Treatment of biliary dyskinesia with drugs and other methods. Biliary dyskinesia: symptoms and treatment Essence and brief description of biliary dyskinesia

Biliary dyskinesia is a disease in which the motility of the gallbladder is disturbed and the bile ducts malfunction, which causes stagnation of bile or its excessive secretion.

This disorder occurs mainly in women. As a rule, biliary dyskinesia suffers from young patients (20-40 years old), thin build. In some women, the relationship between the exacerbation of complaints and the period of the menstrual cycle is expressed (the exacerbation occurs 1-4 days before the onset of menstruation), and the disease can also worsen during the menopause.

Since in this disease there are changes in the properties of bile, the absorption of some important substances and fat-soluble vitamins is impaired. At risk are women who have diseases related to the genital area, as well as people who are often exposed to stress.

There are two main forms of gallbladder dyskinesia:

• Hypertonic (hyperkinetic)- the tone of the gallbladder is increased;
• Hypotonic - the tone of the gallbladder is lowered.

Causes

Why does biliary dyskinesia occur, and what is it? Primary Causes

1. Long-term, systematic violation of the diet (irregular meals, overeating, the habit of eating well before bedtime, abuse of spicy fatty foods).
2. Disorders of neurohumoral regulatory mechanisms of the biliary tract.
3. Sedentary lifestyle, congenital underdeveloped muscle mass.
4. Neurocirculatory dystonia, neuroses, stress.

Secondary Causes biliary dyskinesia:

1. Previously transferred acute.
2. , infection().
3. With bends of the neck or body of the gallbladder (organic causes).
4. With enteritis.
5. Chronic inflammatory processes of the abdominal cavity (chronic inflammation of the ovaries, etc.).
6. Hormonal disorders (menopause, menstrual irregularities, endocrine gland insufficiency: hypothyroidism, lack of estrogen, etc.).

Most often, biliary dyskinesia is a background symptom, and not a separate one. It indicates the presence of stones in the gallbladder, the occurrence of pancreatitis, or other abnormalities in the function of the gallbladder. Also, the disease can develop as a result of the use of certain foods: sweet, alcohol, fatty and fried foods. Severe psychological or emotional stress can cause the onset of dyskinesia.

Classification

There are 2 types of dyskinesia:

1. Dyskinesia of the hypokinetic type: the gallbladder is otanic (relaxed), it contracts poorly, stretches, has a much larger volume, therefore bile stagnation and a violation of its chemical composition occur, which is fraught with the formation of stones in the gallbladder. This type of dyskinesia is much more common.
2. Dyskinesia by hyperkinetic type: the gallbladder is in constant tone and reacts sharply to the intake of food into the lumen of the duodenum with sharp contractions, throwing out a portion of bile under great pressure.

Accordingly, depending on what type of dyskinesia and biliary tract you have, the symptoms of the disease and methods of treatment will vary.

Symptoms of biliary dyskinesia

Considering the symptoms of dyskinesia, it is worth noting that they depend on the form of the disease.

Mixed variants of JVP usually appear:

• 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.

For hypotonic dyskinesia the following symptoms are typical:

• aching pains that occur in the right hypochondrium;
• constant feeling of nausea;
• vomiting.

For the hypotonic form of the disease characterized by the following set of features:

• pain of an acute nature, periodically occurring in the right hypochondrium, with pain radiating to the back, neck and jaw. As a rule, such pains last about half an hour, mainly after eating;
• constant feeling of nausea;
• decreased appetite;
• general weakness of the body, headache.

It is important to know that the disease not only manifests itself as a gastroenterological clinical picture, but also affects the general condition of patients. Approximately every second large biliary dyskinesia diagnosed initially turns to a dermatologist because of. These skin symptoms indicate problems with the gastrointestinal tract. At the same time, patients are worried about regular skin itching, accompanied by dryness and flaking of the skin. Blisters with watery contents may occur.

Diagnosis of biliary dyskinesia

As laboratory and instrumental methods of examination, the following are prescribed:

• 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.

However, the main method for diagnosing JVP is ultrasound. With the help of ultrasound, you can evaluate the anatomical features of the gallbladder and its tracts, check for the presence of stones and see inflammation. Sometimes a stress test is performed to determine the type of dyskinesia.

Treatment of biliary dyskinesia

• Treatment of hyperkinetic form of dyskinesia. Hyperkinetic forms of dyskinesia require restriction in the diet of mechanical and chemical food irritants and fats. Table No. 5 is used, enriched with products containing magnesium salts. To relieve spasm of smooth muscles, nitrates, myotropic antispasmodics (no-shpa, papaverine, mebeverine, gimecromon), anticholinergics (gastrocepin), as well as nifedipine (corinfar), which reduces the tone of the sphincter of Oddi at a dose of 10-20 mg 3 times a day, are used.
• Treatment of hypokinetic form of dyskinesia. A diet should be used within the framework of table No. 5, with hypokinetic dyskinesia, food should be enriched with fruits, vegetables, foods containing vegetable fiber and magnesium salts (food bran, buckwheat porridge, cottage cheese, cabbage, apples, carrots, meat, rosehip broth). The emptying of the gallbladder also contributes to vegetable oil, sour cream, cream, eggs. It is necessary to establish the normal functioning of the intestine, which reflexively stimulates the contraction of the gallbladder. Cholekinetics (xylitol, magnesium sulfate, sorbitol) are also prescribed.

Patients with biliary dyskinesia are shown to be monitored by a gastroenterologist and neurologist, annual health courses in balneological sanatoriums.

Physiotherapy

In the hypotonic-hypokinetic variant, diadynamic currents, faradization, sinusoidal modulated currents, low-pulse currents, low-intensity ultrasound, pearl and carbon dioxide baths are more effective.

In the case of a hypertensive-hyperkinetic form of dyskinesia, patients are recommended inductothermia (a disk electrode is placed above the right hypochondrium), UHF, microwave therapy (UHF), high-intensity ultrasound, novocaine electrophoresis, ozokerite or paraffin applications, galvanic mud, coniferous, radon and hydrogen sulfide baths.

Diet for dyskinesia

Any advice on how to treat biliary dyskinesia will be useless if you do not follow certain dietary rules that help normalize the condition of the biliary tract.

Proper nutrition will help create favorable conditions for the normal functioning of the gastrointestinal tract and normalize the work of the biliary tract:

• everything strongly salty, sour, bitter and spicy is prohibited;
• seasonings and spices are limited, fried is prohibited;
• fat is sharply limited in nutrition with its replacement as much as possible with vegetable oils;
• a strict ban is imposed on potentially harmful and irritating foods (chips, nuts, soda, fast food, salted fish);
• 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.

Sample menu for the day:

1. Breakfast: soft-boiled egg, milk porridge, tea with sugar, butter and cheese sandwich.
2. Second breakfast: any fruit.
3. Lunch: any vegetarian soup, baked fish with mashed potatoes, vegetable salad (for example, cabbage), compote.
4. Afternoon snack: a glass of milk, yogurt, fermented baked milk or kefir, a couple of marshmallows or marmalades.
5. Dinner: steamed meatballs with vermicelli, sweet tea.
6. Before going to bed: a glass of kefir or drinking yogurt.

Treatment of children with biliary dyskinesia

In children with biliary dyskinesia, treatment 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 dysfunctions and proper treatment of children, depending on the type of violations detected, can prevent the formation of inflammatory diseases of the gallbladder, liver, pancreas in the future and prevents early stone formation in the gallbladder and kidneys.

Prevention

To prevent pathology from developing, observe the following rules:

• a full night's sleep for at least 8 hours;
• go to bed no later than 11 pm;
• alternate mental and physical labor;
• walks in the open air;
• eat fully: eat more plant foods, cereals, boiled animal products, less -
• fried meat or fish;
• Avoid stressful situations.

Secondary prevention (that is, after the onset of biliary dyskinesia) is its earliest detection, for example, with regular preventive examinations. Biliary dyskinesia does not reduce life expectancy, but affects its quality.

Biliary dyskinesia is a functional disorder of the flow of bile into the duodenum. The condition is considered a harbinger or "accomplice" of other more complex diseases of the digestive system. Therefore, timely treatment of biliary dyskinesia requires separate consideration and careful attention.

Basic principles of treatment

There are many tips for the treatment of dyskinesia. We will make a plan of action for ourselves and we will follow it. What do we have to do to cure dyskinesia?

1. Normalize emotional stress, help the nervous system to endure stressful conditions, overwork.
2. Provide a diet and diet during an exacerbation of the disease.
3. Control weight and exercise.
4. Build a choice of medicines depending on the type of dyskinesia.
5. Use mineral waters according to indications.
6. Medicinal plants and traditional medicine are no less important than drugs.

What to do with "abnormal" emotions?

It is known that the nervous system is the source of all "commands" and "control decisions". With biliary dyskinesia, one of the good reasons is the breakdown of nervous regulation. To normalize, you need to calm down by any means (except alcohol!). It is suitable to take a decoction of valerian root or tincture, preparations from motherwort, and other sedatives as prescribed by a doctor. The usual home treatments: a warm bath in the evening, milk with honey at night, may normalize sleep, help cure dyskinesia.

You will have to get rid of excessive nervous load. The daily routine should include time for rest, walks. You can do yoga, swimming, cycling.

This will also help to reduce excess weight, if any. Because excess weight raises the level of the diaphragm and puts pressure on the gallbladder from below, preventing it from contracting effectively. In addition, excess calories in fatty foods create an unbearable burden on the liver and disrupt the work of the biliary tract.

Dietary changes

You will have to eat without sandwiches, fast food, chips, shawarma and kebabs. The diet recommends table number 5 with the restriction of spicy dishes, fried and fatty meat and fish, sauces and seasonings, sausages, mayonnaise, cakes, strong coffee.

Shown: boiled or steamed, low-fat meat and fish dishes, cereals (rice and semolina are not recommended), dairy products, vegetable salads with vegetable oil dressing, fruits.

It is impossible to cure dyskinesia without a diet. The restoration of bile secretion depends on the organization of nutrition in small portions several times a day.

Medication use

Do not use medicines on the advice of neighbors. They will not be able to establish your type of dyskinesia, choose a medicine that matches the condition of other organs. Only a doctor can treat.

For hypertonic type apply:

• as sedatives (Motherwort-forte in capsules, Motherwort and Valerian in tincture, tablets with a sedative effect);
• to relieve pain, antispasmodics (injections of Platifillin, No-shpa, Papaverine or tablets in the interictal period);
• from the group of choleretic drugs, drugs that promote the promotion of bile (Oxafenamide, Nicodin);

With a hypotonic type, the body needs a different effect:

• to activate nervous processes (tinctures of Ginseng, Eleutherococcus, Levzei, Schisandra chinensis, Aralia);
• choleretic agents stimulating muscle atony (Cholecystokinin, Flamin);
• recommended tubage or "blind probing" twice a week for two months every six months, for this use magnesia, xylitol, sorbitol.

It is necessary to treat biliary dyskinesia with antibacterial drugs only if an infectious cause is established during duodenal sounding.

Mineral water

Reception of therapeutic mineral waters must be coordinated with the acidity of gastric juice and also the type of biliary dyskinesia:

• with hypertensive form of dyskinesia, normal or high acidity, mineral waters such as Narzan, Essentuki-4, Smirnovskaya, Slavyanovskaya are recommended in a warm state one hour - 40 minutes before meals;
• for the hypotonic type, low acidity, you need to drink Essentuki-17, Arzni (they are more mineralized) at room temperature half an hour before meals, carefully in the presence of kidney diseases.

Treatment of dyskinesia with herbs

The benefits of herbal treatment have long been known: they have been tested for centuries by traditional medicine, they are easy to prepare, and side effects are minimal. It is necessary to take herbs for biliary dyskinesia only after consulting with a good specialist.

• For the hypertensive type, decoctions are recommended in treatment: chamomile, valerian, mint, licorice root, dill seeds.
• A person with a hypotonic type is shown: chamomile, immortelle, wild rose, corn stigmas, nettle.

It is most convenient to brew herbs overnight in a liter thermos in proportion to 3 tablespoons of dry raw materials per liter of boiling water. In the morning you can drink warm, pouring into a cup through a strainer. You can use each plant individually or mix in advance. Such a collection will be much more efficient. The brewed volume is enough for the whole day. Take herbal decoctions 30-40 minutes before meals.
The main contraindication: increased individual sensitivity.

The main task of treating biliary dyskinesia is to prevent the development of chronic cholecystitis, cholelithiasis. This can be done with firm determination and perseverance.

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

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

JVP - what is it?

Bile duct dyskinesia- this is a syndrome in which the normal motor activity of the biliary tract is disturbed, the tone of the gallbladder decreases. Allocate an organic and functional type of disorder.

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

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

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

Types of biliary dyskinesia

There are 3 types of JVP:

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

Hypomotor type dysfunction

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

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

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

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

DZHVP on hypertonic type

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

The occurrence of JVP according to the hypertensive type is possible in children and adolescents

mixed form

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

Causes of JVP

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

Causes of the primary syndrome:

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

Causes of secondary dysfunction:

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

Symptoms of gallbladder dysfunction

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

Table: Signs of JVP depending on the type of disease

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

Which doctor should I contact?

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

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

According to indications, consultations are possible.

Diagnostics

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

The survey includes:

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

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

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

Treatment of biliary dyskinesia

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

Patient management includes:

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

Physiotherapy is prescribed for gallbladder motility disorders

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

Medications

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

In the treatment of hypomotor dysfunction

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

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

Taking Hofitol enhances the contractile activity of the gallbladder

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

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

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

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

Plant-based tonics that normalize the state of the nervous system:

• extract from ginseng root.

Take Eleutherococcus tincture to stabilize the nervous activity of the body

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

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

Contraindications to the appointment:

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

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

The procedure is aimed at improving the outflow of bile.

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

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

In the treatment of hypermotor dysfunction

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

• Oxaphenamide;

Gepabene is prescribed to relax the bile ducts and relieve spasms

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

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

No-shpa will help remove pain during an attack

Additionally, sedatives are indicated at the doctor's choice.

Folk remedies

Phytotherapy is referred to as folk methods of treatment. But at the same time, medicinal herbs used in official medicine are used. The duration of treatment with phytocollections is from 2 to 3 weeks.

Decoction of immortelle flowers

Use immortelle flowers to make a medicinal decoction

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

Corn silk

Brew corn silk to make a medicinal infusion

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

Chamomile tea

Replace regular tea with chamomile tea to improve the digestive tract

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

Liquorice root

Boil licorice root for an effective remedy for FAD

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

Mint tea

Take mint tea 3 times a day before meals

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

Diet for JVP

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

sample menu

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

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

First day:

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

Second day menu:

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

Features of treatment in children

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

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

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

Snacking with various goodies - nuts, sweets, buns - is strictly prohibited. The best choice in this case are fruits.

Drug therapy is represented by drugs for the normalization of microflora, antispasmodics for pain, light sedatives on a plant basis, choleretics. Additionally, massages, electrophoresis with antispasmodics, a course of exercise therapy are shown.

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

Features of treatment during pregnancy

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

In this case, the best solution would be to hospitalize the woman in the gynecological department of the hospital.

With DZHVP in pregnant women, hospitalization and constant monitoring of doctors are necessary.

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

Permissible medical treatment is the intake of herbal teas. For example, decoctions of corn stigmas, dill, mint. Antispasmodics are allowed.

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

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

Possible Complications

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

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

Duodenitis and cholecystitis are common complication of improper treatment of DVP.

Prevention

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

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

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

Causes of biliary dyskinesia

Depending on the cause, primary and secondary forms of the disease are distinguished.

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

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

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

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

Disease types

There are three types of this disease:

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

Symptoms of biliary dyskinesia

Pain. With hypotonic dyskinesia, dull aching pain in the right hypochondrium is present almost constantly, subsides at night, intensifies after eating. With the hypertensive type of the disease, the pain syndrome is quite intense, radiates to the right arm and shoulder blade, occurs as a result of eating fatty foods, physical activity, a stressful situation, and lasts up to half an hour. And between attacks, patients may complain of heaviness and slight discomfort in the left hypochondrium, the general state of health is quite satisfactory.

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

Nausea and vomiting. This symptom is necessarily provoked by something, most often it appears with a plentiful intake of fatty foods, overeating, or if the meal was too fast. With biliary dyskinesia, vomiting of undigested food mixed with bitter bile occurs at the peak of pain.

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

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

Treatment of biliary dyskinesia

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

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

Diet

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

and additionally excluded fresh fruit.

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

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

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

Drugs for biliary dyskinesia

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

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

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

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

The autonomic nervous system has a direct impact on the regulation of motility of the gallbladder and biliary tract, therefore, complex therapy includes agents that tonic or relax it.

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

Mineral water

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

Physiotherapy

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

Surgical treatment for biliary dyskinesia is not indicated.

In case of dysfunction with an increase in the tone of the sphincters, a complete diet with a normal protein content, maximum restriction of fats (primarily refractory - lamb, goose, internal) and products that enhance the processes of fermentation and decay in the intestine (whole fresh milk, pastry, canned food, etc.) .). Foods are needed that are high in vitamins A, C, group B, as well as vegetable fiber and fluid, which contributes to the outflow of bile and bowel movements. Food should be taken in small portions 5-6 times a day.

They exclude meat, mushroom and fish broths, green cabbage soup, fatty meats and fish, animal fats, fried foods, including pancakes and pancakes, freshly baked bread, pastry and puff pastry products, egg yolks. canned food, sausages, smoked meats, mustard, pepper, horseradish, vinegar essence of any concentration, onion, garlic, sorrel, radish, peas, mushrooms, cocoa, chocolate, ice cream, sour fruits and berries.

Recommend gray, coarse, dried rye bread, not rich, sugar cookies. Soups should be cooked on a vegetable broth, any vegetables, cereals, pasta, fruit soups are allowed. Low-fat varieties of meat and poultry are desirable in boiled form, baked with preliminary boiling, stewed with juice removed, low-fat varieties of fish (cod, pike perch, perch, navaga, pike, etc.) in boiled or baked form. Protein omelet can be cooked 1 time per week from 1 egg. Sour cream is shown in dishes, fat-free cottage cheese in natural or baked form, cheeses up to 30% fat, sour-milk one-day low-fat products (kefir, yogurt, etc.). Vegetables are allowed in raw, boiled, baked form; onions should be boiled before adding to dishes. All fruits are allowed. except sour. From drinks recommended rosehip broth, non-acidic juices. diluted in half with water, tea with milk or lemon, coffee with milk. dried fruit compotes. You can not eat very cold and very hot food.

With hypomotor disorders in the child's diet, vegetables and fruits rich in dietary fiber (dried apricots, strawberries, raspberries, oatmeal, dried rose hips, etc.) are needed, which reduce the content of cholesterol and triglycerides, the lithogenicity of bile. Shown are wheat bran, rich in magnesium salts, as well as buckwheat, oatmeal and seaweed. The American Dietetic Association recommends calculating fiber intake by adding the number 5 to a child's age. For example, a child at the age of 4 years should receive 9 g of dietary fiber, and at 17 years old - 22 g.

The diet should be enriched with refined vegetable oils added to ready meals after cooking. Use corn, olive, linseed, soybean, peanut oil. Protein lipotropic products (cottage cheese, fish, egg whites, lean meat) have a good choleretic effect.

Food is served boiled or baked, chopping is optional. The temperature of ready meals is normal, the number of meals is 5-6 times a day.

Drug treatment of biliary dyskinesia in children

Antispasmodics are considered the main drugs for stopping and preventing attacks of acute abdominal pain in biliary tract dysfunctions. It is advisable to use drugs with a rapid achievement of maximum serum concentration, for example, fast-acting nitrates under the tongue, anticholinergics and type I phosphodiesterase inhibitors for parenteral administration.

Fast-acting nitrates (nitroglycerin) are most effective for relieving severe pain attacks. The drug is given under the tongue at a dose of 2.5-5 mg at the age of 7-12 years; 5-10 mg 1 time per day for a child over 12 years old. Platifillin is administered orally or subcutaneously 1 mg at the age of 5 years; 2 mg - at 10 years; 3-4 mg for a child over 12 years old. Hyoscine butylbromide is administered intramuscularly or intravenously in doses of 10-20 mg to children over 12 years of age. Myotropic antispasmodics (drotaverine) are prescribed intramuscularly at 0.5 ml of a 2% solution 2-3 times a day at 5 years; 1 ml - a child of 10 years; 1.5-2 ml - from 15 years. Antispasmodics of plant origin (cholagol 5-20 drops on sugar or hofitol 1 tablet inside) are indicated for an attack of hypertensive dyskinesia.

With severe, long-term intractable pain, the treatment of biliary dyskinesia is based on the use of narcotic analgesics, such as promedol, intramuscularly 0.25 ml of a 1% solution at the age of 5 years; 0.5 ml - at 10 years old; 0.75-1.0 ml for a child of 15 years old 1-2 times a day. Codeine and morphine-like drugs should be avoided.

To prevent the development of seizures, one of the type IV phosphodiesterase inhibitors, sodium and calcium channel blockers is used orally in courses for 1-2 months:

• drotaverine inside 0.01 mg (child 5 years old) 3-4 times a day; 0.02 mg (10 years) 3-4 times a day or 0.03-0.04 mg (15 years) 3-4 times a day;
• papaverine orally or rectally, 5 mg (child from 6 months to 2 years); 5-10 mg (3-4 years); 10 mg (5-6 years); 10-15 mg (7-9 years) 15-20 mg (10-14 years) 3-4 times a day;
• otilonium bromide inside 1/2 tablet of 40 mg (child 5 years) or 1 tablet (10 years and older) 2-3 times a day;
• mebeverine inside 50 mg (from 6 years old); 100 mg (9-10 years old), 150 mg (over 10 years old) 20 minutes before meals 2 times a day;
• gimecromon for children over 12 years of age, 200-400 mg orally 3 times a day.

Hymecromon's action resembles the biological effects of cholecystokinin.

The drug has a selective antispasmodic effect on the sphincter of Oddi and the sphincter of the gallbladder, provides an outflow of bile into the duodenum, reduces pressure in the biliary system, and has practically no effect on smooth myocytes of other localization. Drugs that eliminate hypertonicity of the gallbladder:

• platifillin inside 0.001 g (5 years), 0.002 g (10 years), 0.003 g (15 years) 2-3 times a day before meals;
• Hymecromon 0.1 g - 1/2 tablet (5-10 years), 0.2 g - 1 tablet (15 years) 3 times a day 30 minutes before meals for 2 weeks.

To stimulate bile formation, true choleretics are used, in particular drugs containing bile or bile acids:

• cholenzym inside 1/2 tablet (child 5-10 years old) or 1 tablet (15 years old) after meals 3 times a day for 2 weeks;
• allochol - for children under 7 years old, 1 tablet, over 7 years old - 2 tablets 3 times a day for 3-4 weeks. Synthetic drugs:
• tsikvalon inside 1/2 tablet (child 5-10 years old) or 1 tablet (15 years old) after meals for 2 weeks;
• oxafenamide orally 1/2 tablet (child 5-10 years old) or 1 tablet (15 years old) before meals 3 times a day for 2 weeks.

Choleretic preparations of plant origin are widely used:

• flamin inside 1/2 tablet (child 5-10 years old) or 1 tablet (15 years old) 30 minutes before meals for 2 weeks;
• gepabene inside 1 capsule 3 times a day during meals for 2 weeks;
• hofitol inside 1 tablet (child 5-10 years old) or 2 tablets (15 years old) 3 times a day before meals for 2 weeks;
• olimetin 1-2 capsules 3 times a day before meals for 3 weeks.

To increase the secretion of bile and reduce its viscosity, as well as to stimulate blood and lymph circulation in the liver, mineral waters of medium mineralization are prescribed ("Essentuki No. 4" orally 3 ml / kg 30 minutes before meals for 1 month) or hydrocholeretics:

• magnesium sulfate 20% solution, 1/2 tablespoon 2-3 times a day;
• xylitol 5 g 2 times a day after meals for 2 weeks;
• sorbitol 2.5 g (child 5-10 years old); 5 g (15 years) 2 times a day 30 minutes before meals for 2 weeks.

Physiotherapy

In the hyperkinetic form of gallbladder dyskinesia, electrophoresis with procaine, paraffin baths, radon and pine baths are prescribed. With hypokinetic disorders, electrophoresis with magnesium sulfate, faradization, galvanization, Bernard's diadynamic currents, massage of the cervical-collar region, mud applications on the right hypochondrium are indicated.

Sanatorium-resort treatment of biliary dyskinesia in children

Sanatorium-and-spa treatment is widely used for cholepathies in children. Apply treatment with mineral waters (balneotherapy-crenotherapy, hydrotherapy, hydrotherapy in the form of showers, baths, etc.).

Indications: cholangitis, cholecystitis without exacerbation; biliary dyskinesia.

Contraindications:

• cholelithiasis in the presence of frequent and prolonged severe attacks with a violation of the outflow of bile and signs of an active infection;
• liver failure;
• fever;
• exacerbation of the inflammatory process in the stomach or intestines;
• chronic renal failure;
• serious condition of the child.

When prescribing mineral water, it is necessary to pay attention to the following factors: total mineralization of water (the sum of all substances dissolved in water must be at least 2 g / l), ionic composition of water (hydrocarbonate, chloride, sulfate, sodium, calcium, magnesium, combined waters) , the content of biologically active components (iron, cobalt, copper, manganese, iodine, bromine, fluorine, silicon). Most often, for medicinal purposes, hydrocarbonate, hydrocarbonate-chloride, hydrocarbonate-sulfate waters of low (2-5 g / l) or medium (5-15 g / l) mineralization are used for oral administration (Borjomi, Essentuki 4 and 17, Arzni, Jermuk , Slavyanovskaya, Smirnovskaya, etc.). Depending on the degree of mineralization of water, they can be hypo-, iso- and hypertonic. Hypo- and isotonic waters have a diuretic effect; hypertensive drugs are poorly absorbed and have a laxative effect. The nature of mineral water depends on pH (pH of alkaline waters is higher than 8.5; acidic waters - 5.5; neutral waters - 6.8-7.2). Mineral water, taken warm, has a secretion-stimulating effect. Cold waters stimulate the motor function of the stomach, are quickly evacuated, poorly absorbed, and have a laxative effect. Bile-secretory effect is exerted by water of low mineralization, choleretic - by water of high mineralization. The combination of sulfate with magnesium in the water increases the release of bile from the bladder, while relaxing the sphincter of Oddi. When mineral water is taken internally, the gallbladder contracts, the peristalsis of the biliary tract increases, which contributes to the emptying of the gallbladder, reducing bile stasis and the tendency to form stones. Water bicarbonate reduces the viscosity of bile and inflammation in the gallbladder. Mineral water is dosed at the rate of 3-5 ml / kg per dose or as follows:

• children aged 6-8 years - 50-100 ml;
• at the age of 9-14 years - 120-150 ml;
• over 12 years old - 150-200 ml per appointment.

Usually, water intake is prescribed 3 times a day. In the first 5-6 days, in order to avoid a sharp choleretic effect, water is used in half the dose. It is taken in the form warmed up to 36-42 ° C 1 hour before meals for 4-6 months. Mineral water can be used for tubage in order to improve the outflow of bile.

Radon baths in children are not used.