Hypomotor function of the gallbladder. Hypomotor dyskinesia of the gallbladder

Violation of the motility of the gallbladder and the outflow of bile is accompanied by cholestasis. Pathology can be suspected by characteristic pains and a feeling of heaviness in the stomach. The problem is that people who have gallbladder dyskinesia very rarely seek help from specialists. Patients almost never associate the regimen and quality of nutrition with a large list of complaints about their own health.

Causes of dyskinesia of the gallbladder

Women are 10 times more susceptible to pathology than men. According to statistics, the bulk of diagnosed cases are young thin girls who cannot or refuse to fully eat, suffer from neuroses. However, obesity of any stage can also provoke dyskinesia.

The etiology is mainly associated with an increase in pressure within the biliary tract, complemented by a decrease contractile function bubble walls. In such situations, there is no complete emptying of the organ, bile is not transported to the duodenum, and digestive disorders develop. There is an unpleasant aftertaste in the mouth, nausea, vomiting is possible.

Important! In some cases, the disease is associated with the inability of the gallbladder to create the necessary pressure. Because of this, bile stagnates and is not delivered to duodenum.

Types of disease

Depending on the nature of the appearance, types of dyskinesia are distinguished:

• primary;
• secondary.

These types of pathologies have different causes.

Primary dyskinesia

The etiology of the primary disease lies in congenital anomalies of the biliary system. It could be:

• a significant reduction in the gallbladder;
• narrowing of the excretory ducts;
• the presence of scars or adhesions.

A disorder of the motor function of the biliary system, a decrease in the susceptibility of cells to hormonal-type mediators are the causes of diagnosed primary dyskinesia.

Secondary dyskinesia

The secondary type is a consequence of:

The secondary form is also recognized as a consequence of such common diseases as hepatitis and cholecystitis.

In a child, the secondary type can be caused by:

• birth trauma;
• jaundice, dysentery;
• chronic course of sinusitis and tonsillitis;
• psycho-emotional disorders;
• anomalies of the digestive organs.

Dyskinesia is distinguished by the features of the contractile function of the bile organ:

• hypokinetic - inherent in women after forty years, the motor activity of the biliary system is greatly reduced;
• hyperkinetic - occurs in people of younger and middle age categories, characterized by increased motor skills.

Attention! The clinical picture has significant differences, depending on which form is diagnosed in patients.

There are common symptoms that indicate the pathology of the biliary organs.

Patients show:

• frequent pain on the right side. This is due to the fact that even a slight stretching of the walls of the gallbladder can cause discomfort;
• belching with bad smell, occurs immediately after eating a meal or between meals;
• severe nausea, often accompanied by vomiting. Arises from a large amount or excessive fat content of food;
• plaque on the tongue, burning and dulling of taste, bitterness occurs after eating, physical exertion or immediately after waking up;
• a change in the figure, namely an increase in the abdomen;
• frequent constipation or, conversely, diarrhea. Usually the urge occurs immediately after eating;
• increase or decrease in body weight, depending on the type of dyskinesia;
• increased secretion of sweat and saliva;
• changes in the work of the vegetative system - a decrease or increase blood pressure, pulse;
• staining of the skin and sclera in an icteric hue, at the same time, the urine darkens;
• redness of the skin of the face, over time, the phenomenon becomes permanent.

Due to discomfort during and after eating, a person's appetite may decrease. The reasons are related to psychological factors - the patient develops an aversion to food.

There are also signs that are characteristic of a certain type of pathology:

1. Hypomotor dyskinesia is characterized by constant, dull, spreading pain in the right hypochondrium. Systematic constipation is observed, there is no possibility to empty the intestines for several days. Obesity is caused by poorly digested fats.
2. Hypermotor (hypertonic) dyskinesia is characterized by a sharp, paroxysmal pain that occurs on the right side due to physical overload or errors in the diet. Shooting pains under the heart last 20-30 minutes, simulating angina pectoris. Disturbed digestion leads to weight loss of the patient. Against the background of exacerbation, diarrhea often occurs. Outside of attacks, a person is characterized by increased irritability, fatigue.

With dyskinesia of the hypotonic type, pressure and heart rate are reduced. With hypermotility of the biliary system, these same indicators are increased.

Diagnosing the primary form of the disease is not always easy. Ultrasound helps to identify abnormalities of the biliary system. But the changes that occur during the development of the disease can be noticed only after a long time after the onset of the disease.

With secondary dyskinesia, ultrasound is also indicated. This method allows you to assess the size of the bile organ, examine its contents, make sure the presence or absence of torsion, screeds. At the time of the diagnostic procedure, the contractile function of the walls of the bile ducts is assessed.

Know! Any deviation from the norm may indicate dyskinesia.

Indications for carrying out ultrasound are:

• patient complaints of frequent pain in the right side;
• color of the skin in yellow;
• detection of compaction in the abdomen during palpation;
• enlargement of the liver, spleen.

In addition to the ultrasound, laboratory tests are prescribed:

• general and biochemical blood test;
• analysis of feces for eggs of helminths, lamblia.

In addition to these methods, additional studies are being carried out. They are aimed at identifying any changes that occur with the biliary system:

1. Cholecystography. Assigned to detect stones in the bladder. Additionally, the efficiency and extensibility of the gallbladder are studied.
2. sphincter manometry. Performed to determine the tension and functionality of the sphincter of Oddi.
3. Cholangiography. Performed to examine the bile duct.

Duodenal sounding is done to study the composition of bile and the functionality of the biliary tract. Additionally, with this type of diagnosis, doctors can detect concomitant pathological changes organs of the digestive system.

Important! To obtain a complete clinical picture, computed or magnetic resonance imaging of the bile organs and excretory ducts may be required.

Treatment of dyskinesia

Dyskinesia of the gallbladder and biliary tract is treated by gastroenterologists. Treatment is based on patient compliance with the prescribed diet. Additionally, a course of drug therapy is carried out. Surgical intervention is practically not required, since its effectiveness has not been confirmed.

If motor skills are increased, limit the intake of products that stimulate the outflow of bile:

• vegetable fats;
• animal fats;
• meat broths.

Attention! If the motility of the biliary system is reduced, the above products, on the contrary, make up the bulk of the daily diet. The diet involves fractional consumption of food - frequent, but small portions.

In a child or adult suffering from biliary dyskinesia, fried, fatty and spicy foods should be excluded from the menu. Older people are strongly advised to avoid bad habits- Drinking alcohol and smoking. Any patient should be careful about their own weight. During the rehabilitation period, physical overload should be avoided.

Medication treatment

Drugs are prescribed depending on the diagnosed type of disease:

1. Hypotonic dyskinesia is treated with prokinetics, choleretics and cholekinetics.
2. Discomfort in the gallbladder associated with excessive contraction of the ducts and characterized by increased motility is corrected with tricyclic antidepressants, antispasmodics.

Know! If the illness lasts for a long time, a specialist may recommend bile-containing compounds.

Folk methods of treatment

Recipes of alternative medicine are used as additional method treatment. Consider the most effective means.

Pumpkin

Traditional medicine involves the use of pumpkin juice. A diet, part of which consists of pumpkin pulp and derivatives, will help you recover faster with a hypotonic form.

Sunflower oil

To create a choleretic effect, you can take 15 ml sunflower oil daily. It should be washed down with a little sweetened lemon juice mixed in equal proportions with water.

Not always able to fix the problem choleretic compounds. If dyskinesia has a hypertonic form, then products that promote the outflow of bile will only increase the manifestation of symptoms.

Important! Any action must be agreed with the attending physician.

Prevention and prognosis

The prognosis for patients is always favorable. The disease practically does not affect the patient's life expectancy, but affects its quality.

Prevention is about maintaining a healthy lifestyle. A person, in order to avoid the occurrence or recurrence of pathology, should be attentive to his diet and behavior. It is necessary to avoid stress, psycho-emotional stress, give up bad habits.

3

1 SBEI HPE "Kazan State Medical University" of the Ministry of Health of Russia

2 GAUZ "Republican Bureau of Forensic Medical Examination of the Ministry of Health of the Republic of Tajikistan"

3 GAUZ "City clinical Hospital No. 7"

The relationship between motor dysfunction of the gallbladder in diseases of the biliary system and the presence of duodenogastric reflux (DGR), which causes changes in the morphology of the gastric mucosa (GM), corresponding to those in biliary or reflux gastritis, was studied. Patients with chronic non-calculous cholecystitis (CNC) and JVP were examined. In patients with GVP, the presence of GHD was associated with a lower emptying ratio (EC) of the gallbladder when examined by FGDS: EC with GHD 38 (13)%, without GHD 57 (15)%, t = -2.37 (p = 0.037), when examining the morphological data of the gastric mucosa, the corresponding indicators of CO with GHD 26 (4)%, without GHD 37 (3)% t=-3.39 (p=0.027). In patients with CNC, the FGDS method did not reveal any difference in CR rates in the group with and without GHD. However, the method of morphological assessment of gastric mucosa revealed a difference in the parameters of CO in patients with GHD at the level of the body of the stomach: CO with GHD 12 (25)%, without GHD 53 (18)%, t=-2.66 (p=0.038), but there was no difference in indicators at the level of the antrum of the stomach. Thus, in patients with GAD, there is a close relationship between a decrease in gallbladder contractility and the presence of GHD with the development of reflux gastritis. In CNH patients, a decrease in the contractile function of the gallbladder contributes to an increase in the level of GHD and reflux gastritis from the antrum to the body of the stomach.

diseases of the biliary system

contractile function of the gallbladder

duodenogastric reflux

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Duodenogastric reflux (DGR) is a common occurrence in both healthy patients and patients with diseases of the upper gastrointestinal tract. So, according to studies, bile in the stomach in healthy patients is present 37-40% of the time. The works of many authors describe the protective and adaptive nature of the GDR. However, as motor disorders progress, in combination with other factors, this physiological phenomenon becomes the cause of the development of chronic biliary or reflux gastritis.

One of the causes of reflux gastritis is diseases of the biliary tract, primarily the gallbladder. In patients with chronic cholecystitis DGR is significantly more common than in healthy individuals. This applies to both calculous and non-calculous cholecystitis. Among the pathogenetic factors due to which pathological reflux occurs with cholecystitis, the first place is given to the violation of the motility of the gallbladder and gastroduodenal zone, which occur together. So, in the course of the studies, with a parallel measurement of the evacuation function of the stomach and contractility of the gallbladder, it was found that these indicators are associated with a statistically significant correlation. It was revealed that with an increase in the motor activity of the stomach, the contractility of the gallbladder increases. This pattern is consistent with the physiological mechanism of regulation of these two organs, which occurs with the participation of both the vagus nerve and multiple gastrointestinal hormones. In the study of patients with pathology of the biliary system (BVS), it was found that 75.0% of patients with cholelithiasis and 62.1% of patients with postcholecystectomy syndrome have morphofunctional changes in the upper gastrointestinal tract. Reverse patterns were also revealed: in patients with diseases of the gastroduodenal zone, violations of the motility of the ventricular vasculature occur significantly more often. Among patients with gastroduodenal ulcers, only in 8.6% of patients the motor-evacuation activity of the VA corresponded to the average indicators of healthy people. In other cases, accelerated emptying of the bladder, hypermotor dyskinesia of the biliary tract with no latent period of bile secretion, hypomotor dysfunction of the biliary tract, as well as a violation of the nature of bile secretion, which consisted in a periodic increase and decrease in the volume of the gallbladder during its contractile period, were diagnosed.

Reflux gastritis (alkaline reflux gastritis) is considered as a disease associated with the reflux of the contents of the duodenum into the stomach, which has a damaging effect due to the constant traumatization of the gastric mucosa (GM) by refluxate components. Morphological changes in the GM in GHD are stereotypical: foveolar hyperplasia, edema and proliferation of smooth muscle cells in the lamina propria against the background of moderate inflammation. Foveolar hyperplasia, which is defined as the expansion of mucous cells, with reflux gastritis covers only the surface epithelium. Rough vacuolization of the cytoplasm, pyknosis of the nuclei, necrobiosis and necrosis are noted in the epithelial cells, which is considered the beginning of the formation of erosions. Over time, atrophic changes increase, accompanied by the progression of proliferative processes and the development of dysplasia of varying severity, which increases the risk of malignancy. The informativeness of morphological diagnostics of changes in the coolant in GHD is very high. Due to the stereotype of GM changes, it became possible to develop a biliary reflux index (BRI) based on histological data. This index was introduced by M. Dixon et al., 1993, based on biopsy data from the gastric mucosa. IBR value greater than 14 indicates the concentration of bile acids in the stomach? 1.00 mmol/l with 70% sensitivity and 85% specificity. IBR is calculated as the sum of the scores of mucosal edema (the score is multiplied by a factor of 7), intestinal metaplasia(score multiplied by a factor of 3), chronic inflammation (coefficient 4) minus a score characterizing the density of H. pylori colonization (coefficient 6). Does the calculated IBR at a value of more than 14 indicate the concentration of bile acids in the stomach? 1.00 mmol/l with 70% sensitivity and 85% specificity. Based on these data, and also on the fact that most of the methods for diagnosing GDR do not currently have high accuracy, this index is used by a number of authors as diagnostic criterion the presence of GDR in clinical research.

In the presence of many studies demonstrating the general mechanisms of GI and gastroduodenal motility, as well as studies regarding the clinical and morphological features of the development of reflux gastritis, the relationship between motor impairment of GI and the development of pathological GHD has not been investigated.

aim This work was to determine the nature of the influence of the contractile function of the gallbladder (SCF) on the development of reflux gastritis at various levels of the gastric mucosa (GM) in patients with functional disorders of the GI and chronic non-calculous cholecystitis (CNC). The objectives of the study were to identify the difference in the indicators of gallbladder motility in biliary dyskinesia (BBD) and chronic non-calculous cholecystitis (CNC), to determine the most common type of gallbladder contractile dysfunction (BCF) in CNC. The presence of a relationship between the frequency of GHD and motor disorders of the GI was also determined, for which the methods of FGDS and morphological assessment of the gastric mucosa (GM) were used.

Materials and methods. A total of 38 patients with dyspepsia and abdominal pain were examined. The exclusion criteria were the presence of signs chronic pancreatitis, surgical interventions on the organs of the biliary system, stomach and duodenum in history. In 31 patients, diseases of the gallbladder were detected, of which 19 patients had CHD, 12 had DZHVP in the form of impaired contractile function, 11 were of the hypomotor type, and one of them was of the hypermotor type. All patients were assessed SFZHP by dynamic ultrasonography with a choleretic solution of sorbitol. The presence or absence of DGR during fibrogastroduodenoscopy (FGDS) was determined by staining the "lake" with gastric secretion in yellow, hyperemia and swelling of the coolant. 21 patients underwent a biopsy of the gastric mucosa from 4 sites to identify morphological changes in the gastric mucosa caused by bile reflux. Biopsy specimens were taken in accordance with European recommendations"Management of precancerous conditions and lesions in the stomach (MAPS)", 2012, developed by a multidisciplinary team of experts. The resulting biopsies were stained with hematoxylin and eosin to determine morphological changes. Giemsa staining was performed to detect H. pylori bacterial bodies. The gastric mucosa was examined on a scale of inflammatory changes, which assessed foveolar hyperplasia, glandular atrophy of the gastric mucosa, mucosal edema, vasodilation or hyperemia of the gastric mucosa, its infiltration with acute and chronic inflammation cells, and the presence of intestinal metaplasia. Along with this, biopsy samples were evaluated in accordance with the M. Dixon reflux scale with the calculation of the biliary reflux index (BRI).

Results. In the analysis of SFZHP in patients with CNC, the following indicators were revealed: hypomotor type disorders in 15 patients out of 19, normotonus was detected in 3 patients, hypermotor type disorder in 1 patient. Thus, in these patients, the violation of SFZhP according to the hypotonic type was predominant. When comparing the indicators of the volume of the gallbladder in patients with CNC compared with a group of healthy patients, there were no differences in absolute indicators. The values ​​of the average fasting (initial) volume of the gallbladder were 25 and 27 cm 3, respectively, the minimum volume of the gallbladder during its emptying was 18 and 10 cm 3, respectively, without statistical differences between these indicators. However, when comparing relative indicators, it was found that the average emptying fraction (FO) - the difference between the initial and minimum volume of the gallbladder - differed in the two groups. So, the average FO in patients with CNC was 6 cm 3 (8 cm 3), and in healthy people - 17 cm 3 (13 cm 3) with a significant difference in t=-2.46 (p=0.024). The coefficient of emptying (EC) of the gallbladder also differed in these two groups. The average CR in patients with CNC was 28(34)%, in healthy people 63(8)% t=-2.68 (p=0.014). These data are consistent with studies of the pathogenesis of chronic chronic hepatitis, in which a decrease in FPZhP is one of the leading factors leading to chronic inflammation walls of the gallbladder.

In the study of GHD by FGDS, it was found in 8 patients with DVP out of 12 (67% of the total number) and 10 patients out of 19 with CNC (53% of the total number). This percentage is higher than in healthy patients, in whom GHD occurs on average in 30-40% of cases according to the literature and in 28.6% in our study (see table).

GDR in gallbladder disease

	No violations of SFZHP

When analyzing GHD in patients with gallbladder diseases, data were obtained on the difference between the groups of patients with CNC and GVP. In the group of patients with GVP, a difference was found in the indicators of gallbladder CR in patients with GHD and without it. Thus, in patients with GHD, the average CR of the gallbladder was 38(13)%, and in patients without GHD, the indicator was 57(15)%, with a statistical difference between the indicators t=-2.37 (p=0.037). Thus, in patients with GVP, the presence of GHD is associated with lower indicators of the contractile function of the gallbladder. At the same time, when analyzing the indicators of gallbladder contractility in patients with CNC, with GHD and without it, no significant difference was found between the two groups. Thus, the data obtained allow us to state that in patients with functional disorders in the form of DVD, one of the leading factors in the pathogenesis of GHD is motor impairment of VAD. At the same time, in patients with CNC, when examining the routine method of FGDS, no relationship was found between the presence or absence of GHD and changes in SFZhP.

When analyzing the morphological changes in the gastric mucosa with calculated IBD, the presence or absence of reflux gastritis coincided with the data obtained with EGD in 14 cases out of 21, which amounted to 67%. This corresponds to the data of previous studies, in which the correspondence of endoscopic data to morphological and instrumental data ranged from 66 to 84%.

When analyzing the morphological data of GM obtained in patients with diseases of the gallbladder, it was found that in 8 people out of 15 IBR was 15 or more units, which accounted for 53% of the total. Since morphological data were taken from four areas of the gastric mucosa, all data were analyzed for the presence of a relationship with the indicators obtained in the study of the contractile function of the gallbladder. In addition, the question was considered, whether there is a difference in the EFZHP in patients with or without GHD according to the calculated IBR at the level of the body and the antrum of the stomach. As a result, it was found that patients with GHD and reflux gastritis had significant differences in gallbladder CR compared with patients without GHD. Moreover, the indicators differed in the groups of patients with CNC and without it. Thus, in patients with CNC, the average EC of the gallbladder in the group of patients with GHD at the level of the body of the stomach was 12(25)%, the same indicator in patients without GHD was higher and amounted to 53(18)% with a significant difference in t = -2 .66 (p=0.038). At the same time, patients with CNC who had GHD at the level of the antrum of the stomach according to the calculated IBR, the size and parameters of gallbladder motility did not significantly differ from those of patients without GHD. In patients with GVP, the average EC of the gallbladder differed in groups with and without GHD already at the level of the antrum of the stomach. Thus, in the group with GHD, the LR of the gallbladder was 26(4)%, and in the group without GHD, it was 37(3)% with a significant difference in t=-3.39 (p=0.027). Thus, in patients with GVP, a relationship was found between the presence or absence of GHD and SFZHP both at the level of the antrum and the body of the stomach.

In previous studies, it was noted that the difference in the frequency of GHD between the proximal and distal parts of the stomach is normal and is associated with the presence of physiological GHD at the level of the antrum. At the same time, the surgical interventions performed on the organs of the gynecomastia create conditions for the development of pathological DGR with the development of reflux gastritis. One of the characteristics of the latter is the presence of duodenal contents at the level of the stomach at which it is normal or not found, or is less common than usual. In a study of patients who underwent various manipulations on the biliary tract, such as endoscopic papillosphincterotomy, endoscopic stenting or choledochoduodenostomy for pathologies not associated with malignant neoplasms, it turned out that all of the above procedures are associated with an increased risk of developing GHD. The highest percentage of DGR occurs in patients after choledochoduodenostomy. At the same time, if in patients who have not been operated on, GHD mainly affects the antrum of the stomach, then in patients who underwent the above operations on biliary tract, including after CE, DGR affects both the antrum and the body of the stomach.

In our work, we investigated the presence of pathological DGR and reflux gastritis at the level various departments stomach at chronic diseases ZhVS in the form of CNH and DZHVP without previous surgical interventions on ZhVS. Our data showed the presence of pathological DGR in patients with pathology of the biliary system both at the level of the body and at the level of the antrum of the stomach. In the course of the analysis of the presence of a relationship between SFZhP and GHD in patients with CNC, it was found that such a relationship exists at the level of the body of the stomach and is absent at the level of the antrum of the stomach. So, in these patients, the presence of GHD at the level of the body of the stomach was associated with a significantly lower indicator of gallbladder contractility in the form of a lower CR. That is, dysmotility of the ventricular vasculature in CNH contributes to an increase in the level of pathological GHD to the body of the stomach and is not associated with the occurrence of GHD at the level of the antrum of the stomach. Perhaps this is due to the fact that in CNH, the dysmotility of the gastroduodenal zone becomes permanent with the course of the disease and is not directly related to the motor function of the gallbladder. At the same time, deeper disorders of gallbladder motility in CNH contribute to an increase in the level of pathological GHD to the level of the body of the stomach. This may be the reason why the study of GDR by the routine method of FGDS does not reveal the relationship with SFZhP. But the study of the morphological data of the gastric mucosa shows the presence of such a relationship with the topical definition of pathology.

In patients with JVP, the relationship between SFZhP and the presence of GHD was established both using the routine FGDS method and using a more reliable method of morphological assessment of gastric mucosa with calculated IBR. More low rates gallbladder contractility was observed in patients with GHD, which was detected by two methods. That is, according to our data, in functional disorders of the VA, there is a closer relationship between the violation of SFZhP in the form of hypomotor dysfunction and the occurrence of GHD.

Conclusion. The data obtained by us made it possible to establish that the predominant nature of the change in SFZhP in patients with CNC was motor dysfunction of the hypotonic type. In patients with GAD, there is a close relationship between a decrease in gallbladder contractility and the presence of GHD and reflux gastritis. In CNH patients, a decrease in the contractile function of the gallbladder contributes to an increase in the level of development of GHD from the antrum to the body of the stomach. The use of the calculated IBR based on the analysis of the morphological data of the gastric mucosa allows a more in-depth study of the nature of the relationship between the violation of SFZHP and the localization of changes in the gastric mucosa corresponding to GHD and reflux gastritis.

Bibliographic link

Galiev Sh.Z., Amirov N.B., Baranova O.A., Zakirova G.R., Zinatullina Z.Kh. DISTURBANCES OF THE CONTRACTIVE FUNCTION OF THE GALL BLADDER AS A FACTOR IN THE DEVELOPMENT OF REFLUX-GASTRITIS IN DISEASES OF THE BILE EXECUTIVE SYSTEM // Contemporary Issues science and education. - 2016. - No. 2.;
URL: http://site/ru/article/view?id=24285 (date of access: 02/01/2020).

We bring to your attention the journals published by the publishing house "Academy of Natural History"

Dyskinesia of the gallbladder is considered a fairly common pathology, which is characterized by a violation of the functioning of this organ, which causes an insufficient outflow of bile into the duodenum. The disease can be both primary and secondary, which will differ in the reasons for its formation. Often they are congenital anomalies or other ailments of the digestive system.

The clinical picture will also depend on the type of disease. Such a disorder has non-specific symptoms, for example, pain in the area under the right ribs, bouts of nausea and vomiting, and an unpleasant aftertaste in the oral cavity.

A wide range of instrumental diagnostic procedures will help to make the correct diagnosis and determine the type of ailment. However, laboratory tests may be required, and information obtained by the gastroenterologist during the examination is also taken into account.

Ways to treat dyskinesia are always limited to conservative methods such as medication, diet therapy and folk remedies.

Etiology

Depending on the factors that led to dyskinesia of the gallbladder and biliary tract, the disease is divided into primary and secondary.

The most common sources of development of the first type of ailment are:

• doubling or narrowing of this organ or cystic ducts;
• the formation of scars and constrictions;
• improper motor activity of smooth muscle cells;
• dysfunction of the ANS, which may develop due to acute or chronic;
• increase or decrease in the production of cholecystokinin;
• congenital failure of the muscles of the gallbladder and bile ducts;
• poor nutrition, in particular overeating, irregular meals or excessive addiction to fatty foods. It is for this reason that sparing nutrition for dyskinesia is not the last place in the treatment;
• the presence in a person of any stage or, conversely, a lack of body weight;
• sedentary lifestyle.

Secondary JVP develops against the background of already occurring in human body diseases, which makes it difficult to establish the correct diagnosis, since the symptoms of the underlying disease prevail over the signs of improper functioning of the gallbladder.

In addition, gastroenterologists have put forward a theory that the development of such a disease can be affected by improper functioning of liver cells, which is why they initially produce bile with a changed composition.

In a child, such a disease can be caused by:

• perinatal lesions of the central nervous system, for example, trauma during childbirth;
• or ;
• or ;
• psychoemotional disorders and diseases of the gastrointestinal tract.

Classification

According to the time and causes of development, gallbladder dyskinesia is divided into:

• primary- this variety is associated either with congenital anomalies or with disorders that affect only the functioning of this organ, and not its structural integrity. In such cases, no violations during instrumental examinations will be observed;
• secondary- is formed during life and is associated with the course of other acquired serious diseases.

There is also a division of pathology regarding the characteristics of motor skills, i.e., contraction of the muscles of the affected organ:

• hypertensive dyskinesia of the gallbladder- at the same time, the contractile activity of the biliary system is increased. Most common in children and young adults;
• hypomotor dyskinesia of the gallbladder- has the opposite picture and is characterized by reduced activity of the biliary system. It is most often diagnosed in females over forty years of age;
• mixed.

Symptoms

Clinical signs of the disease will differ depending on the form in which dyskinesia of the gallbladder and bile ducts proceeds. However, there is a group of symptoms that can be attributed to both increased and decreased activity of the biliary system.

Hypotonic dyskinesia has the following symptoms:

• pain under the right ribs - the pain is constant, dull and aching. May increase during a meal or immediately after eating;
• belching, which in some cases is accompanied by an unpleasant odor - often occurs after eating, less often between meals;
• attacks of nausea, ending with vomiting - in some cases, bile impurities are present in the vomit. Very often it is the result of overeating or eating a large number of fatty foods;
• the feeling of bitterness in the mouth is the most feature ailment. Appears mainly in the morning, after a meal or excessive physical activity;
• an increase in the size of the abdomen, which is often accompanied by pain;
• loss of appetite or complete aversion to food - occurs against the background of the fact that a large number of symptoms appear during or after eating;
• violation of the act of defecation - constipation is more common than diarrhea and occurs after a short period of time after a meal;
• weight gain - in cases with dyskinesia of the hypokinetic type, obesity acts not only as a cause, but is also a symptom;
• decrease in blood pressure, which occurs against the background of a decrease in heart rate;
• increased secretion of saliva and sweat;
• pathological redness skin faces.

Hyperkinetic type of dyskinesia is represented by the following symptoms:

• pain syndrome - pains are sharp, intense and colicky, localized in the area of ​​the right hypochondrium. The duration of the attack is often half an hour and can be repeated several times during the day;
• irradiation of pain to the right side of the back, shoulder blade or upper limb. Less commonly observed pain, expressed in angina pectoris or scoliosis;
• constant feeling heaviness under the right ribs;
• total absence appetite, against the background of which there is a decrease in body weight;
• nausea and vomiting that accompany an attack of intestinal colic;
• disorder of the act of defecation - in contrast to gallbladder dyskinesia of the hypotonic type, diarrhea predominates in the hypertonic form;
• rapid heartbeat;
• increased sweating;
• headache;
• irritability and sleep disturbance;
• an increase in blood tone;
• aching pains in the heart;
• fast fatigue.

Signs that are observed regardless of the type of course of the disease:

• acquisition of a yellowish tint by the skin, mucous membranes of the mouth and sclera;
• the tongue is coated with a white-yellow coating;
• discoloration of faeces;
• darkening of urine;
• an increase in the size of the liver;
• severe itching of the skin;
• decreased sexual activity;
• violation menstrual cycle among women.

Dyskinesia of the gallbladder in a child proceeds in the same way as in adults, however, it is worth noting that in this age category, the hypotonic form is quite rare.

Diagnostics

What is dyskinesia, how to diagnose it and prescribe treatment, a gastroenterologist knows. All diagnostic measures are aimed at differentiating the hypermotor type of the disease from the hypomotor form.

The first stage of establishing the correct diagnosis includes manipulations performed directly by the clinician, including:

• studying the life history and medical history of not only the patient, but also his close relatives - because the possibility of a genetic predisposition is not excluded;
• a thorough examination aimed at palpation of the anterior wall of the peritoneum in the area under the right ribs, assessment of the condition of the skin and measurement of blood pressure;
• conducting a detailed survey of the patient - to compile a complete symptomatic picture, since each variety has characteristic features.

Laboratory diagnostic measures are limited to:

Instrumental diagnostics is based on the implementation of the following procedures:

• Ultrasound and MRI of the affected organ are the most informative diagnostic methods;
• cholecystography;
• dynamic scintigraphy;
• sphincter of Oddi manometry;
• FEGDS;
• duodenal sounding;
• RKHPG;
• CT scan of the bile ducts.

Treatment

Despite the variety of symptoms, the treatment of gallbladder dyskinesia will be carried out using conservative methods.

The basis of therapy is a diet for gallbladder dyskinesia, based on the following rules:

• frequent and fractional food intake;
• complete rejection of spicy and fatty foods, smoked meats and preservatives;
• reducing the daily volume of salt intake to 3 grams;
• cooking only by boiling and stewing, baking and steaming;
• reception of a large amount of mineral water without gas.

The rest of the nutritional advice is provided by the attending physician according to the dietary table number five.

Drug treatment is carried out by taking such drugs:

• choleretics;
• cholespasmolytics;
• enzyme substances;
• neurotropic drugs prescribed by a psychotherapist, in particular, Novo-Passit.

Dyskinesia of the gallbladder and biliary tract is successfully eliminated with the help of physiotherapy procedures, including:

• diadynamic therapy;
• electrophoresis;
• acupuncture;
• hirudotherapy.

Conservative treatment in children and adults also includes:

• duodenal sounding;
• closed tubes;
• acupressure;
• application of funds traditional medicine, but only after consulting with your doctor, because use medicinal herbs necessary depending on the course of the disease. With hypotonic dyskinesia, oregano, helichrysum and corn stigmas are useful, and with hypertonic dyskinesia - mint, licorice and chamomile;
• spa therapy.

Surgical intervention is inappropriate for use in gallbladder dyskinesia.

Possible Complications

Ignoring the symptoms or self-treatment with folk remedies can lead to the development of a large number of consequences. They should include:

• and cholecystitis;
• gastritis and cholelithiasis;
• duodenitis;
• severe weight loss up to exhaustion.

Prevention and prognosis

To reduce the likelihood of such an ailment, you must follow these simple rules.

Dyskinesia of the gallbladder is a pathology of the tone and functioning of the organ and the ducts extending from it. Is this violation in the improper excretion of bile into the duodenum, resulting in problems with intestinal digestion.

Gastrointestinal dyskinesia ranks eighth in prevalence among diseases of this organ. It develops in both adults and children. It appears more often in women than in men.

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

For a complete cure of dyskinesia, timely treatment and a properly selected diet are necessary. .

Organ structure

The gallbladder is located on the right side of the ribs. It reaches a length of 6-14 cm, and a width of 3-5 cm. Its capacity is 30-80 ml, but in case of stagnation it can increase. The shape is oblong. It consists of several parts - the bottom, the body and the neck, from which comes the cystic duct, which connects to the hepatic duct.

The role of the gallbladder is:

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

During this process, the bubble shrinks. In addition, at this moment, the sphincter relaxes, thereby contributing to the promotion of bile.

This process depends on:

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

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

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

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

Reasons for the development of pathology

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

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

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

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

Secondary dyskinesia may develop due to the following factors:

Types of disease

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

• hypermotor(hypertonic). It develops with an increased tone of the bladder and the paths extending from it. Occurs in people with nervous system parasympathetic nature, enhancing the tone of the organ. Children and teenagers are most affected.
• Hypomotor form (hypotonic), appearing with reduced tone. The most susceptible people are over 40 years old, in whom the sympathetic system dominates.
• hyperkinetic form (hyperkinesia) with active bile outflow;
• hypokinetic form (hypokinesia) with a slow outflow of the secreted substance.

Symptoms

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

Symptoms of the hypomotor type of the disease include:

With hypermotor dyskinesia, the patient has the following symptoms:

These two forms of dyskinesia also have common features:

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

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

Diagnostic methods

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

Then laboratory tests are being carried out:

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

Therapy

The use of medicines

For the treatment of biliary tract disease according to the hypotonic type, such medications are used as:

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

The following drugs are used to treat hypertensive dyskinesia:

Physiotherapy

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

In some cases, other procedures are also prescribed:

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

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

If dyskinesia of the gastrointestinal tract is detected, the patient needs to:

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

Important! In some cases, patients try to fight dyskinesia with folk remedies, but it is first necessary to consult a doctor.

Proper nutrition

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

This diet involves the exclusion of certain foods.:

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

With such a diet allowed to use the following products:

The development of the disease in children

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

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

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

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In the body of a healthy person, the processes of accumulation and excretion of bile into the digestive tract regularly occur. At serious violations in the work of the gallbladder, the bile secretion stagnates, accumulates in excess or is supersaturated with cholesterol. One of the most common organ pathologies is dyskenesia, or dysfunction.

Gallbladder dysfunction is associated with a violation of its contractility. The disease occupies a leading position among other disorders of the biliary system. Adults and children suffer from dyskinesia, but women with low body weight are at risk.

Classification

Pathology occurs in 2 variants:

• dyskinesia of the hypokinetic type - the contractility of the organ is reduced, bile constantly flows into the duodenum;
• dyskinesia of the hyperkinetic type - gallbladder motility is accelerated, bile enters the duodenum intermittently.

Another classification is associated with the etiological factor, or the nature of the onset of the disease. From this position, gallbladder dysfunction is divided into primary and secondary. Based on the localization of the disorder, biliary dyskinesia and sphincter of Oddi dyskinesia are isolated directly.

Causes

The causes leading to impaired motility of the gallbladder are often associated with anatomical features - constrictions in the organ cavity and kinks cause congestion. Other factors that provoke dyskinesia include:

• hormonal imbalance in women during pregnancy, menopause;
• taking hormonal contraceptives;
• poor nutrition against the background of strict and frequent diets;
• abuse of fatty, salty, smoked, spicy foods;
• non-compliance with the diet, long intervals between meals;
• hereditary predisposition;
• overweight;
• diseases of the nervous system;
• helminthic invasions;
• sedentary lifestyle.

Background diseases, the presence of which increases the likelihood of gallstone dysfunction, are acute and chronic gastritis, pancreatitis, hepatitis, liver cirrhosis, and cholelithiasis.

Clinical picture

A typical sign indicating dysfunction of the gallbladder is pain syndrome. Pain in dyskinesia is paroxysmal in nature, the location is in the right side, under the ribs. Attacks are long, from 20 minutes and longer. The nature of the pain depends on the form of motor dysfunction:

• with dysfunction of the hypotonic type, pain is not expressed intensely, but is aching in nature; discomfort increases with a change in body position;
• characteristic of hypermotor dysfunction sharp pain(biliary colic), which occurs 1-1.5 hours after eating; irradiation of pain sensations in left shoulder or left upper chest.

Other signs indicating the presence of hypomotor type of bile dysfunction include:

• bouts of nausea, often accompanied by vomiting with inclusions of bile secretion;
• belching with a bitter taste;
• decreased appetite;
• bloating and increased gas formation;
• constipation or diarrhea.

For dyskinesia with hypermotor course, other manifestations are characteristic:

• increased sweating;
• irritability (with hypertonic type VSD);
• constant nausea;
• heaviness in the epigastric region;
• cardiopalmus.

Often, jaundice occurs in patients with dyskinesia due to bile stasis. At the same time, the feces become colorless, and the urine darkens, acquiring the color of beer. With a long course of dyskinesia, the likelihood of developing cholecystitis increases. This may be evidenced anxiety symptoms as a frequent liquid stool, increased body temperature and moderate pain on the right under the ribs.

The course of pathology in children

Dysfunction also occurs in children, mainly in adolescents. IN childhood dyskinesia often occurs in a mixed type, when the motility of the gallbladder is unstable - periods of excessive contractility are replaced by sluggish, weak contractions. The causes of dysfunction in childhood are associated with congenital defects of the organ, nervosa, the presence of VVD, but more often the provoking factor is poor nutrition and the wrong approach to its organization:

• force feeding;
• overeating, which creates an excessive load on the digestive system;
• lack of fiber in the diet;
• early introduction to "adult" food, including untimely introduction of complementary foods to infants.

The clinical picture in a child with dyskinesia is identical to the symptoms in adults - pain, dyspepsia. Additionally, marked anxiety and poor night sleep are added, especially in children. preschool age. Infants with ADHD often do not gain normal weight and are malnourished due to decreased appetite and poor digestion.

Diagnostics

Examination for suspected gallbladder dysfunction is complex. At the initial stage, the gastroenterologist finds out the patient's complaints, features of eating behavior and lifestyle, the presence of a history of chronic pathologies of the gastrointestinal tract. In the course of diagnosis, it is important to differentiate dyskinesia from other diseases of the biliary system.

From laboratory research indicative blood test for biochemistry. With its help, bile dysfunction is distinguished from similar diseases in the clinic. Characteristic changes in the blood in the presence of dyskinesia are an increase in the concentration of bilirubin, cholesterol (as a sign of bile stasis), and white blood cells. However, changes in blood biochemistry occur with prolonged congestion and indicate dysfunction of the gallbladder in the later stages.

Among the methods of functional diagnostics, ultrasound provides the maximum information content. With dysfunction of the hypokinetic type, an enlarged gallbladder is visualized, which has shifted downward. Hypermotor dyskinesia is indicated by a reduced organ with tense walls and frequent contractions. In addition to ultrasound, to clarify the diagnosis, they prescribe:

• duodenal sounding;
• cholecystography;
• endoscopy.

Treatment

The primary goal of treatment for biliary dyskinesia is to restore organ motility, eliminate bile stasis, and relieve negative dyspeptic manifestations. In the acute period, the patient needs complete rest, which is provided by bed rest. Treatment of biliary dysfunction is reduced to the appointment of medications and diet.

Conservative therapy is selected based on the type of disorder:

• with a hypotonic functioning gallbladder, choleretics are indicated (Hologon, Allochol);
• with hypomotor disorder, cholekinetics (Besalol, Metacin) and enzymes (Mezim, Festal) are prescribed.

To relieve the phenomena of dyspepsia in the form of nausea, bloating and flatulence, prokinetics are prescribed (Motilium, Domperidone). Attacks of pain helps to relieve the use of antispasmodics (Papaverine, Baralgin). Often gastroenterologists prefer medicines based on herbs or prescribe herbal medicine with folk remedies - decoctions and infusions of sage, knotweed, lemon balm, leaves and dandelion root. Herbal medicine is more often used to get rid of dysfunction in children and in the early stages of the disease.

A certain positive result in the treatment of dyskinesia gives physiotherapy. Physiotherapeutic procedures are indicated outside the acute period and help relieve spasms, inflammation, normalize metabolic processes and blood supply to the gallbladder. TO effective procedures include electrophoresis, paraffin heating, microwave therapy. Patients with dyskinesia benefit from special water procedures - pine baths, jet showers.

Surgical treatment is indicated when the contractility of the organ decreases by more than 40%. Perform a complete excision of the gallbladder - cholecystectomy. After the operation, the recovery of the patient lasts at least a year. Further, lifelong dieting is mandatory.

Nutrition principles

Diet for biliary dysfunction is an integral part of the treatment. Nutrition for patients is sparing, the best option is treatment table No. 5. Spicy and fatty foods, alcohol, spices, onions and garlic are excluded from the diet. It is important to observe the principle of fractional nutrition, up to 6 meals per day, the last one at bedtime. This avoids stagnation of bile.

Diet in the acute period involves the rejection of solid foods. The patient is allowed fruit and vegetable juices, diluted with water, or liquid homogenized puree from apples, peaches, plums. Useful mineral water in a warm form, the degree of mineralization is selected taking into account the type of violation. Such nutrition helps to relieve the inflammatory process, reduce the load and restore the functions of the organ.

The diet for patients is selected individually. With hypermotor type of dyskinesia, it is forbidden to eat food that stimulates the motility of the gallbladder - rich broths from meat, fish, mushroom dishes. A hypomotor type disorder involves eating with a choleretic effect - egg dishes, fish, apples, fresh vegetables. Stimulates the motility of bile consumption of fats - vegetable and animal.

Forecast and prevention

Among other types of disorders associated with gallbladder, dyskinesia in 90% of cases has a favorable prognosis for recovery. Adequate drug therapy, nutrition correction, elimination of psychotraumatic factors can completely eliminate dysfunction. An unfavorable course of pathology with subsequent cholecystectomy is possible with late detection of dyskinesia and the presence of concomitant diseases of the gallbladder - multiple calculi, kinks, total cholesterosis.

Preventive measures are aimed at maintaining a diet, proper eating behavior, and a healthy lifestyle. An important role is given to daily moderate physical activity, which contributes to correct work biliary system. The first signs of ill health from the gallbladder require seeking medical help.