which the following changes in the biliary tract are revealed:

volume;
dimensions;
deformations.

An examination is also carried out for the presence of gallstones. After that, food is taken that provokes the release of bile into the duodenum 12. It can be dairy products, chocolate or bananas. Thus, it becomes clear how and in what sequence the movement of bile occurs.

2. Cholecystography

In this case, two methods of contrast radiography are used:

cholecystography, in which the extrahepatic bile ducts are examined. This method assumes oral intake a contrast agent, which subsequently allows you to identify how the contrast reaches the gallbladder, leaves it;
cholangiography, when the bile ducts inside the liver are examined. In this case contrast agent administered by injection, when the substance reaches directly the bile ducts. Subsequently, the progress of the contrast along the bile ducts is monitored.

3. Cholescintigraphy

This diagnostic method refers to a radiological examination, in which a radioisotope preparation is introduced into the body, after which, in the light of special radiation, its passage to the liver and excretion into the bile ducts is visualized.

4. Duodenal sounding

It is carried out by assessing portions of the contents of the 12 duodenal ulcer. For this purpose, a study is made in which it becomes necessary to swallow a thin probe. When the device reaches the 12th duodenum, its contents are taken, which consists of bile, liquid and juice.

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Subsequently, choleretic drugs are introduced into the probe for biliary dyskinesia in the form of magnesium sulfate. Thus, the gallbladder contracts, and the bile contained in the organ enters the intestine, which is also taken for the purpose of research. After a certain time, bile flows here, previously located in the bile ducts inside the liver. Such a sample is also taken for analysis. In order to make a diagnosis, the time interval between the administration of a choleretic drug and the receipt of portions of samples is important. The content of various lipids in the portions taken last is also important.

Treatment

When confirming biliary dyskinesia, it is prescribed complex treatment, which is:

normalization of the mode and nature of nutrition;
sanitation of infectious foci;
elimination of intestinal dysbacteriosis and hypovitaminosis;
getting rid of dysfunctional symptoms.

Medical

In many ways, how to treat biliary dyskinesia corresponds to the form of the disease:

1. Hyperkinetic

This course of the disease requires the restriction of mechanical and chemical food irritants and fats. Table #5, which is enriched with products containing magnetic salts, becomes relevant. To relieve spasm smooth muscle apply:

nitrates;
myotropic antispasmodics;
anticholinergics;
nifedipine, which helps to reduce sphincter tone.

2. Hypokinetic

Table #5 also applies. The diet should be rich in vegetable and fruit products, as well as products containing vegetable fiber and magnesium salts. Of no small importance in therapy is the timely emptying of the intestines, for which it should be used vegetable oils and cream. In order to normalize the functioning of the intestine, which automatically stimulates the contraction of the gallbladder, cholekinetics are prescribed.

Physiotherapy

Often, treatment of biliary dyskinesia is carried out through physiotherapy procedures:

low impulse currents;
ultrasonic irradiation of low intensity;
pearl and carbonic baths.

Diet food

The basis of a successful medical tactics biliary dyskinesia is a dietary diet, in the absence of which other methods of treatment become useless. Proper nutrition contributes to the creation of favorable conditions for the normal functioning of the digestive tract, as well as the normalization of the bile ducts:

bitter, spicy and fried foods are prohibited;
the consumption of various seasonings and spices is limited;
Fats are strictly prohibited. It can be replaced with oils of vegetable origin;
it is forbidden to accept potentially harmful products that can irritate the digestive organs;
at the very beginning of treatment, food is applied in a semi-liquid form and warm temperature regime, which is especially important in the presence of pain attacks;
before eating, the dishes are processed by boiling, steaming, stewing and baking in foil.

Prevention measures

In order to prevent the development of pathology, the following rules must be observed:

adhere to a full night sleep regimen lasting 8 hours;
going to sleep no later than 11 a.m.;
alternation of mental and physical activity;
frequent outdoor walks of high duration;
full nutrition with the use of food of plant origin, products from cereals;
limitation fried foods high-fat diets;
exclusion of situations that cause a serious traumatic effect on the mental state.

Secondary preventive measures are early detection dyskinesia, which becomes possible in the case of regular preventive examinations. JVP is not capable of influencing life expectancy, but significantly affects its quality.

Biliary dyskinesia is a disease of the gastrointestinal tract, which is characterized by a violation of the motility of the gallbladder and the functions of its sphincters, in particular, the sphincter of Oddi. As a result of these disorders, problems are found with the delivery of bile to the duodenum: its amount may be too small, not enough to digest food, or more than necessary, which negatively affects the entire gastrointestinal tract.

According to statistics, women suffer most from biliary dyskinesia. Some statistics indicate that women are 10 times more susceptible to this disease than men. Moreover, you can get sick with dyskinesia at any age. There are also statistics, JVP in young people is characterized by excessive bile secretion, and in more adulthood its insufficiency for digestion is observed. The treatment of this disease has positive prognosis if the patient consults a doctor at the first symptoms.

What it is?

Biliary dyskinesia - functional disorders tone and motility of the gallbladder, bile ducts and their sphincters, manifested by a violation of the outflow of bile into the duodenum, accompanied by the appearance of pain in the right hypochondrium. At the same time, there are no organic changes in these organs.

Classification

It is on how the contraction of the gallbladder occurs that the definition of the form of dyskinesia also depends:

Depending on the cause of the development of the pathology in question, doctors can divide it into two types:

Causes

Speaking about the causes of dyskinesia, it must be remembered that the disease is primary and secondary. Depending on this, the reasons that provoked dyskinesia will also change.

The primary form of dyskinesia can be caused by the following reasons:

inconsistency in the work of the parasympathetic and sympathetic parts of the nervous system, as a result of which the bladder itself and the sphincter of Oddi lose their tone;
stresses (acute, chronic), development of psychosomatic pathologies;
malfunctions in the liver, as a result of which bile with an altered chemical composition is produced;
malnutrition (overeating, eating too much fatty foods, untimely breakfasts, lunches and dinners);
violations of the production of intestinal hormones responsible for the contractility of the gallbladder;
non-systemic eating, eating too fatty food, overeating, insufficient food grinding, eating in a hurry, etc .;
allergy, as a result of which the neuromuscular apparatus of the gallbladder is in an irritated state and does not provide normal contractions body;
underweight, sedentary lifestyle, muscular dystrophy.

Causes of secondary dyskinesia may include the following:

a history of chronic organ disease abdominal cavity- ovarian cyst, pyelonephritis, adnexitis, etc.;
previous duodenitis, peptic ulcer, gastritis, atrophy of the mucous membrane of the gastrointestinal tract;
helminthic invasion;
cholelithiasis, hepatitis, cholangitis, cholecystitis;
congenital anomalies of the biliary tract and gallbladder;
endocrine disorders, hormonal surges;
inflammatory diseases of the gastrointestinal tract caused by pathogenic bacteria such as salmonella.

There are recorded cases of diagnosing biliary dyskinesia against the background of sedentary image life, excess weight(obesity stage 2-3), excessive physical activity(especially if weights are constantly lifted) and after psycho-emotional breakdowns.

Symptoms of biliary dyskinesia

The clinical picture of the described pathology is quite pronounced, so the diagnosis is not difficult for specialists. The main symptoms of biliary dyskinesia in adults are:

Dyspeptic syndrome is characterized by nausea, bitterness and dry mouth, belching with a bitter taste, bloating, unstable stools with a predominance of constipation or diarrhea, fatty stools. Such symptoms are caused by violations of the digestive processes associated with insufficient or excessive flow of bile into the intestinal lumen.
Pain syndrome. The occurrence of pain is due to errors in the diet or stressful situations. In the hyperkinetic form of dysfunction, the patient is disturbed by spastic pains in the right half of the abdomen under the ribs, radiating to the left half of the chest, into the shoulder blades or taking on a girdle character. With the hypokinetic form of pain, they are bursting, pulling, with or without irradiation, intensifying or disappearing with a change in body position. Pain can disappear on its own and reappear at different intervals - from several attacks a day to rare episodes throughout the month.
Astheno-vegetative syndrome is characterized by weakness, increased fatigue feeling of constant weakness, drowsiness or insomnia, increased level anxiety and other symptoms.
Cholestatic syndrome rarely occurs with a hypokinetic variant of dyskinesia, when bile that continues to be produced normally does not enter the intestine in the proper volume, but accumulates in the gallbladder, leading to the appearance of jaundice skin and sclera, skin itching, dark urine and light stool, liver enlargement.
Symptoms of neurosis - panic attacks, phobias (fears), intrusive thoughts, compulsive actions, aggression, anger, tearfulness, resentment, etc.

If the patient suffers from manifestations of hypotonic dyskinesia, then this condition is characterized by dull and aching pain, in which there is also a feeling of fullness in the right hypochondrium. Such pain constantly worries the patient, while his appetite noticeably decreases, the person often feels sick, and belching appears. The rise in body temperature is not observed, a clinical blood test also does not indicate the presence of abnormalities.

If we are talking about hypertensive dyskinesia, then the pain is paroxysmal in nature. In this case, the pain is quite acute, but lasts a short period of time. Pain may radiate to the right shoulder or shoulder blade. Especially often such attacks occur after eating fatty foods, strong stress, both physical and emotional. Very often, patients with hypertensive dyskinesia note a manifestation of bitterness in the mouth, which most often happens in the morning.

Possible Complications

As a rule, with biliary dyskinesia, patients seek help from doctors almost immediately after the first attack of pain. But many of them, having removed unpleasant symptoms, stop the prescribed treatment, thereby provoking the development of complications:

duodenitis - an inflammatory process on the membrane of the duodenum;
the formation of stones in the gallbladder and its ducts - cholelithiasis;
chronic cholecystitis - inflammation of the gallbladder that lasts more than 6 months in a row;
atopic dermatitis - a skin disease that is a consequence of a decrease in the level of immunity;
pancreatitis chronic nature- inflammation of the pancreas for 6 months.

Biliary dyskinesia has a fairly favorable prognosis and does not reduce the patient's life expectancy. But in the absence full treatment and non-compliance with the recommendations of a nutritionist, the development of the above complications is inevitable. And even these diseases are not dangerous for human life, but the patient's condition will worsen significantly, eventually leading to disability.

Diagnostics

play an important role in the diagnosis instrumental examinations sick. The most effective results are duodenal sounding, ultrasound procedure, gastroduodenoscopy, cholecystography.

Ultrasound examination for biliary dyskinesia is carried out in two stages. First on an empty stomach, and then again 30-40 minutes after the "trial breakfast". As a result of such procedures, the functionality of the biliary tract is analyzed.
Duodenal sounding is carried out using a special probe that is placed in the duodenum. During the study, bile samples are taken for laboratory analysis. During manipulations, the work of the biliary tract is monitored, the opening of their sphincters, the amount of bile secreted is analyzed.
Peroral cholecystography. During the study, the patient drinks a contrast agent. When it gets into bladder, a study of its functioning is carried out, on the basis of which it can be concluded which form of dyskinesia manifests itself in the patient.
Gastroduodenoscopy is carried out using a probe. During this procedure, the state of the mucous membranes of the esophagus, stomach and duodenum is analyzed. If the mucous membrane of these organs is in a state of inflammation and irritation, then we can conclude that there is an excess secretion of bile acids.
Laboratory methods: to assess the state of the biliary system, they use biochemical analysis blood. Blood test for lipid spectrum, or "lipidogram" shows the content of high, low and very low density lipoproteins (HDL, LDL, VLDL), as well as cholesterol.

It is also necessary to carry out a differential diagnosis of the disease with other pathologies of the gastrointestinal tract, in which similar symptoms are noted.

How to treat biliary dyskinesia?

In adults, treatment should be comprehensive, aimed at normalizing the outflow of bile and preventing its stagnation in the gallbladder.

For this, the following methods are used in the treatment of biliary dyskinesia:

Dieting (table number 5);
Normalization and maintenance of the regime of work and rest;
Reception of mineral waters;
Physiotherapy (electrophoresis, diadynamic currents, paraffin applications);
The use of closed tubes and duodenal sounding;
Acupuncture;
Massage;
Sanatorium treatment (Truskavets, Mirgorod, Transcarpathian resorts of Ukraine);
Taking medications that normalize the outflow of bile, relieve pain, relieve spasm of sphincters and eliminate painful symptoms (enzymatic, choleretic, antispasmodics);
Taking medications that normalize the state of the nervous system (sedatives, sedatives, tonics, etc.).

Mandatory methods of treating dyskinesia are the normalization of the regime of work and rest, diet, medication and the use of tubes. All other methods are auxiliary, and can be applied at will and if possible. The duration of the application of mandatory methods of treatment of dyskinesia is 3-4 weeks. Auxiliary methods can be used much longer, periodically repeating courses in order to prevent the recurrence of the disease.

Medicines

Since dyskinesia refers to diseases caused by a violation nervous regulation, directly depends on the state of the psyche, then before starting the treatment of motor activity disorders in the biliary tract when using choleretic drugs, it is necessary to restore the mental background of the patient. If the pathology appeared on the background depression, it is necessary to prescribe a course of light antidepressants. If the violation of the process of bile secretion was caused by severe anxiety, neuroses, then it is advisable to start with neuroleptics and tranquilizers.

Such drugs can be prescribed by a psychiatrist or a psychotherapist. In addition, the causes of dyskinesia are treated: correction of dysbacteriosis, elimination of hypovitaminosis, treatment of allergies, antihelminthic therapy.

The choice of drugs to restore the functions of bile formation and bile secretion depends on the type of dyskinesia.

With a hypotonic type of biliary dyskinesia, flamin, cholecystokinin, magnesium sulfate, pancreozymin are prescribed; mineral waters of high mineralization (Essentuki 17, Arzni and others, at room temperature or slightly warmed up 30-60 minutes before meals, depending on the secretion of the stomach). Phytotherapy: corn stigmas, immortelle flowers, chamomile, nettle leaves, rose hips, St. John's wort, oregano.
With hypertensive type of biliary dyskinesia, oxafenamide, nikodin, mineral waters of low mineralization (Slavyanovskaya, Smirnovskaya, Essentuki 4, 20, Narzan in hot or heated form 5-6 times a day) are used. For herbal medicine, chamomile flowers, peppermint, licorice root, valerian root, motherwort grass, dill fruits are used.
With intrahepatic cholestasis, tubes are performed (tubeless drainage of the biliary system, or "blind" probing) 1-2 times a week. Assign tonic drugs, choleretics and cholekinets. With increased activity of the liver enzyme ALT, choleretics are not prescribed.
With a hypokinetic type of biliary dyskinesia, sorbitol, xylitol, cholecystokinin, pancreozymin, magnesium sulfate, mineral waters of high salinity at room temperature or slightly warmed up 30-60 minutes before meals are recommended. Phytotherapy as in the hypotonic type.
With a hyperkinetic type of biliary dyskinesia, antispasmodics are used in a short course, potassium and magnesium preparations, mineral waters of weak mineralization in a heated form 5-6 times a day. Phytotherapy: chamomile flowers, peppermint, licorice root, valerian root, motherwort herb, dill fruit.

Therapy in each case is selected individually, and for this you need to contact a specialist. A comprehensive examination will be prescribed, and after making a diagnosis, the doctor will select the appropriate drugs. Self-medication is dangerous: incorrect recognition of symptoms can only lead to a deterioration in well-being.

Diet and proper nutrition

Nutrition is the cornerstone of treatment for dyskinesia. Only through strict adherence to the rules can you avoid the occurrence of seizures and carry out prevention surgical complications such as gallstone disease and acute cholecystitis. Diet for dyskinesia implies compliance general rules nutrition, however, there are points that differ significantly depending on the type of disease (hyperkinetic and hypokinetic).

The following foods should be completely excluded from the diet for any type of dyskinesia:

spicy, fried, fatty, smoked, sour, pickles and all canned;
fatty meats and fish;
confectionery, including chocolate, cocoa;
sweet pastry;
carbonated drinks, coffee, alcohol;
seasonings;
vegetables that irritate the digestive tract - garlic, onions, radishes, sorrel;
foods that increase gas formation in the intestines (legumes, rye bread, etc.);
milk;
marinades.

Features of nutrition in hypomotor dyskinesia. The diet should consist of products that stimulate the motility of the biliary tract:

cream;
eggs;
black bread;
sour cream;
vegetable and butter;
vegetables (boiled, stewed, baked);
fruit.

Features of nutrition in hypermotor dyskinesia:

In the presence of this form of pathology, it is imperative to exclude from daily diet foods that stimulate bile secretion and bile formation: soda, broths, fresh vegetables, fatty sour-milk and dairy products, black bread, animal fats.

With any form of dyskinesia, it is necessary to eat 5 to 6 times a day in small portions (the contents of a serving should fit in two handfuls). Do not allow breaks between meals for more than 2 hours. All food and drinks should be warm or at room temperature, not cold or hot, as too high or low temperature can provoke an attack of dyskinesia. Salt must be limited, consuming no more than 3 g per day to eliminate fluid stagnation in the tissues. Cooking various dishes should be done by boiling, baking or steaming.

Mineral water

Mineral water should be drunk regularly, 1/2 - 1 glass 20 - 30 minutes before meals in a warm form, choosing the required variety depending on the form of dyskinesia. So, with hypomotor dyskinesia, it is recommended to drink water of high mineralization (for example, Essentuki 17, Batalinskaya, Borjomi, Mashuk, etc.), and for hypermotor - low mineralization (for example, Darasun, Karachinskaya, Lipetskaya, Narzan, Smirnovskaya, etc.) .

Mineral waters can and should be drunk, as well as diet, long span time, i.e. at least 3-4 months. However, if mineral waters cannot be included in the complex therapy of the disease, then their use can be completely abandoned.

Lifestyle with dyskinesia

For a patient with biliary dyskinesia, it is very important to healthy lifestyle life, which includes:

rejection of bad habits,
moderate physical activity, without physical overload,
rational mode of work and rest,
a full night's sleep

The main component of the lifestyle - healthy eating- the exclusion of fatty, fried, spicy, salty, spicy foods, the restriction of animal products, the increase in the consumption of plant products. During the treatment of dyskinesia, it is necessary to observe strict diet, or treatment table number 5.

Folk remedies

At home, the treatment of dyskinesia is best done in combination with the use of folk methods. But before preparing and taking them, you should consult your doctor.

Infusions, decoctions, extracts and syrups of herbs are used that can activate the formation of bile, improve the motor function of sphincters and bile ducts.

In the hypertensive and hyperkinetic type, mint, chamomile flowers, motherwort herb, licorice root, dill fruits, valerian root are used.
In the hypotonic and hypokinetic form, rose hips, immortelle flowers, St. John's wort, corn stigmas, oregano, nettle leaves, and chamomile are used for herbal medicine.

Milk thistle, immortelle, tansy, dandelion leaves and root, corn stigmas, chicory, wild rose, pharmacy fume, parsley, turmeric root, cumin, yarrow have a choleretic effect.

Herbal decoctions are used 20-30 minutes before meals.

Surgery

In the absence of long-awaited relief after adequate and comprehensive conservative therapy doctors use surgical techniques. They can be:

minimally invasive (more often with the use of endoscopic equipment);
radical.

In case of revealed dysfunction of the sphincter of Oddi, the following is performed:

injections directly into this sphincter of botulinum toxin (it significantly reduces spasm and pressure, but the effect is temporary);
balloon dilatation of this sphincter;
setting a special caterer-stent into the bile duct;
endoscopic sphincterotomy (its excision together with the duodenal nipple) followed (if necessary) by surgical sphincteroplasty.

An extreme measure to combat severe hypotonic-hypokinetic variant of biliary dysfunction is cholecystectomy ( complete removal atonic gallbladder). It is performed laparoscopically (instead of an incision on abdominal wall make several punctures for equipment and instruments) or laparotomy (with a traditional incision) by. But the effectiveness of this serious surgical intervention not always felt by patients. Often after this, the resumption of complaints is associated with the developed postcholecystectomy syndrome. Rarely done.

Biliary dyskinesia in children

For therapy in children, preference is given to herbal preparations. They are selected depending on the type of pathology.

So, with hypomotor dyskinesia, the following are prescribed:

medicines that increase the tone of the biliary tract: magnesium sulfate, sorbitol or xylitol;
drugs that stimulate the formation of bile: cholagol, holosas, allochol, liobil;
"blind probing" with the intake of sorbitol or xylitol;
herbal therapy: decoctions of dandelion, wild rose, corn silk, mint;
mineral waters: "Essentuki 17".

With hypermotor dyskinesia, treatment is carried out:

herbal therapy: decoctions of St. John's wort, chamomile, nettle dioecious;
antispasmodic drugs: eufillin, riabal;
electrophoresis with novocaine on the gallbladder area;
low-mineralized waters: "Slavyanovskaya", "Smirnovskaya".

After stopping the attack, rehabilitation is carried out in a sanatorium, where mineral waters and other physiotherapy are prescribed:

sodium chloride baths;
microwave therapy;
galvanic collar according to Shcherbak;
with a sedative purpose: coniferous baths, bromelektroson;
to improve the motor activity of the biliary tract: SMT therapy, magnesium sulfate electrophoresis.
to eliminate spasm of the biliary tract: magnetotrapy, electrophoresis of antispasmodics (no-shpy, papaverine) on the area of the biliary tract /

Children with dyskinesia are registered with a pediatric gastroenerologist, neurologist and pediatrician. They are assigned twice a year scheduled ultrasound. Also, once every 6 months, courses of choleretic therapy are carried out. Once or twice a year, the child is given referrals for sanatorium treatment.

Prevention

To prevent the appearance and development of pathology, you should:

Set up good sleep and rest (sleep at least 8 hours a day);
Provide daily walks in the fresh air;
Organize a proper and balanced diet;
Eliminate the presence of stress and psycho-emotional stress.

At secondary prevention(i.e. already after the detection of dyskinesia) it is possible to prevent the disease by adhering to the recommendations of the doctor and regularly undergoing preventive examinations