Dyskinesia of bile ducts - Causes, symptoms and treatment. MF.

Often, patients have complaints from the digestive tract, caused by functional disorders of its departments. In this case, there are no organic processes( inflammatory, scarring, tumor), and unpleasant symptoms arise due to improper operation of the internal organs. One of these diseases is biliary dyskinesia.

Normally, bile in the amount of 1-2 liters is formed in the hepatic cells and enters the gallbladder through the bile ducts and then into the duodenum, where it performs its functions in digesting food, basically splitting the fat molecules in the lumen of the intestine. If the formation of bile occurs almost continuously during the day, then it enters the gut during the process of digestion and is regulated by subtle neurohumoral mechanisms, including caused by the ingestion of food into the stomach. In regulating the outflow of bile from the gallbladder into the gut, the sphincter of Oddi, located in the intestinal wall, dominates the gut. It opens the common bile duct and the pancreatic duct, through which bile and enzymes, necessary for the digestive process, come.

In the case when the outflow of bile changes due to functional disturbances in the regulation of these processes, dyskinesia( movement disorder) or dysfunction of the bile ducts arises. Also such a disease can be called dysfunction of the biliary system, which includes dysfunction of the gallbladder, dysfunction of the sphincter of Oddi, or a combination of both.

There are two forms of dyskinesia - the hyperkinetic and the hypokinetic type, the first is characterized by increased bile flow along the ducts, the second - by the slow release of bile. In addition, dyskinesia can be primary, that is, developed against a background of congenital anomalies of the bile excretory system, and secondary, that is, acquired in the course of life against the background of other diseases, most often, diseases of the digestive tract.

Biliary dysfunction is widespread, but still among the population occurs two to three times less often than cholelithiasis and cholecystitis. Often, dysfunction of the ducts precedes stone formation and inflammation in the gallbladder.

Causes of biliary dyskinesia.

The causes of primary dysfunction of the biliary tract include congenital anomalies in the structure of the bile ducts:
- constrictions in the cavity of the gallbladder,
- bending and doubling of the gallbladder.

Secondary dysfunction can develop on the background of diseases such as:
- pathology of the digestive tract organs - gastritis, pancreatitis, cholecystitis, stomach ulcer, hepatitis and cirrhosis,
- vegetative-vascular dystonia and neurosis-like conditions that cause disorders in the activity of the autonomic nervous system, involved in the regulation of bile secretion,
- surgery on the abdominal organs - resection( removal) of the stomach, removal of the gallbladder( leads to a violation of rhythmic contraction of the sphincter of Oddi),
- hormonal disorders - premenstrual syndrome, pregnancy, menstrual disorders, diabetes, obesity, a lack of thyroid hormones( hypothyroidism).

Risk factors for the development of the disease are:
- hereditary predisposition,
- malnutrition - intake of fatty, fried foods and excess in the diet of foods rich in cholesterol( eggs, fatty meat, dairy products, liver, caviar, etc.).
- long psycho-emotional and physical overload, severe stressful situations, sedentary lifestyle,
- the presence of parasites in the body - worms or protozoa, more often lamblias. Symptoms of biliary dyskinesia.

Clinical manifestations of biliary dyskinesia can be divided into a number of syndromes:

- Pain syndrome .The occurrence of pain is due to inaccuracies in the diet or stressful situations. In the hyperkinetic form of the patient's dysfunction, pains of a spastic character in the right side of the abdomen under the ribs, which give to the left half of the thorax, into the scapula or assume a shingling character, are of concern. With hypokinetic form of pain, they have the character of bursting, pulling, with or without irradiation, amplifying or disappearing when the position of the body changes. Pain can disappear and reappear with varying frequency - from several attacks a day to rare episodes throughout the month.

- Dyspeptic syndrome is characterized by nausea, bitterness and dry mouth, belching with a bitter taste, bloating, an unstable stool with a predominance of constipation or diarrhea, fatty stools. Such symptoms are caused by impaired digestion processes associated with insufficient or excessive intake of bile in the lumen of the intestine.

- The cholestatic syndrome of occurs rarely in the hypokinetic version of dyskinesia, when the bile continues to be normally produced and does not enter the bowels properly, but accumulates in the gallbladder, resulting in the appearance of jaundice of the skin and sclera, itching, dark urine and light feces,enlargement of the liver.

- Asteno-vegetative syndrome is characterized by weakness, increased fatigue, a sense of permanent weakness, drowsiness or insomnia, an increased level of anxiety and other signs.

- Symptoms of neurosis - panic attacks, phobias( fears), obsessive thoughts, obsessive actions, aggression, anger, tearfulness, touchiness, etc.

Diagnostics.

To confirm the diagnosis, in addition to clarifying complaints and examining the patient, the following examination methods are indicated, prescribed by a physician or gastroenterologist:

- general blood and urine tests,
- biochemical blood test with determination of hepatic enzymes( ALAT, ASAT), pancreatic enzymes( alkalinephosphatase), direct, indirect and total bilirubin, cholesterol,
- immunological blood tests for suspicion of parasites( eg antibodies to lamblia),
- detection of antibodies to viruses, causing hepatitis B and C, as well as to the virus of immunodeficiency( HIV),
- determination of the level of hormones in the blood in case of suspicion of a violation of hormone metabolism in the body( sex hormones, thyroid hormones, etc.),
- ultrasound of internal organs - liver,pancreas, gall bladder, kidney,
- ultrasound of the bile duct after a test meal consisting of a small amount of fatty food in order to evaluate the flow of bile through the ducts in response to food stimulation of the biliary system,
- duodenal soundingbile sampling with a probe inserted into the stomach and duodenal lumen with the subsequent study of the chemical properties of bile and its ability to stone formation, as well as the determination of the inflammatory process in the bile,
- gastroscopy in case of suspected gastritis or gastric ulcer,
- examination of bile ductswith the help of X-ray methods of diagnosis - cholecystography, which can be oral( the introduction of radiopaque substance through the mouth followed by its accumulation of bile in the gall(introduction of contrast into the vascular bed), and endoscopic( invasive method of examination with retrograde contrast injection directly into the bile ducts),
- consultation of a neurologist, a psychotherapist, according to indications - an endocrinologist.

Treatment of biliary dyskinesia.

Therapy for dyskinesia of the bile ducts includes the following activities:

- diet-adjusted lifestyle,
- mineral water treatment,
- drug treatment,
- physiotherapy methods, most often electrophoresis on the skin in the liver area,
- massage, acupuncture, physiotherapy exercises,
- sanatorium treatment.

To treat the hypokinetic form of the disease, the following methods are preferable:

- reception of mineral water with a high degree of mineralization( Essentuki №17),
- carrying out tumbling once a week for a month followed by a monthly repetition of the procedure - taking cholagogue or mineral water in theright side with a warm warmer in the right hypochondrium,
- taking choleretics( drugs that stimulate the formation of bile - allochol, hofitol, corn stigmas, nicodine, cholenzyme) and cholekinetis( agents that facilitate the flow of bile through the ducts - olive oil, magnesium sulfate, sorbitol, xylitol).

For the treatment of hyperkinetic form of dyskinesia,

is prescribed for mineral water of moderate and weak mineralization( Essentuki No. 4, No. 20, Narzan, Borjomi, Slavyanovskaya),
-choleospasmolytics-preparations that eliminate spasm of muscle fibers in the biliary duct wall: closton, duspitalin,but-spa, etc.

Lifestyle with dyskinesia.

It is very important for a patient with dyskinesia of bile ducts to lead a healthy lifestyle, including

- rejection of bad habits,
- moderate physical activity, without physical overload,
- rational mode of work and rest,
- full night sleep,
- the main component of a lifestyle - healthy food - the exclusion of fatty, fried, spicy, salty, spicy food, limiting the products of animal origin, increasing the consumption of vegetable products. During the treatment of dyskinesia should follow a strict diet, or a treatment table number 5.

Complications of biliary dyskinesia.

Despite the fact that dyskinesia can occur against the background of diseases of the gastrointestinal tract, this pathology itself can lead to the development of such diseases as cholecystitis, cholangitis( inflammation of the bile duct wall), gallstones, chronicpancreatitis, weight loss, vitamin deficiency and anemia due to impaired absorption of nutrients in the intestine. Prevention of complications is timely treatment and an annual examination by a specialist.

Forecast.

The prognosis for timely treatment is favorable, the disease does not endanger life. In the event that dyskinesia is accompanied by chronic diseases of the gastrointestinal tract, the prognosis for health is determined by the severity of the underlying disease.

Physician therapist Sazykina O. Yu.