How to diagnose biliary dyskinesia. Biliary dyskinesia on hypertonic type treatment. Why does the syndrome develop in children

Biliary dyskinesia is today the leader among the pathologies associated with diseases of the digestive system. The syndrome is noted in 75% of cases of violations of the gastrointestinal tract. At the same time, organic dysfunctions not associated with digestive disorders do not exceed 10%. Adolescents, preschool children and asthenic women are at risk. The depressing statistics make us think about the culture of food. According to statistics, it is the neglect of the rules of healthy eating that in most cases becomes a catalyst for the development of dyskinesia. We offer to figure out what kind of diagnosis it is - JVP and whether the probability of the disease depends only on nutrition.

How is a functional disorder formed?

In a healthy body, the synthesis and secretion of bile is carried out by special hepatocyte cells in the liver. From there, through the ducts, the substance in the composition of the gastric juice goes to the gallbladder and remains there until food enters the duodenum. At this time, the walls of the bladder begin to actively contract, stimulating the outflow of a portion of bile. Its main function is not only in the process of digestion, but primarily in the emulsification and breakdown of fats to fat-soluble acids "familiar" to the body.

When the correct outflow of bile is disturbed, they talk about. In ICD 10, JVP is assigned the code K82.8.0. The development of a functional disorder occurs according to two scenarios, equally unfavorable. Violation of the outflow of bile can be caused by its stagnation and then there is a threat of intoxication of the body. Bile thickens, loses its antimicrobial function. When a sharp, uncontrolled release of bile is recorded, useful substances, fat-soluble vitamins from food do not have time to be absorbed, leaving together with the feces in a “raw” form.

General classification of pathology

In gastroenterology, a double classification of dyskinesia is used. Based on the basic markers of the work of the bile ducts, the JVP is divided into:

• hypotonic (hypokinetic, hypomotor) - characterized by a decrease in the tone of the sphincters, a decrease in the motor activity of the ducts, the gallbladder contracts sluggishly;
• hypertonic (hyperkinetic, hypermotor) - there is a sharp, under strong pressure, the release of bile, spastic phenomena predominate;
• combined - combines violations of both types of pathology, in different situations behaves unpredictably.

With dyskinesia, the process of splitting food is disrupted, the quality of assimilation of nutrients decreases, which is fraught with complications, especially dangerous in childhood.

Why does the syndrome develop in children?

DZHVP at children's and teenage age meets often. In some cases, the manifestation of pathology is explained by the active growth of the musculoskeletal system and is temporary. However, serious functional disorders of the digestive system can also become a catalyst for JVP in children, as in adults. There are organic and functional dyskinesia.

Organic suggests congenital defects in the development of the bile ducts (scars, constrictions, doubling or narrowing of the bladder, dysplasia), systematic malnutrition, chronic allergies, increased excitability of the nervous system. JVP of primary etiology occurs in 10-15% of cases.

The development of biliary dyskinesia syndrome in children is preceded by an unhealthy lifestyle or a long period of concomitant disease.

Factors in the development of the syndrome in adults

The triggers for the development of JVP in adulthood are:

• vegetoneurosis and VVD;
• hormonal imbalance;
• improper, irregular nutrition;
• recent acute infections;
• allergic diseases that have become chronic.

In women, causes of dysfunction include:

• cysts and other formations in the ovaries;
• inflammation of the reproductive organs;
• kidney disease;
• menopause.

During pregnancy, the symptoms of JVP appear in the third trimester. The enlarged uterus compresses the gallbladder, making it difficult for bile to flow out. Progesterone, which is synthesized during pregnancy in a double volume, has a relaxing effect on the smooth muscles of the biliary tract, reduces tone, and impairs motor skills. In the first trimester, the syndrome can often be confused with manifestations of toxicosis.

How does dyskinesia manifest itself?

Clinical symptoms of JVP appear with varying degrees of severity and in various combinations. This is due to the type of pathology, as well as the individual characteristics of the course of the disease.

With hypotonic dyskinesia, patients note:

• pain syndrome in the right side;
• feeling of heaviness in the area under the rib;
• "tasteless" belching;
• lack of appetite;
• weight loss;
• frequent constipation.

Hypertensive type of dyskinesia is characterized by:

• colicky attacks in the hypochondrium on the right, radiating to the shoulder blade;
• vomiting;
• diarrhea
• increased separation of urine;
• sweating;
• mood swings;
• headaches.
• the formation of a whitish coating on the mucous membrane of the tongue.

Both types of dyskinesia can become a source of such unpleasant manifestations as:

• bad breath;
• yellowness of the skin;
• violation of the cycle in women;
• decreased sex drive in men.

The mixed type combines the symptoms of both forms of JVP. They can be expressed in varying degrees and manifest themselves chaotically. Note that with JVP, body temperature remains within the normal range. A high temperature indicates a bacterial infection or the onset of an inflammatory process.

Features of diagnosing JVP

At the diagnostic stage, the main task of a specialist is to establish the type of violation, identify the causes that caused it, and exclude comorbidities.

A comprehensive examination of a patient with suspected DVD includes instrumental and laboratory diagnostics, radiological methods:

• visual inspection;
• detailed analysis of complaints;
• assessment of anatomical features, contractile activity, the presence of inflammation, gallstones through ultrasound;
• blood chemistry;
• coprogram;
• cholecystography.

Diagnostic methods are selected and approved by the attending physician. As the results of the examination become available, additional studies and consultations with specialized specialists can be applied.

Therapeutic approach for JVP

Treatment of DZHVP is aimed at eliminating the root cause of the disease and provides for a comprehensive method with a mandatory correction of nutrition.

Therapy using medications depends on the type of pathology. Drugs are prescribed in courses to stop attacks and prevent complications. Hypotonic JVP is treated with choleretic drugs. Hypertensive dyskinesia requires the appointment of sedatives, antispasmodics. For pregnant women, homeopathic preparations and traditional medicine are selected individually.

Features of the nutrition of people with a diagnosis of JVP

Diet with JVP is a prerequisite for complex treatment. Without it, therapy will be ineffective and will not lead to the normalization of the condition. General recommendations are as follows:

• limit chemical and physical food irritants;
• refuse excessively sour and salty foods, spicy, bitter, as well as sweets;
• vegetable oils are preferable to animal fats;
• bake, boil, stew, cook without salt;
• eat only warm food of a liquid consistency;
• adhere to frequent fractional meals.

The diet is relevant and necessary not only for the diagnosis of JVP, but also as a preventive measure for gastrointestinal diseases.

How to protect a child from JVP?

To reduce or completely eliminate the risk of developing biliary dyskinesia in childhood, it is important to adhere to a proper diet and lead a healthy lifestyle:

• remove fast food, carbonated drinks, "chemical" sweets, chips from the children's diet;
• do not overfeed the child, take into account the ratio of serving size and age;
• food according to appetite, on demand;
• enrich the diet with seasonal vegetables, fruits;
• observe sleep and wakefulness;
• spend more time outside the city, in parks and squares;
• timely treat diseases of the gastrointestinal tract;
• regularly carry out the prevention of helminthiasis.

Prevention of JVP in children will avoid serious pathologies in the work of the organs of the gastrointestinal tract.

Functional digestive disorders and congenital structural features of the biliary tract, which determine the specifics of the digestive system of children, occupy a large part of the visits to a pediatrician or gastroenterologist. Parents turn to specialists, complaining from babies of abdominal pain, nausea in the morning and heaviness in the side, a bitter taste on the tongue. After examinations, the diagnosis "" is often clarified, hereinafter referred to as DZHVP, and such an abbreviation is often incomprehensible to parents, which is why it causes worries and worries about further treatment. What is JVP, where do problems with the structure of the gallbladder come from, according to the type of its inflection, and how can this affect the future life of babies?

About diagnosis and pathology

Functional digestive disorders and minor developmental anomalies in relation to the biliary system and gallbladder are among the subjects of controversy in medical circles among pediatricians and pediatric gastroenterologists. Not all of the specialists, especially in European countries, recognize biliary dyskinesia (this is how the abbreviation JVP stands for) as a separate pathology and consider it legitimate to make such a diagnosis.

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Many doctors consider such manifestations to be solely the fault of parents who do not follow the principles of rational nutrition of children, thereby provoking such functional deviations.

Meanwhile, another part of the experts notes that similar digestive problems can be detected in children who eat properly, and are not always recorded in children who eat even unhealthy food. In this regard, referring the pathology data to functional deviations, and having complaints from children and parents, data obtained from the results and, most specialists still tend not to expectant tactics - “it will outgrow itself”, but to active treatment, which consists of more part in non-drug effects. In the treatment of this particular pathology, the role of parents and the formation of a healthy lifestyle and proper nutrition is great.

The term JVP: what is meant by it?

Under the biliary dyskinesia or the letters JVP, in a literal interpretation of the terms, they understand a violation of the movement of bile inside the bile ducts (dis - disorder, kinesio - motor function). For such a situation, the movement of bile through the intrahepatic ducts, bile capillaries and common choledochus is specifically considered, as well as problems with its release from the gallbladder during the digestion process.

Generally speaking, the concept of DZHVP includes a violation of the contractility of the gallbladder and all its sphincters, because of which bile cannot leave the bladder cavity in time and penetrate to the place of its direct action - the lumen of the duodenum, therefore, such a phenomenon can disrupt the digestive system. functions. Bile can stagnate for a long time and flow sluggishly, or ahead of time, while it is not yet needed, it is sharply and a lot of it is released into the intestinal lumen. Because of this, digestive problems are possible, but not always and not in all children.

Does JVP always lead to digestive disorders?

In order to understand the problems that are possible in the presence of LAD, it is worth discussing the issue regarding the functions of the liver and bile, as well as its role in the digestive processes. So, bile refers to the digestive secret, actively involved in the processes of digestion and assimilation of food. It is produced by liver cells, then it is secreted into the bile ducts inside the liver, collected in the ducts and flows down the common common choledoch into a reservoir where it accumulates and is stored - the gallbladder.

Bile is unique in composition, it contains a lot of biologically active and important compounds for the body - these are bile acids, active digestive enzymes that actively saponify, break down fats, as well as cholesterol, bilirubin and other pigments that are dangerous for the body, but are neutralized in the intestines and are taken out with a chair. Due to bile, as well as its active secretion into the lumen of the intestine, the synthesis of digestive hormonal compounds, enzymes is launched and the work of the pancreas is started. It is difficult to overestimate the function of bile in a healthy child's body.

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Bile is released into the intestinal lumen not constantly, but in portions, under the influence of stimuli from the digestive tube, which is irritated by food intake - breakfast, lunch or snacks.

Impulses from the stomach or the lumen of the duodenum lead to relaxation of the sphincter, which causes the gallbladder to contract, releasing the previously accumulated portion of bile into the intestinal cavity. In its lumen, in addition to the digestion of fatty foods, bile has a number of important functions:

• Emulsifies fats, breaks them down to small droplets that are easily absorbed by the intestinal wall
• Possessing a pronounced bactericidal effect, it finishes off pathogenic microorganisms that the acid in the stomach did not have time to neutralize
• Inactivates stomach acid, creating an alkaline environment in the intestine
• Activates digestive enzymes, stimulates the production of such important digestive hormones as cholecystokinin and secretin, and they activate the pancreas
• Irritates the intestinal walls, due to which it activates the contraction and prevents food gruel from stagnation, prevents constipation when eating solid food
• Does not allow food gruel to ferment and bloat the intestines.

Thus, bile helps to absorb fats, prevents constipation and helps in the digestion of carbohydrates and proteins by activating the functions of pancreatic juices.

Against the background of JVP, the production of bile occurs out of time and not in the volume that is needed. Either it is released a little and too late to fully assimilate the food, or it is too much, it is released sharply, painfully, with spasm of the bladder.

As a result, digestion in the intestines and even the stomach suffers, as a result of which pain, constipation, nausea, bloating, diarrhea and bitterness in the mouth are formed.

Who happens: children at risk

Most children suffering from JVP are toddlers at preschool and school age who already have various digestive problems, including those associated with malnutrition - (fast food, soda, snacks, chips, etc.). In rare cases, JVP is diagnosed in children under the age of five, for them such problems are not typical due to the fact that in kindergartens they monitor nutrition relatively normally and offer healthy food.

About 85-90% of children suffering from JVP describe manifestations in bright colors with a variety of manifestations that change from time to time:

• , usually in the umbilical region, on the right side of the abdomen
• Dull aching, on the background and bitter on the tongue
• It is possible from the mouth, the tongue is white-gray, with a yellowish coating closer to the back.

But with all these symptoms, there are no defects in the structure of the stomach or intestines, as well as the liver and the gallbladder itself. Often, with JVP, an inflection in the area of ​​\u200b\u200bthe body or neck of the bladder can be detected, and it is not detected in everyone and not always.

DZHVP is not classified as a life-threatening organic pathology, it is a violation of the functioning of the biliary system, a kind of immaturity and uncoordination of the contractile apparatus. There are no stones, tumors, or other obstructions in the ducts that prevent bile from entering the intestines. The bubble and ducts are either “active haste” or “sluggish lazybones”.

This is due to the work of the autonomic nervous system, the characteristics of the child himself, his diet and some other factors. Thus, the contraction of the walls of the gallbladder is regulated by special intestinal hormones that are secreted by the duodenum. If it is irritated or inflamed, the secretion of hormones will be incorrect - this leads to problems with the separation of bile. Therefore, the manifestations of JVP are a concomitant pathology in the presence of various inflammatory processes of the intestine -, or against the background of poisoning or intestinal infection.

Rarely, the cause of the development of JVP can be stagnation of bile inside the bladder cavity due to an anomaly in the structure of the ducts, the presence of structural disturbances in them, with the development of cholelithiasis (an extremely rare pathology in a child).

By their nature, JVP and tone in the bladder area have options in the form of:

• hypertension (excessively tense and strongly reduced walls)
• Hypotension (atony, when the walls are relaxed and contract weakly and inactively).
• Dystonia – when there are problems with tone and contraction, each time they are different.

Factors predisposing to JVP in children

In fact, the problems of bladder contractility and tone are temporary, they mainly arise due to the immaturity of digestion and problems with the coordination of the nervous system during the maturation of the digestive tract. The maturation of the digestive tube occurs gradually, around school age.

In addition, some children have a hereditary predisposition to high excitability of the muscular sphincter apparatus, the predominance of sympathetic innervation in choleric temperament, as well as the consequences of difficult labor and CNS injuries. This creates muscle weakness. The consequences can influence the formation of JVP, it occurs due to strength or malnutrition.

If we analyze all the mechanisms that create a predisposition to digestive disorders and the formation of JVP, then it is put in the first place. This is a kind of functional disorder of the nervous system, which leads to an imbalance in the mechanisms of regulation of the muscles of the bladder itself and its sphincters.

No less actively affects the reduction in the synthesis of cholecystokinin by the intestinal wall. If its influence is completely absent or weakly affected, bile flows weakly.

The contraction of the walls of the biliary system and the bladder is affected by a hormone secreted by the pancreas - glucagon.

In a healthy child born without problems, the processes of excitability and inhibitory influences are balanced, and in case of pathology, either one process or the second predominates. If bile stagnates and concentrates, its characteristics may change - viscosity, composition and fluidity, it may lose its bactericidal properties, thicken and may create conditions for the formation of crystals, and then stones. Usually, JVP is considered a predisposing factor for the further development of calculous.

Options for the development of JVP in children

Based on the cause of the problem and the origin of the pathology, two variants of JVP can be distinguished - either primary or secondary variants of the course:

In addition to origin, JVP is divided into several types, based on their ability to contract the bladder and the tone of its muscles and sphincter apparatus. There are two main types of JVP:

• dyskinesia of hypertonic, hyperkinetic flow with sharp contractions and the release of large portions of bile at once.
• dyskinesia of hypotonic, hypokinetic type with sluggish contractions and a small outflow of bile into the intestine.

In both variants of GIVP, an abnormal amount of bile enters the intestinal lumen, which leads to indigestion and the manifestation of unpleasant symptoms from the intestines. In the initial period, an asymptomatic course of the disease is possible, but then, upon careful examination, the first symptoms of digestive disorders can be noted - especially in the morning, a feeling of heaviness in the abdomen and navel, and stool disorders - alternating with or persistent constipation against the background and seething. The most typical manifestations of discomfort after taking fatty foods, fast food or after eating fried or spicy, salty. With such complaints, it is necessary to consult a doctor and conduct an examination to identify a specific type of JVP, since the principles of treatment differ significantly.

DZHVP by hypertensive type: features in children

If a child has a hypertensive and hyperkinetic type of pathology, an increase in the activity of the parasympathetic department will be characteristic. In fact, this is part of the manifestations of primary neurosis, disorders of the nervous system with severe disturbances in the activity of internal organs.

Typical symptoms for this type of JVP are:

• pain syndrome: soreness of an attacking nature, localized in, sometimes extending to the area of ​​\u200b\u200bthe subscapular zone or the right shoulder, including against the background of deep breaths. The pain is formed after eating fatty foods and its large volume, in violation of the diet, as well as after physical exertion, experiences and stress.
• Pain duration short, well removed with painkillers or. During attacks, aggression or anxiety is usually typical, there may be nausea to vomiting attacks, headache or palpitations, and the release of a large amount of urine.
• palpation of the tummy leads to soreness in the bladder projection area.

All the time between attacks, when there are no exacerbations of the process, there is no pain in the abdomen, or there is an unexpressed sensitivity to probing the right hypochondrium. The liver in the case of such a pathology does not increase, there are no signs of toxicosis.

A similar pathology occurs in the form of attacks, and between attacks the children feel quite well, the kids do not have any complaints. Or there may be problems with the stomach in the form of pain attacks or spasms, as well as discomfort in the right side or umbilical region. This is typical for irritating foods - eating a lot of chocolate or ice cream, eating chips with soda. These attacks are well eliminated by taking antispasmodics (papaverine or in age doses).

JVP by hypotonic type: features in children

In the presence of hypotension of the bladder and reduced motility in the area of ​​the bile ducts, other symptoms usually occur. They are typical for children with increased activity of the sympathetic department. They usually complain about:

• Pain aching, pressing nature, which usually spreads on the right side, blunt and almost constant in the hypochondrium. Usually it is accompanied by a feeling of heaviness, pressure with bursting in the area of ​​​​the right side, located directly under the ribs. Usually, the increase in pain occurs against the background of provoking adverse factors. However, as such, strong, acute pain is practically not formed.
• against the backdrop of pain abdominal discomfort of a non-localized nature, nausea and a taste of bitterness on the tongue are formed, a decrease in appetite up to the refusal of food. However, vomiting and stool problems are not typical.
• palpation of the abdomen reveals soreness according to the projection of the gallbladder, especially against the background of exacerbation. In this case, a special symptom of Ortner can be detected - tapping the edge of the palm along the border of the lower ribs (only on the right side), pain may increase.
• for this type of JVP is typical stasis of bile inside the bladder(cholestasis), which leads to the detection of an increase in the size of the liver, while it is elastic and soft and does not hurt when probed. When conducting duodenal sounding or using choleretic agents, the outflow of bile is stimulated, which leads to a decrease in the size of the liver and the size of the bladder.

The state of JVP is not an isolated single pathology in a child, but only one of the manifestations of the systemic neurosis of his organism. In addition to problems with the functioning of the biliary tract, various organs and systems can be affected that help maintain the constancy of the internal environment of the child's body.

In addition to identifying JVP, other functional abnormalities in the work of many systems and organs can also be determined - the heart and blood vessels, the nervous system and the respiratory tract.

Structural changes in its composition are typical against the background of stagnation of bile - the concentration of proteins and fat components is disturbed, which significantly affects the subsequent digestion of such bile food. Due to changes in the composition and separation of bile, the digestive functions of the body may suffer - conditionally pathogenic flora actively reproduces in the intestinal lumen, the synthesis and absorption of vitamins, especially the fat-soluble group, may suffer.

Diagnosis of JVP in childhood

Although it seems that the pathology is obvious, making an accurate diagnosis is not always simple and easy. The doctor can make a preliminary diagnosis on the basis of typical complaints that the child himself makes, and supplement the stories of the parents. But this is not enough in order to start treatment, it is necessary to determine the cause of JVP (that is, identify its primary or secondary nature), as well as clarify the type by tone and motility. This requires a whole cycle of analyzes and instrumental examinations, which are sometimes extremely unpleasant for the child.

The beginning of the diagnosis is a detailed examination of the doctor and palpation of the abdomen, as well as an examination of the entire body of the child with the identification of typical symptoms characteristic of damage to the liver or parts of the biliary system. These include:

But only examination and symptoms will not be enough, it is necessary to conduct both aiming and identifying the state of motor skills. First of all, ultrasound evaluates the size of the bladder, its location and shape, patency, the width of the bile ducts and their congenital anomalies, deformities, stones in the ducts or bladder (rare in children). Then an ultrasound is performed with trial breakfasts or stimulants to determine the type of dyskinesia. Unlike many others, ultrasound is painless and safe, it does not bring discomfort to the baby.

There is no need for special preparation for ultrasound, it is only important to come in the morning on an empty stomach, so that functional tests can also be performed to determine the specific type of JVP.

Features of ultrasound for dyskinesia

If JVP is suspected, ultrasound can be performed several times to assess not only the anatomy of the biliary organs, but also their functionality. Therefore, it is important to prepare for the study in advance, correctly and fully. You can determine the type of JVP on an empty stomach, using choleretic breakfasts or medications that stimulate the secretion of juices during the procedure.

The methodology is simple:

Based on the ultrasound picture, you can see the initial size of the gallbladder on an empty stomach and after eating, the presence of its complete contraction and emptying or partial, the presence of a neck inflection, whether such an anomaly interferes with the digestion process.

The presence of detected changes in the biliary system and bladder does not give the right to insert a diagnosis and start treatment. The ultrasound specialist only states the presence or absence of any functional failures in the area of ​​the child's biliary system.

Only a pediatrician or a narrow specialist, on the basis of previously obtained analyzes, examination data, complaints and all the problems identified during an ultrasound examination, makes a conclusion about the presence of JVP and its type, the causes of the formation of the pathology and the need for treatment. If there is only ultrasound data, but there are no complaints, soreness, problems with stools and assimilation with digestion of food, the diagnosis is not made - this is illegal.

If the diagnosis is in doubt: clarifying procedures

Often, only the data of the review and complaints, as well as information obtained from ultrasound and analyzes, will not be enough for the final diagnosis, the type of DZHVP remained unspecified. Then an invasive examination, which is not very pleasant for the child, but extremely informative for a specialist, is prescribed - duodenal sounding with obtaining fractions of bile and intestinal juice.

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This technique, by introducing a tube into the lumen of the intestine, allows you to get portions of the contents with bile, evaluating its composition and activity in relation to digestion. Bile is taken at certain intervals, using secretion stimulants and trial breakfasts, evaluating the work of the gallbladder and the secretion of bile into the intestinal lumen.

Based on the volume of bile portions and the rate of its release into the intestinal lumen, it is possible to assess the state of tone of the biliary tract and motility, as well as the performance of individual sections in the biliary tract - in the area of ​​the sphincters of the bladder, which remove bile from it and also in the area of ​​​​the common bile duct.

In children with hyperkinetic problems, cholesterol and fat levels are lowered against the background of GIVP, and their increase is typical against the background of the hypokinetic type.

Extremely rarely, in the case of detection of developmental anomalies that require surgical correction in the future, x-ray cholecystography with contrast is used, a method that allows you to visually assess the structure of the bile ducts.

Treatment: nutrition, restrictions, drugs

The first thing you need to start therapy with any type of established JVP is a special dietary correction, and doctors call it "Three G Diet" It will also be needed for children who do not have digestive problems, but problems with the bladder were found - its excesses, difficulty emptying and difficulty in the outflow of bile from the bladder.

So, with a diet of three "F" are excluded from the diet of babies:

• Fatty foods
• Fried foods (including fast food)
• Yolks and dishes with them.

These products have a pronounced irritating effect on the liver and biliary system, lead to work stress and excessive separation of bile into the intestinal lumen. The child's diet should contain more vegetables and fruits in any form, as well as dairy products of any kind (except for highly fatty foods and foods).

The diet of a child with problems of the liver and biliary system should exclude fatty lamb and pork meat, all snacks and fast food, mineral water with gas, and especially sweet soda. Food is offered to the child in small fractional portions up to six times a day, in agreement with the doctor, herbal medicine courses can be used several times a year to improve bile secretion. If there are abdominal pains, digestive problems, you should not rely only on a diet, you should consult a doctor and carry out a full course of treatment.

The basis of therapy: important for parents

The basis of any treatment for JVP, whatever its type, is the normalization of motor activity and the work of the autonomic nervous system. This means that during periods of exacerbations, you need more rest and less stress, daytime sleep, the child's mood for success in treatment and a positive mood.

Diet is the basis of the treatment of JVP and it is necessary that parents and the child himself, as well as all relatives, without exception, understand this. Violation of the diet is a path to aggravation, you need to instill this in caring grandmothers who are trying to feed the child more densely and more satisfyingly.

Fractional and frequent meals in small volumes are required so that bile flows evenly and continuously, without long breaks. There should be at least 4-5 meals, and sometimes more frequent meals, you can not create large gaps in nutrition, so as not to accumulate bile in the bladder and not lead to pain attacks.

Overeating is strictly prohibited! Fried chicken, potatoes, garlic, fresh onions, fatty fish and meat, pickles and marinades, mushrooms, pancakes and fried pies are prohibited. The strictest ban on smoked and spicy foods, sausages and canned food, as well as dishes and products with puff and pastry. The rest of the meals in the diet depend on the specific variant of the JWP.

Nuances of the diet depending on the type of JVP

At hypertonic type of JVP it is important to follow a specific diet, especially against the background of exacerbations. So, if it is present, it is necessary to limit any products that have a mechanical irritant effect on the intestines or contain chemical irritants. It is important to exclude choleretic foods and dishes.

The following are under the ban:

• Very hot food and dishes
• Cold dishes, desserts and ice cream
• Coarse fiber and all products with it
• Chocolate and all dishes with it
• Sodas, both sweet and mineral waters.

At hypotonic form of JVP on the contrary, it is necessary to enrich the diet with foods and dishes with choleretic effects. In nutrition you need:

Often, as prescribed by the doctor, the child will be shown special cocktails that stimulate the separation of bile and the work of the sluggish biliary tract. This is vegetable oil with egg yolk, kefir or cream with vegetable oils, rosehip broth with the addition of xylitol or sorbitol instead of sugar. These mixtures help the separation of bile into the intestinal lumen, preventing the bile from stagnating and thickening overnight.

Medications for hypertensive JVP: doctor's prescription

Based on the fact that this type of pathology is classified as a neurosis, the basis of treatment is to balance the processes of inhibition or excitation. The doctor uses drugs that even out the tone of the nerves, restores the work of the muscles that regulate the separation of bile and the contraction of the intestinal walls. All this leads to the removal of spasms in the bladder and intestines, eliminates constipation and diarrhea.

With increased motor skills with JVP, sedative, sedative therapy is used in the form of herbal preparations and herbal teas (motherwort, lemon balm,), bromine preparations, belladonna, passionflower,.

In the presence of complaints of pain in the tummy, they are applicable in an age dosage(papaverine or sho-shpa, benziklan or platifillin). In children with increased stomach acidity, pirenzepine is applicable. Drugs are used against the background of exacerbation courses, but they do not cure, but only eliminate the symptoms.

The basis of treatment is the regulation of bile secretion: the creation of normal muscle tone, excretion rate and balance of composition. If the separation of bile is too sharp and fast, its portions are small due to spasm of the ducts, choleretics are indicated. Such drugs help to strengthen the separation of bile, may have a plant base or synthetic (tsikvalon, allochol, flamin). Usually, the course is calculated for 2-3 weeks of continuous use, then the drug is replaced so that the body does not get used to the drug and the effect does not decrease.

It is useful to use mineral water to secrete bile into the intestines.(salt in it is not more than 5g / l) - such as Morshanskaya, Slavyanovskaya. Water is preliminarily degassed by shaking in a glass, heated to a warm appearance, applied before meals 60 minutes in advance at an age dose. The exact regimen will be prescribed by the doctor.

The intake of herbal preparations with choleretic properties is shown - corn stigmas, and others. They are used in the form of collections of 2-4 plants in order to have a combined and pronounced effect. Initially, treatment is selected in stationary conditions or during treatment as part of a day stay in the clinic. The initial course lasts a month, the fees are changed every two weeks, as the condition improves, maintenance therapy is carried out once a quarter, the treatment lasts two weeks and herbal medicine is usually practiced.

Additionally, game methods of psychotherapy, non-traditional practices are used.- acupuncture and osteopathy, physiotherapy is prescribed. Often these practices are applicable in the aftercare period as part of sanatorium treatment. Thermal effects on the zones of the bladder and liver, paraffin treatment, various types of current, electrophoresis with the use of antispasmodic solutions, massages of the collar region, exercise therapy with the use of special exercises are shown.

Any procedures in the area of ​​the liver and gallbladder are carried out only with the exclusion of inflammatory processes.

Medications for hypotonic JVP: doctor's prescription

A more complex treatment involves a flaccid bladder if it has a reduced tone and outflow of bile. So, in these cases, the doctor takes measures to activate muscle tone in the area of ​​the bile ducts and the whole body of the child. Massages and water stimulating procedures, exercise therapy techniques with a program to increase muscle tone are applicable.

Of the medicines, plant stimulants and adaptogenic preparations are used - ginseng, in combination with magnesium preparations.

It is forbidden to use thermal procedures and antispasmodics, blockers of bile secretion .

Shown for taking drugs are stimulants of the outflow of bile through the ducts from the bladder - cholekinetics. These include sorbitol, magnesia, vegetable oil. They are used in courses at an age dose before meals, courses up to four times a year, usually 10-15% sorbitol solutions, vegetable oils are used in spoons.

It is shown that, against the background of these events, such techniques as "blind probing" or tubazhi are carried out a couple of times a week - a course of up to a month. Hot and warm heating pads are prohibited during tubing, they give the effect of antispasmodics, and the ducts in this variant of the JVP are initially in a relaxed state.

At the end of the active part of the therapy, phytotherapy courses are applicable(use medicinal herbal preparations) with stimulating and bile-secreting effects. These include wild rose, decoction of corn stigmas, chamomile infusion, mountain ash.

Together with them, agents are used that enhance the outflow of bile through the ducts from the bladder cavity (holiver, hofitol), as well as drugs to activate the liver and protect it from negative influences. Applicable mineral water with high mineralization, cold and up to three times a day: the course lasts up to one and a half months. Electrophoresis performed on the liver zone and the use of a diet with a smooth transition to a normal healthy diet have a positive effect.

It is important that parents be attentive and balanced about the treatment of JVP in children and be aware of the timing of dispensary observation due to this pathology. If there is no exacerbation, the duration of the rehabilitation course lasts up to two years, and it is necessary not to passively monitor, but to constantly improve the health of children in sanatoriums and resort areas - these are the Black Sea coast, the Krasnodar Territory, the Carpathians, Mineralnye Vody and Altai Territory. Mineral sources of these regions are extremely useful for the biliary system.

In the presence of a hereditary predisposition to JVP and liver pathologies, if there are children and adult members in the family who suffer from such anomalies, but the child is healthy, it is worthwhile to carry out the prevention of JVP in advance. It is important to identify and treat digestive pathologies, helminthic invasions, giardiasis, strictly monitor the nutrition of children and their physical activity, and prevent stress. It is important to correct the work of the nervous system in the presence of problems with autonomic tone.

Prevention of exacerbations and development of DZHVP

When anomalies of the gallbladder with its kinks, hypotension of muscle elements or deformities are detected on ultrasound, it is necessary to use the “three G diet” for preventive purposes, even before the onset of exacerbations and pathological processes in the biliary system. This is one of the simplified lightweight types of diet No. 5 (or it is also a liver table), but against the background of this nutrition, butter must be changed to vegetable oils or completely excluded from the diet.

The volume of highly carbohydrate foods is sharply reduced, at the same time correcting the problem of overweight children. The main purpose of such dietary nutrition in predisposed children is to unload the gallbladder and reduce the load on the liver, eliminating the production of excess bile, which will then accumulate in the gallbladder. It is clear that bile is more actively secreted when the baby consumes fatty foods, this leads to an increased contraction of the bladder with large portions of bile entering the intestines. This loads the digestive system, but it is also impossible to eat completely without fats in the diet.

Strict diets are prohibited, children do not tolerate them well, and they will worry, be nervous due to prohibitions, trying to spitefully eat dangerous foods. It is important to transfer the whole family to proper and rational nutrition.

Therapeutic and preventive procedures for children

Previously, we mentioned the implementation of specific procedures - "blind probing" and tubage. These techniques are used to activate the outflow of bile, they are useful for both children and adults during periods of overeating and weight loss. In children, they are recommended during periods of seasonal exacerbations - spring and autumn intervals. Tubazhi are especially useful in hypotonic type of JVP with a flaccid bladder, due to this method it is actively released from the contents.

Tubage is carried out twice a week, in the morning, after the toilet and washing, brushing your teeth. It is important to take a choleretic breakfast and then put the child to lie down on his left side. In this position, the gallbladder is turned upside down, which helps in the outflow of bile simply by gravity. Heat is applied to the right side, asking the children to lie down like this for 30 to 90 minutes. It is important to help the child not toss and turn, captivating him with reading or watching a movie. This time is needed for the complete emptying of the bladder.

Cholagogue breakfasts can be:

• magnesia solution (25%) in the amount of 2 tablespoons from the ampoule
• sorbitol or xylitol - two tablespoons
• shaken yolks with honey or regular sugar added to them
• olive oil a couple of teaspoons
• juice mixture of choleretic vegetables (carrots, beets)
• radish juice, with the addition of honey to it.

To normalize digestion, you need to carry out up to seven procedures at intervals of about 5 days. If abdominal pain occurs during the use of a choleretic breakfast, it is recommended to give the child no-shpu before the start of the tubage or during the process.

Nutrition in children with JVP

It is important to have constant therapeutic and preventive nutrition in children with problems in the biliary system. It is important to change the diet so that the child eats as often as possible, up to six times a day, and portions should be small.

It is important to know which of the foods and dishes should be excluded from the diet:

note

It is important for parents to be assertive and firm in dieting and dietary restrictions, as this is what the child needs. When using these products, pain and nausea, malaise will occur. It is important to be honest and explain in an accessible way why these particular dishes and products are not allowed.

• Vegetable soups and cereals, soups with cabbage, milk soups with pasta are useful.
• Low-fat varieties of meat, fish or poultry without skins baked or stewed, steamed or in a slow cooker.
• Steam meat and fish cutlets, meatballs, meatballs, etc.
• Any cereals in cereals and side dishes (except for millet)
• Any kind of pasta in all their forms
• Vegetables boiled and stewed
• Milk porridges thick and boiled
• Dishes with cottage cheese (dumplings, casseroles)
• Eggs in any form, except fried
• Dairy products in any form, with the exception of fatty sour cream and cream (they are only in soups)
• Cheese, except spicy and salty
• Unrefined vegetable oil in salads
• Yesterday's bread, biscuits, crackers
• Sweet fruits with berries
• Any vegetables, except dishes with garlic, onions, radishes, turnips, radishes
• Sweet fruit juices and purees
• Green and weak black tea, herbal decoctions
• Honey and jams, jams, marmalade and marshmallows.

For both types of FDA, the inclusion of choleretic foods in the diet is beneficial, but it is important that they are consumed during breakfast or lunch. The effect will be in the daytime and the food will be absorbed more fully. These include beets, sour cream, butter and vegetable, carrots, cucumbers, sweet fruits, cabbage.

DZHVP or biliary dyskinesia is a functional disorder of the walls of the gallbladder and bile ducts, as a result of which the timely and uniform separation of bile into the intestine is disrupted.

The importance of this problem is great because bile is the main component of digestive juices and is directly involved in the breakdown of food, as well as in stimulating the intestines due to its irritating effect.

The reasons

Most often, biliary dyskinesias are detected in children over the age of three years, and the disease can also occur in young people.

Stagnation of bile in the bladder and ducts leads to its thickening, the formation of stones, a violation of the properties of bile - the loss of its antimicrobial function. In case of violation of bile secretion, the breakdown of fats, the absorption of fat-soluble vitamins suffer, metabolism is disturbed, digestive problems are formed - constipation or diarrhea.

Causes of JVP:

Often, biliary dyskinesias are combined with diabetes mellitus, obesity, food allergies, they often occur in excitable and capricious children.

Types of biliary dyskinesia

Allocate the main indicators of the work of the biliary tract - the tone of the muscles and sphincters and kinesia (outflow of bile along the passages). Based on these two indicators, there are several options for JVP:

• hypotonic (with a decrease in the tone of the sphincters)
• hypertonic (with increased tone),
• hypokinetic (with slowing and lethargy of the outflow of bile)
• hyperkinetic (with outflow activations, a sharp release of portions).

In practice, doctors use a dual classification, for patients, knowledge of the hypotonic and hypertonic types is sufficient, in addition, a mixed type is also distinguished. Manifestations of various types of the disease vary significantly.

Manifestations of JVP

Symptoms of biliary dyskinesia depend on muscle tone and bile flow.

In the hypertensive type, the following symptoms are characteristic:

• the occurrence of a sharp pain in the right side during running or physical exertion,
• episodes of frequent loose stools,
• burning sensation in the intestinal area after stress or eating sweets,
• nausea with vomiting, with an admixture of bile,
• white is worn on the tongue, its overlay,
• appetite disorders up to refusal of food,
• weakness and headaches, asthenia.

In the hypotonic variant of biliary dyskinesia, there are

• decreased activity of the gallbladder, manifested by heaviness in the right side,
• loss of appetite,
• chronic prolonged constipation,
• weight reduction.

Mixed variants of JVP usually present

• pain and heaviness in the right side,
• constipation or their alternation with diarrhea,
• loss of appetite,
• pain when probing the abdomen and right side,
• fluctuations in body weight
• belching, bitterness in the mouth,
• general disorder.

Diagnostics

The main diagnosis of JVP is a thorough analysis of complaints, especially indications of nutritional problems and the connection of seizures with them.

An indication of soreness in the right side, problems with stool and digestion is important.

Supplements the diagnosis of laboratory and instrumental examination:

• general analysis of blood and urine,
• fecal analysis for Giardia and coprogram,
• liver tests, blood biochemistry,
• conducting an ultrasound examination of the liver and gallbladder with a choleretic breakfast,
• carrying out fibrogastroduodenoscopy (swallow "honey"),
• if necessary, gastric and intestinal sounding is carried out with sampling of bile by stages.

Treatment of JVP

Biliary dyskinesia is treated by a general practitioner, pediatrician, or gastroenterologist.

The basis for the treatment of dyskinesia is the normalization of nutrition, and at first, to establish the physiological work of the biliary tract, special nutrition. Sometimes only dietary correction and normalization of the daily regimen and activity is enough to treat JVP.

Diet for biliary dyskinesia

• a strict ban is imposed on potentially harmful and irritating foods (chips, nuts, soda, fast food, salted fish),
• everything strongly salty, sour, bitter and spicy is prohibited,
• fat is sharply limited in nutrition with its replacement as much as possible with vegetable oils,
• seasonings and spices are limited, fried is prohibited,
• all nutrition at first is given in a warm and semi-liquid form, especially during pain attacks,
• all food is boiled, steamed or stewed, baked in foil.

It is also necessary to review the diet, preference is given to dairy, vegetable products, lean meat and fish. Sweets are severely limited.

It is necessary to take into account the properties of the products, it is recommended to use carrots, apples, cabbage, vegetable oil, beets, because. these products have a choleretic effect.

In the hypertensive type of biliary dyskinesia, relaxing muscles (antispasmodics) and sedatives are prescribed, unload the nervous system, exercise therapy and limit physical activity. Mineral water is accepted with low mineralization and only warm.

With the hypotonic type of DZHVP, choleretic agents, activation of physical activity, mineral waters with choleretic and stool-stimulating properties are necessary. These are highly mineralized waters, cold.

Treatment of the disease that caused JVP is necessary, as it is rarely the primary condition. When the underlying disease is cured, biliary dyskinesia in most cases disappears.

Complications

With a long course of JVP, the formation of cholelithiasis is possible due to a violation of the properties of bile and its stagnation. In addition, a violation of the outflow of bile leads to damage to the biliary tract, to the development of cholangitis (inflammation of the biliary tract) and hepatitis (inflammation of the liver).

Biliary dyskinesia (JVP) is considered one of the most common diseases of the gastrointestinal tract, which provokes dysfunction of the gallbladder, liver, adversely affects the overall system of cooking and assimilation of food, and also disrupts the activity of the pancreas. As soon as there is a violation of the stable process of moving bile through the ducts, biliary dyskinesia develops, which causes various kinds of disorders in the work of most abdominal organs, a person experiences severe pain, metabolism is disturbed, adjustments are urgently made to the nutrition system, a special diet is selected . The sooner the treatment of the disease begins, the greater the chances for a speedy recovery and reduced risk of unwanted complications.

Signs of stagnation of bile in the ducts of the gallbladder, or vice versa, its too rapid movement with entry into the cavity of the duodenum with an insufficiently saturated consistency, leads to the fact that a sick person begins to experience the following symptoms of the disease:

• in the right hypochondrium, from the side of the location of the liver, aching pain appears, which periodically passes into an exacerbation phase and takes on a cutting character;
• the first urge to nausea occurs, and after eating fatty foods, the release of vomit is not excluded;
• the stool is disturbed (an adult suffers from liquid diarrhea, or from prolonged constipation lasting 2-3 days or more);
• urination becomes more frequent, and the urine itself acquires a rich brown hue;
• appetite decreases and the patient may not feel hungry for a long period of time;
• there is increased gas formation, belching with air appears, and bloating, which is an integral sign of flatulence, can be observed with the naked eye, or by palpation of the abdominal cavity.

Symptoms of intoxication in biliary dyskinesia are completely absent, which is almost always confirmed by blood tests.

In particularly difficult cases, if inflammation of the gallbladder walls occurs, the overall body temperature may slightly increase, which reaches 37.2 - 37.4 degrees Celsius, but such a clinical picture is recorded extremely rarely.

Causes of biliary dyskinesia

There are a large number of direct and indirect factors that affect the stable functioning of the organs of the digestive system and the process of bile synthesis. Based on this, JVP is classified according to the type of dysfunction and the causes of its development are distinguished. They look like this.

hypotonic type.

In patients with this type of disease, there is a weakness in the muscle fibers responsible for the production of bile secretion, as well as its movement through the ducts with further delivery to the duodenal cavity for the breakdown of complex fatty acids that have entered the human body along with food.

Reduced activity and weakened tone of the walls of the gallbladder can be triggered by a lack of food hormones, poor heredity on the part of parents, a sedentary lifestyle and reduced physical activity of the person himself. In the hypotonic type, bile is secreted in insufficient quantities, or it moves too slowly through the channels.

By hypertensive type

This type of JVP, in contrast to the hypotonic type of the disease, is characterized by excessive activity of the walls of the gallbladder. They are constantly reduced under the influence of nerve impulses coming to the organ from the centers of the cerebral cortex, which are responsible for regulating the activity of organs located in the abdominal cavity.

As a result of the incessant spasm, bile also loses the ability to calmly move through the channels and ensure the normal process of digestion. The most common cause of hypertensive dyskinesia is neurological diseases associated with dysfunction of nerve endings.

Hypokinestic type.

This diagnosis is made to patients most often, as it is characterized by a deficiency of bile. As a result of frequent overeating, eating too much fatty foods, alcoholic beverages, improperly organized nutrition, there is a lack of bile. It begins to be produced in much smaller volumes than the gastrointestinal tract requires.

In this regard, dysfunctions develop in the digestive system, fatty foods are not digested, a person has liquid diarrhea, nausea and vomiting appear.

hypomotor type

Complex and most rare dyskinesia (hypokinesia) of the biliary tract, as it is characterized immediately by a whole complex of disorders in the gallbladder. Not only the lethargy of the work of this organ is noted, but also the complete or partial lack of motility of the muscle fibers located in the circumference of the channels through which the bile secret is transported to the duodenum is recorded.

This pathology is very difficult to treat, and the causes of its occurrence can be acute liver failure, helminthiasis, giardiasis, viral liver damage, oncological processes in the digestive tract.

By hypermotor type

JVP with increased activity of the gallbladder and all its departments that are involved in the process, which includes the stage of bile synthesis up to the final stage of its reflux into the duodenum. In the presence of biliary dyskinesia of the hypermotor type, the patient has an ongoing reflux of bile into the organs of the gastrointestinal tract with its significant excess. A person begins to experience a strong bitterness in the mouth, appetite disappears, nausea and vomiting appear, and the stool becomes a rich dark color with a greenish tint. Most often, the cause of the disease is hidden in malnutrition, alcohol abuse, recent food poisoning, or severe intoxication of the body with chemicals.

Differentiation and allocation of DZHVP by types enables the attending gastroenterologist to more correctly diagnose the patient and further form a course of treatment that allows, in the shortest possible period of time, to eliminate not only the symptoms of the disease itself, but also to stop the causative factors of its occurrence.

Methods of treatment of adults with biliary dyskinesia

Therapy of any disease that affects the mucous membrane, muscle fibers and dense layers of epithelial tissues of the organs of the human digestive system consists of two main areas. These are traditional methods of treatment, consisting of a drug effect on the focus of pathology, or the use of folk medicines based on the healing properties of herbs.

Let us consider in more detail how, in both cases, to stabilize the movement of the bile secretion without harm to health.

Cholagogue preparations

Modern pharmacology offers a wide range of tablets that are designed to increase the activity of bile movement in the bladder and its ducts, or to eliminate spasm and reduce the intensity of its reflux into the duodenum.

The following drugs have the best therapeutic effect:

• Allochol (choleretic, which contains natural bile and is used for hypodyskinesia);
• Nicodin, Osalmid, Oxafenamide (synthetic agents that stimulate the gallbladder);
• Urosan, Holosas, Flamin, Hofitol, Febihol (combined preparations, which include both chemical components and part of the extracts obtained from medicinal plants).

How exactly to take a particular medication, in what dosage and duration, is determined solely by the gastroenterologist based on the diagnosis made to the patient, as well as based on the general clinical picture of the course of the disease.

Cholagogue herbs

Among a large number of the most diverse plants with choleretic properties, it is recommended to brew such herbs as:

• dandelion leaves collected from May to the end of June;
• stigmas from corn cobs;
• rosehip berries;
• calamus marsh;
• common apricot;
• burdock root;
• stalks of wormwood;
• St. John's wort;
• wild strawberry leaves.

The ratio of the dry mass of the medicinal plant and the volume of boiling water with which they are poured to obtain a medicinal mixture is determined based on the type of dyskinesia. More detailed information is displayed in the instructions for use of a particular herb. At all stages of therapy, it is necessary to periodically do an ultrasound of the gallbladder, controlling the condition of its walls and ducts.

Diet

Compliance with the norms of proper nutrition takes the process of treating JVP to a completely different level, which ensures an accelerated recovery. Patients with biliary dyskinesia are advised to completely stop taking the following products:

At the same time, for the treatment and prevention of biliary dyskinesia, an adult needs to saturate his diet with foods such as:

• lean skinless chicken breasts;
• pasta and cereals boiled in water or low-fat milk;
• vegetables, boiled or steamed (can also be baked in the oven);
• wheat bran;
• egg omelet;
• low-fat fermented milk products (kefir, fermented baked milk, sour cream, milk, yogurt, and butter and spicy cheeses are strictly prohibited);
• white bread that has lain down for 1 day and has become a little stale;
• dry diet cookies "Maria", biscuits, crackers;
• lean fish species;
• honey, natural marshmallow, marshmallow, marmalade;
• not strong green tea;
• salads from fresh vegetables and fruits, with the exception of those listed above;
• dairy and vegetable soups prepared according to fat-free vegetarian recipes.

Compliance with this diet makes it possible to avoid exacerbation of biliary dyskinesia, to ensure the stable functioning of the gallbladder and other organs of the gastrointestinal tract. Also, this menu is perfect for pregnant women who are undergoing JVP treatment and at the same time need a sufficient amount of vitamins, minerals, proteins, amino acids and carbohydrates to enter the body.

Possible complications and consequences in adults

In the absence of timely treatment, the patient can expect the development of secondary diseases, which include the following pathologies:

• chronic cholecystitis;
• the appearance of stones in the gallbladder and its channels;
• liver failure with an increase in the effect of intoxication;
• inflammatory processes of the intestinal mucosa and stomach;
• weight loss and poor digestibility of food eaten.

The most dangerous complication of biliary dyskinesia is the formation of a large number of stones in them, which exclude the possibility of further patency of bile and lead to the fact that the patient gets an appointment with a surgeon. In 85% of cases, this ends with an operation and complete removal of the gallbladder, and the person becomes forced to adhere to a diet until the end of the remaining days.

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

General information

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

The reasons

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

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

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

Symptoms of dyskinesia

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

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

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

Diagnostics

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

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

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

Treatment of biliary dyskinesia

Restoration of the function of bile formation and bile excretion in different types of dyskinesia is also carried out differentially. With hyperkinesia, choleretics (dry bile, livestock pancreas extract, flamin, hydroxymethylnicotinamide, oxaphenamide), low-mineralized mineral waters in a heated form, antispasmodics (drotaverine, papaverine, platyfillin), herbal teas (decoctions of chamomile, peppermint, licorice root, dill fruits) .

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

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

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

Forecast and prevention

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