Violation of the contractile function of the gallbladder. Gallbladder dyskinesia: symptoms and treatment

Dyskinesia of the gallbladder is a violation of the motility of this organ, as well as the outflow of bile. Most often, this disease occurs in women and girls with low body weight.

Bile, as you know, plays an important role in the process of digestion of food and bowel function, so the violation of its outflow leads to various problems. In the vast majority of cases, this disease is secondary and develops against the background of other problems with the stomach, liver, and duodenum.

Description and types of disease

The gallbladder performs important functions in the body: it concentrates and stores bile, which is produced by the liver.

The liver is constantly working, continuously secreting bile, which enters the gallbladder and stored there until the process of digestion of food begins.

To understand what dyskinesia of the gallbladder is, you need to have an understanding of the structure of this organ. As a rule, the gallbladder has the shape of a pear, but there are congenital kinks of the gallbladder, which makes it difficult for the process of outflow of bile.

With dyskinesia, gallbladder motility is impaired, as a result, bile does not enter into duodenum, disrupting the process of digesting food and moving it through the intestines. Allocate primary and secondary dyskinesia. Primary dyskinesia of the gallbladder is an independent disease and develops due to stress, hormonal disruptions and other provoking factors.

As a rule, primary dyskinesia is difficult to diagnose at first, it is not visible on ultrasound, and structural changes appear with the course of the disease. Secondary dyskinesia often occurs against the background of gastritis, colitis, peptic ulcer and other diseases of the digestive tract.

Also, dyskinesia is often a complication of hepatitis and cholecystitis. Secondary dyskinesia is diagnosed quickly and is clearly visible on ultrasound. There are also hypokinetic and hyperkinetic forms of the disease.

1. The hypokinetic form is more common in older people. This disease is associated with a decrease in the contractility of the gallbladder, due to which bile is poorly ejected into the intestinal lumen. Manifestations of hypokinetic dyskinesia are very individual, but rarely accompanied by severe pain, more often it is a dull aching pain in the right side.
2. In the hyperkinetic form of the disease, on the contrary, the tone of the muscles of the gallbladder is increased, it often contracts and intensively ejects bile, which causes attacks of pain. This form of the disease is characteristic of young people, especially girls, who have an increased tone of the gallbladder during menstruation.

See what is gallbladder dyskinesia in the video:

Causes of dyskinesia

As mentioned above, dyskinesia can occur for a variety of reasons, including other diseases:

• Nervous breakdowns and stress. Frequent stress can lead to disruption of the work of many organs, sudden weight loss, psychosomatic diseases, which as a result can provoke dyskinesia of the gallbladder and ducts.
• Hormonal imbalance. The gallbladder is controlled by hormones. Intestinal hormones and neuropeptides are responsible for the contractile function of this organ. If a hormonal failure occurs in the body, the production and release of bile are also disturbed.
• Wrong nutrition. Irregular meals, overeating, an abundance of spicy and fatty foods, a love of fast food and the use of stale and low-quality products - all this leads to a violation of the entire digestive system generally. The peristalsis of the intestine and the production of intestinal hormones are disturbed, the load on the pancreas increases. All this eventually leads to gastritis, constipation and dyskinesia.


• Lack of weight and hypodynamia. People with an asthenic physique and underdeveloped muscle mass are much more likely to suffer from dyskinesia than even overweight people. With weakness of the muscles of the body, the muscles of the gallbladder are also weakened, so there is a violation of the outflow of bile.
• Diseases of the stomach. Diseases such as ulcers and gastritis are often accompanied by hyperacidity gastric juice, which enters the duodenum, which causes an increased tone of the sphincter and disrupts the entry of bile into the intestine.
• Allergy. Allergens irritate the gallbladder and cause a violation of the outflow of bile.

In addition to the standard provoking factors leading to a violation of the outflow of bile and the contractile function of the gallbladder, a theory has recently appeared according to which dyskinesia appears as a result of improper functioning of the liver, which initially produces bile of an altered composition, which disrupts the digestive process.

Symptoms

Dyskinesia manifests differently depending on age, complications, and type of disease. Some symptoms are easily attributed to another gastrointestinal disease, so only a doctor can accurately diagnose after examination and examination.

Symptoms of dyskinesia of the gallbladder:

1. Pain. In the hypokinetic form, the pain is usually dull, constant, with a feeling of fullness, without a clear localization. During or after eating, the pain will increase. The hyperkinetic form of the disease is accompanied by more intense, sharp and cramping pains that occur on the right, but radiate to the back and left side.


2. Nausea and vomiting. These symptoms can occur with any type of dyskinesia, but with hyperkinetic they appear simultaneously with colic. Often a feeling of heaviness and nausea appears after eating, with overeating, diet violations.
3. Lack of appetite. Bile is an appetite stimulant. If it does not enter the duodenum in sufficient quantities, the production of intestinal hormones is disrupted, appetite decreases.
4. Weight loss. People with dyskinesia often lose weight. This is also due to poor functioning of the gastrointestinal tract, lack of desire to eat, nausea, and insufficient absorption of vitamins and nutrients in the intestines.
5. Chair disorders. Diarrhea is extremely rare. More often, with dyskinesia and insufficient release of bile, food is broken down poorly and moves through the intestines more slowly than usual, which causes chronic constipation. Diarrhea is possible with hyperkinetic dyskinesia, when bile is ejected too intensely. In this case, diarrhea begins after eating.
6. Bitterness in the mouth. Most often appears with hypokinetic dyskinesia. It can occur in the morning, immediately after eating or playing sports.
7. Obesity. Despite the fact that weight loss may accompany dyskinesia in the initial stages, with a hypokinetic chronic form of the disease that occurs for a long time, obesity is often found. This is due to a violation of the outflow of bile and the breakdown of food in the intestines, as a result of which adipose tissue grows faster.

Diagnosis of the disease

If dyskinesia is suspected, it is important not only to make a diagnosis, but also to clarify the type, causes of dyskinesia, concomitant diseases and complications, if any.

Most often, with dyskinesia, several examination methods are prescribed at once to get a complete picture:

• ultrasound. The ultrasound procedure is painless, inexpensive, fast and quite informative in case of dyskinesia. Ultrasound examination allows you to evaluate the shape and size of the gallbladder, congenital anomalies, features of its structure, as well as the degree of its emptying. In the hypotonic form of dyskinesia, the gallbladder is enlarged in size, and in the case of hypertonic dyskinesia, on the contrary, it is reduced and greatly reduced. Also, ultrasound can detect stones in the gallbladder and bile ducts.
• Blood test. As a rule, doctors prescribe biochemical and clinical analysis blood in almost any disease. However, this research method will be informative only in the case of secondary dyskinesia, with primary both of these analyzes may not have deviations from the norm. With secondary dyskinesia, elevated bilirubin may be observed, which indicates stagnant processes in the gallbladder, as well as an increase in amylase levels.


• Cholecystography. This is an X-ray examination method using a contrast agent. A contrast agent containing iodine is injected into a vein, it enters the liver and gallbladder with blood, enhancing the clarity of the image. The procedure is not accompanied by pain and difficulties. On the eve of the procedure, it is advisable to give up heavy food and smoking. Cholecystography is contraindicated in people with intestinal obstruction, pregnant and lactating women, people with an allergy to iodine, heart failure.
• duodenal sounding. The probe is inserted through the patient's mouth and advanced to the duodenum. The duodenal fluid in the duodenum is taken for examination.

pishhevarenie.com

Causes

The main reasons for the formation of dyskinesia of the gallbladder include:

Classification

By type of violation:

• Hypomotor (hypotonic) - is formed with insufficient contractility of the bladder and its ducts, most often people over 40 years of age suffer;
• Hypermotor (hypertonic) form - is formed with increased contractions of the organ and its ducts, affects adolescents and young people;
• Mixed (hypotonic-hypertonic) - there are signs of both forms.

Depending on the causes of the formation of pathology, there are:

• Primary JP is an independent disease;
• Secondary dyskinesia, as a result of concomitant pathologies.

Symptoms

Clinical signs depend on the form of the disease:

Diagnosis of the disease

The diagnosis of "dyskinesia of the gallbladder" is made on the basis of patient complaints, anamnesis (lifestyle, the presence of diseases of the digestive tract), on examination (painful abdomen, high or low blood pressure), according to the results of laboratory tests.

Diagnostic examinations:

Treatment Methods

Gallbladder dyskinesia is treated with conservative therapy, symptom suppression, and physical therapy.

Conservative therapy

Holiver, 2-4 tablets three times a day;

• Tubeless tubes - increase the outflow of bile: magnesium sulfate, xylitol, sorbitol

Xylitol: dissolve the drug in 100 ml of water and drink in small sips, then lie on the right side on a warm heating pad, the manipulation is repeated once a week;

• Cholekinetics - increase bladder tone: hepabene, oxafenamide

Gepabene, 1 capsule three times a day;

• Sedatives (sedatives) - to relieve anxiety, improve sleep: tincture of valerian, motherwort, bromides

Bromides, 1-2 tablets three times a day;

• Antispasmodics - to relieve pain: drotaverine, gimecromon, papaverine

Papaverine, 2 tablets 2-3 times a day;

• Tonic preparations - reduce fatigue, lethargy: Eleutherococcus extract, ginseng tincture

Ginseng tincture, 15-25 drops three times a day;

• Mineral waters: with increased bile formation - Narzan, Essentuki 2 or 4, with reduced bile formation - Arzani, Essentuki 17.

Symptomatic treatment

• Antibacterials: cephalosporin, azithromycin, chemomycin

Azithromycin, 2 tablets once a day;

• Antihelminthics: Nemozol, Pyrantel, Wormil

Vormil, 1 tablet once.

Physiotherapy procedures

• With hypomotor form- amplipulse therapy (using sinusoidal alternating currents), electrophoresis with pilocarpine (constant electrical impulses with the introduction of a drug);
• With hypermotor form- electrophoresis with papaverine, laser therapy, paraffin applications (thermotherapy method).

Diet

Nutrition with JP should be fractional, minimal portions, at least 5-6 times a day; dishes should be served boiled, baked, stewed.

Allowed products for hypomotor dyskinesia:

Features of the menu for hypermotor dyskinesia, the same products are allowed, except:

• Sausages;
• Sweets;
• Egg yolk;
• Vegetables, berries and fruits.

During an exacerbation of the disease, the following products are prohibited for any type of dyskinesia:

• Fatty, smoked, salted, fried, pickled dishes;
• Whole milk, cream;
• Semi-finished products;
• Legumes, black bread, cabbage;
• Confectionery with cream, ice cream, chocolate;
• Spices, seasonings;
• Vegetables fortified essential oils(onions, radishes, garlic);
• Canned food;
• Cocoa, coffee, carbonated and alcoholic drinks.

ethnoscience

In the treatment of JP, the following recipes are used traditional medicine:

• 1 teaspoon corn silk pour 200 ml hot water, stand for 30-60 minutes, filter. Take 3 tbsp. spoons 3 times a day;
• 30 gr. leaves dry barberry pour 300 ml of vodka, stand for a couple of weeks in a warm place, shaking the contents regularly. Squeeze the leaves, take 25 drops, which are diluted in 50 ml of water twice a day;
• 2 teaspoons crushed licorice root brew a mug of boiling water, boil for 15-20 minutes over low heat. Cool, filter, bring to the original volume with warm water, take 1/3 cup 3 times a day.

Complications

In the absence or ineffective treatment, a patient with JP may develop the following complications:

• Cholelithiasis;
• Chronic cholecystitis (infection of the gallbladder);
• Gastritis (infection of the stomach);
• Cholangitis (inflammation of the bile ducts);
• Atopic dermatitis (rashes on the skin);
• Slimming;
• Hypovitaminosis (decreased vitamins);
• Duodenitis (infection of the duodenum).

progastromed.ru

Causes of dyskinesia of the gallbladder

Dyskinesia of the gallbladder, depending on the period of occurrence of the disease, can be primary and secondary. Primary dyskinesias are usually associated with congenital anomalies in the development of the gallbladder and bile ducts: doubling or narrowing of the bladder and ducts; scars and constrictions. The cause of primary dyskinesia may be a congenital disorder of the motor activity of the smooth muscle cells of this organ, a decrease in their sensitivity to hormonal mediators.

Secondary dyskinesia of the gallbladder is formed against the background of another pathology: hormonal (taking contraceptives, somatostatin, prostaglandins); somatic (liver cirrhosis, myasthenia gravis, celiac disease, amyloidosis, diabetes); pathology of the biliary tract (GSD, cholecystitis, strictures, discoordination of the gallbladder and sphincter of Oddi).

In the pathogenesis of dyskinesia of the gallbladder most often lies an increase in pressure in the bile duct, combined with a decrease in the contractility of the walls of the gallbladder. In this situation, it does not empty sufficiently, bile does not enter the duodenum, which causes digestive disorders. A less common cause of dyskinesia is the inability of the gallbladder to develop sufficient pressure to evacuate bile into the duodenum. In patients with dyskinesia, pain in the right hypochondrium occurs with much less stretching of the bladder walls than in healthy people. This is due to increased sensitivity to pain.

Symptoms of dyskinesia of the gallbladder

The main manifestations of gallbladder dyskinesia are recurring attacks of pain in the right hypochondrium for at least three months for six months. With the hypokinetic variant, the pain is constant, dull, pressing, practically not associated with food intake. The pain increases with a change in body position, as this increases the pressure in the abdominal cavity, the outflow of bile worsens.

In the hyperkinetic form of the disease, pain is acute, occurs after errors in the diet and psycho-emotional overstrain, radiates to right shoulder, lower back. Often the pain occurs at night, accompanied by nausea and vomiting. In addition, biliary colic may occur: an attack of acute sudden pain in the right hypochondrium, which significantly worsens the patient's condition and requires medical assistance.

The cholestatic syndrome is also characteristic, associated with a violation of the flow of bile into the duodenum and its stagnation in the biliary tract. It develops in less than half of patients with gallbladder dyskinesia, manifests itself as icteric staining of the skin and mucous membranes, discoloration of feces and the appearance of a rich color of urine, itching of the skin, and an increase in the size of the liver.

Violation of the dynamics of bile leads to the appearance of dyspeptic symptoms: nausea and vomiting, bloating, a feeling of bitterness, bad breath. Almost always, gallbladder dyskinesia is accompanied by disorders of the nervous system (irritability, fatigue, increased sweating, headaches), and sexual dysfunction.

Diagnosis of dyskinesia of the gallbladder

Like many others functional disorders digestive system, gallbladder dyskinesia is a diagnosis of exclusion. A consultation with a gastroenterologist allows you to identify the criteria for diagnosing this disease: the presence of a gallbladder, the absence of organic diseases of the hepatobiliary system, normal levels direct bilirubin, transaminases and blood lipases (during liver tests and lipidograms).

Ultrasound of the gallbladder is the most informative method for diagnosing dyskinesia. Ultrasound helps to visualize the shape and size of the gallbladder, the nature of its contents, the presence or absence of inclusions, kinks and constrictions. Identification of deformations of the gallbladder increases the likelihood of diagnosing its dyskinesia. Also during ultrasound the contractility of the walls of the bladder is estimated.

Ultrasonic cholecystography is carried out within two hours after taking a special choleretic breakfast containing a large amount of fat - sour cream, egg yolks. During this study, the speed and extent of the gallbladder returning to its original shape after its contraction is assessed. Normally, the bladder should shrink by one third half an hour after stimulation.

Dynamic scintigraphy of the hepatobiliary system is of great importance for the differentiation of organic and functional changes. This research method allows us to assess the excretory function of the liver, the accumulation activity of the gallbladder, to determine the degree of patency biliary tract and sphincters. During scintigraphy, tests with cholecystokinin, metoclopramide, nitroglycerin can be performed. With less than 40% emptying of the bladder, the diagnosis of gallbladder dysfunction is not difficult. If emptying occurs normally, a further diagnostic search is carried out. It is obligatory to carry out ERCP; if during the study no stones and inflammation in the biliary tract are detected, manometry of the sphincter of Oddi is prescribed to exclude its stenosis.

Fractional duodenal sounding (chromatic) allows you to evaluate not only the functional ability of the gallbladder, but also the quality and quantity of bile secreted, its bacterial contamination during inflammation. Esophagogastroduodenoscopy also makes it possible to identify concomitant organic diseases of the digestive tract, to follow the passage of bile into the duodenum.

For differential diagnosis may require magnetic resonance imaging of the liver and biliary tract, CT scan of the biliary tract, analysis of feces for helminth eggs.

Treatment of dyskinesia of the gallbladder

Patients with gallbladder dyskinesia can receive the necessary medical care in the department of gastroenterology. Diet is essential in the treatment of dyskinesia. In the hyperkinetic variant, food intake that causes contraction of the gallbladder (vegetable and animal fats, broths) is limited. With hypotension of the gallbladder, these products, on the contrary, are included in the diet. Meals should be frequent, fractional, you can not eat fried, smoked, extractive dishes. It is recommended to give up alcohol and smoking, reduce weight to normal, avoid excessive physical exertion.

Drug treatment also depends on the type of gallbladder dyskinesia. In the hypomotor form, prokinetics (domperidone), choleretics and cholekinetics are prescribed. With hypermotor dyskinesia, antispasmodics, non-steroidal anti-inflammatory drugs, tricyclic antidepressants are used. With a long course of the disease, it may be necessary to take bile-containing drugs. Surgery dyskinesia of the gallbladder is ineffective.

The prognosis for gallbladder dyskinesia is favorable, the disease does not affect the patient's life expectancy. Prevention can be primary and secondary. Primary prevention is to maintain a healthy lifestyle, proper nutrition, eliminating stress. Secondary prevention is the early detection and treatment of a disease.

www.krasotaimedicina.ru

Our reference

Gallbladder dyskinesia is a disorder in which the motility of the gallbladder and its ducts is impaired. Because of this, bile enters the duodenum in an inadequate amount, which leads to a breakdown in the digestive process.

Test yourself

There are two types of dyskinesia: hypomotor and hypermotor.

With the hypomotor type, the gallbladder and ducts contract sluggishly, so bile stagnates in the bladder, and enters the duodenum in small quantities. It is often not enough to digest food. This type of disorder makes itself felt with dull pain or a feeling of heaviness in the right hypochondrium (pain can be given to the right arm, right side of the chest). There may also be nausea, bitterness in the mouth, bloating, unstable stools (sometimes constipation, sometimes diarrhea), and sometimes vomiting of bile.

In the hypermotor type, the gallbladder, on the contrary, contracts too actively. Because of this, a spasm of the biliary tract can occur, which causes a sharp, stabbing pain in the right hypochondrium (it can also radiate to the arm, shoulder, right half of the chest). Nausea may occur, vomiting is rare.

Important

Dyskinesia of the gallbladder is a common disease, and there are many reasons leading to it.

Hereditary predisposition: often the children of patients suffering from dyskinesia also face this problem

Anatomical features, such as constrictions in the gallbladder and kinks in the organ that disrupt the normal contraction of the biliary tract.

Diseases of the gastrointestinal tract: motility of the gallbladder and its ducts may be disturbed against the background of duodenal ulcer, gastritis, gastroduodenitis.

However, the root of the problem is not always in the digestive organs. The development of dyskinesia can contribute to diabetes mellitus, diseases thyroid gland and even chronic ENT infection.

A huge role is played by the emotional state of a person: motor skills depend on the state of the nervous system, therefore, with chronic stress, neurosis, and depression, disorders can occur.

Problems with the outflow of bile are often observed in women taking hormonal contraceptives.

One of the most important risk factors is malnutrition. Excess fatty, spicy foods in the diet, large meals (especially if you have not eaten for a long time before) increase the risk of dyskinesia.

Hypomotor biliary dyskinesia leads to stagnation of bile, therefore it is one of the risk factors for the formation of gallstones, that is, the development of cholelithiasis.

www.aif.ru

Symptoms of dysfunction

Gallbladder dyskinesia as a separate disease was identified at the beginning of the last century. But even in ancient times, human behavior was associated with the activity of the biliary sphere. So, nervous, dissatisfied, caustic people were called bile. The theory of temperaments is also built on a "bilious basis." Hypotonic (hypomotor, hypokinetic) dyskinesia is clearly expressed in the character of melancholic people with their depression and lethargy. Angry, irritable choleric people are similar to those suffering from hypermotor (hyperkinetic, hypertensive) disorders.

In addition to these two types of dysfunction, the disease can be detected in primary and secondary forms.

The form	What are the symptoms of gallbladder dyskinesia	What is characterized	Who has
Primary	It does not show itself on ultrasound and radiography, but structural changes in organs continue to develop.	Violation of the regulation of the contractile activity of the bladder.	In asthenics, people with diseases of the nervous, endocrine and sexual spheres, women in menopause those who lead an unhealthy lifestyle.
Secondary	Its signs are obvious in research.	Imbalance of metabolic phenomena, inflammatory processes in the body.	For those suffering from diseases of the stomach and intestines: gastritis, colitis, duodenitis, as well as diseases of the pelvic organs.

The first "alarm bells" of gallbladder dyskinesia are pain symptoms in the right side of the abdomen under the ribs.

They may be different. So, with a hypomotor disorder, dull aching pain is almost constant, at the same time the patient is tormented by nausea, belching, bitter taste, flatulence, constipation, a “heavy” stomach, especially after eating.

Hypotonic disorder occurs due to the insufficient ability of the bladder and its ducts to contract. It is more common in people over forty. Pain here causes stretching of the bottom of the bladder due to stagnation of bile. Constipation occurs due to a lack of bile acids that stimulate the activity of the intestines.

Hyperkinetic dyskinesia involves pain from time to time that sends impulses to the left shoulder blade, diarrhea, heart rhythm disturbances, sweating, irritability. With hyperkinetic dyskinesia, the contractility of the biliary organs is increased, this is a disease of the young, it also occurs in children.

Painful sensations are associated with a sharp contraction of the muscles of the bladder with a high tone of the sphincters. Diarrhea occurs due to the abundance of bile acids that interfere with the absorption of nutrients.

There is also a hypotonic-hyperkinetic disorder with the presence of symptoms of both types of dyskinesia. It is typical for children, young women.

signs different types ailments are similar in both children and adults. A feverish state with an increase in temperature is typical for inflammations requiring medical intervention.

In children and adolescents, biliary tract disorders often develop against the background of vegetative-vascular dystonia, neurotic conditions, congenital organ defects, and poisoning with toxins.

If a child has dyskinesia of the gallbladder, he will need to be observed by a pediatrician for three years from the moment of exacerbation.

Remember: constant stagnation of bile can lead to the development of an inflammatory process, the appearance of stones. A child suffering from such dysfunctions should be supervised by a neurologist and gastroenterologist who observe children.

Diagnosis of the disease

Additionally, stool and urine tests, blood biochemistry, duodenal sounding, cholecystography, and other studies are prescribed. What can they show?

Diagnostic type	Result
	An increase in the volume of the bladder indicates congestion and indicates a hypomotor type. If the organ is less than normal, this is a frequent sign of hyperkinetic type of dysfunction. Thickening of the walls of the bladder indicates acute cholecystitis or chronic during an exacerbation. Moving spots represent stones. The motionless speak of stones blocking the bile ducts. Focal formations on the walls of the organ are signs of cholestasis or tumors. An enlarged common bile duct with sediment at the bottom of the organ confirms the hypomotor type of the disorder. Diagnostic tests with magnesium sulfate, yolks or sorbitol check the rate of contraction of the "bile storage". Increased contractility confirms hyperkinetic dysfunction, decreased - hypotonic.
Total blood sample	The primary type of disorder will show nothing. The secondary will indicate inflammation by a rise in ESR (erythrocyte sedimentation rate), the level of leukocytes and eosinophils. It can also talk about helminthic invasion.
Biochemical	The primary dysfunction will not show any changes. The secondary will reveal the growth of bilirubin due to bile stasis, amylase in the inflammatory process in the pancreas, cholesterol in metabolic disorders, C-reactive protein in the presence of inflammation.
Cholecystography	With the hyperkinetic type, there is a frequent and sharp contraction with a decrease in the size of the bladder, with the hypotonic type, slow contractions of the bulk organ, which almost does not change in size.
duodenal sounding	With hypermotor dysfunction, bile secretion is fast, accompanied by pain. With hypotonic disorder, the outflow of bile is slow, in large portions, with long temporary interruptions.

Complex therapy: nutrition, medicines, additional procedures

Treatment of gallbladder dyskinesia involves strict diet by type number 5.

You will have to remove alcoholic drinks, lemonades, all fatty and peppery dishes, smoked meats, tomato juices and ketchups, spices from the menu. Spicy spices and seasonings, as well as an abundance of salt, will have to say no. The daily portion should be divided into six small 300 kilocalories each. Preference is given to vegetarian dishes.

• With hypertensive dyskinesia of the gallbladder, you should not eat foods that help reduce the bile excretory organs: pork, lamb, rich soups based on meat, fish, mushrooms.
• In case of hypokinetic disorder, doctors advise products that stimulate the secretion of bile (vegetable oils, cabbage, beets, carrots, apples, soft-boiled eggs).
• With mixed disorders, you should not eat food that irritates the mucous membranes of the digestive organs: chocolate, spices, hot soups, ice cream. This is most important if gallbladder dyskinesia is diagnosed in a child.

Then, for ten days, slowly include mashed dishes, baked fruits. Juices and fruit drinks should be diluted with water. It is better to completely refuse store-bought concentrated drinks.

Dishes with medicinal properties:

• Fresh or boiled swede and pumpkin. They are useful and act as bile stimulants that prevent the development of inflammation.
• Juices of lemon and orange, as well as grapefruit. Lemon drink a couple of large spoons with an interval of two hours. Grapefruit - 60 grams 30 minutes before meals.
• A mix of milk and carrot juice. Half a cup of freshly squeezed juice is mixed with slightly warmed milk in equal proportions. A cocktail is drunk instead of breakfast in small sips.
• Salads from grated fresh vegetables. Especially good on the basis of cucumbers, carrots, beets and celery. They are eaten 30 minutes before breakfast, lunch or dinner. Children will be delighted with salads made from sweet fruits and berries.

Treatment of gallbladder dyskinesia with medications is associated with its characteristic features. In the hypomotor type, the drugs contribute to the flow of bile, reduce its stagnation, and in the hypermotor type, they reduce the frequency of contractions.

Dyskinesia of the gallbladder of the hypomotor variant is treated with choleretics. These are drugs that stimulate the production and flow of bile (true choleretics, including bile components, are more popular). Doctors may suggest Cholenzim, Cholecin, Hologon, Allohol, and others. They can recommend preparations based on extracts of plants "Holosas", "Kurepar", "Fumetere", others.

Popular drugs:

• "Holenzim", which includes bile components, as well as enzyme components. It provokes biliary secretion, the ability of the biliary organs to contract, regulates the digestive process, and improves the absorption of nutrients. Apply one tablet after each meal for three weeks.
• "Allohol", which includes bile, nettle and garlic. It improves the production of bile, reduces putrefactive processes in the digestive tract, and increases the motor abilities of the intestine. Drink two tablets after breakfast, lunch and dinner for two months.

The hyperkinetic type of disorder is proposed to be treated with cholikinetics. Their components enhance the formation and transport of bile (true choleretics with bile and its acids are more often used). The doctor can prescribe drugs such as Gepabene, Magnesium sulfate, Bellalgin, Besalol, Xylitol, Metacin and others, as well as anti-spasm drugs - Papaverin, Duspatalin, But -shpu", others. Additionally, digestive enzymes are recommended: Festal, Mezim-forte.

Commonly prescribed drugs:

• "Gepabene", containing fume extract. It improves the formation of bile, has antispasmodic, antitoxic and regenerative effects for hepatocytes. Drink a capsule during breakfast, lunch and dinner for 14 days.
• "No-shpa", which includes components for the elimination of pain. Drink 2 tablets 2-3 times a day. It leads to a decrease in the amount of calcium in the cells and the concomitant relaxation of the smooth muscles of the organs and vessels of the abdominal cavity.

With mixed dyskinesia, drugs such as Motilium, Cerucal, Papaverine, No-shpu are recommended. For all types of disorders, they can offer antidepressants (Amizol, Elivel, Saroten, others), as well as painkillers Ketanov, Ambene, Anoripin.

In children, a hypermotor or mixed type of disorder is more common, so the drugs prescribed to them help to relax smooth muscles and relieve spasms. It can be "No-shpa", "Duspatalin", "Spazmofen", "Papaverine". If necessary, for the normal activity of the nervous system of the child, sedatives containing bromine or tinctures of motherwort, valerian are used.

Gallbladder dyskinesia has a positive prognosis if treated with mineral water during remission. In case of hyperkinetic disorder, waters with weak mineralization are advised ("Smirnovskaya", "Essentuki" No. 2 and No. 4), with hypokinetic - with a strong one ("Arzani", "Essentuki" No. 17).

Health-improving physical culture and physiotherapeutic procedures are useful: for hypomotor disorder - electrophoresis, amplipulse therapy, for hypertensive disorder - electrophoresis, paraffin applications, laser exposure. It is not bad to spend a vacation in a sanatorium for the treatment of diseases of the digestive system. A child during remission can be taken to a mud therapy or balneological resort. There are such in Zheleznovodsk, Goryachiy Klyuch, Essentuki. Psychological assistance is also important, sometimes the disease is caused by psychosomatic factors, more often in children, young women.

Hypokinetics are advised to use tubage therapy to remove excess bile and reduce congestive processes.

It is good to do them on weekends in the morning. You need to take: two small spoons of xylitol or sorbitol, after dissolving them in warm water. Or two raw yolks, can be beaten with sugar (it will be more pleasant, for example, for a child).

After taking the remedy, you should lie down on your left side. The bile will begin to move out of the bladder. To the right side, you can attach a heating pad or a bottle of warm water. It is necessary to lie like this for about two hours, the procedure helps to relieve congestion, it is completely safe for children.

Supporting Folk Methods

The doctor can give permission for the use of folk remedies - decoctions and infusions from medicinal plants.

For hypermotor disorders:

healing plant	Making and receiving	Expected effect
Peppermint	Two small spoons of dried leaves are poured into a glass of boiling water. After half an hour, the infusion is filtered. Drink 1/3 cup 20 minutes before meals twice a day for 21 days.	The remedy reduces pain spasms and vomiting, has a relaxing effect on the biliary tract and sphincters, helping the flow of bile. Improves appetite and digestion.
Liquorice root	Two small spoons of finely chopped root in a water bath are simmered in 200 ml of boiling water for a quarter of an hour. Filter and drink 1/3 cup 30 minutes before breakfast, lunch and dinner three times a day for 21 days.	Relaxes the smooth muscles of diseased organs.

For hypomotor disorders:

healing plant	Making and receiving	Expected effect
Immortelle	Three large spoons of raw materials are poured into a saucepan, pour 300 ml of boiling water. Simmer in a water bath, stirring continuously. The cooled drink is filtered and drunk half a glass 30 minutes before meals for 21 days.	It enhances the contractile function of the bladder and accelerates the outflow of bile, normalizes its composition, stimulates intestinal activity.
stigmas of corn	A small spoon is poured with a glass of boiling water and insisted for half an hour. The filtered infusion is drunk in a quarter of a cup half an hour before breakfast, lunch and dinner for 21 days.	Reduces the density of bile, reduces congestion, reduces the level of bilirubin in the blood and cholesterol.

With a mixed type of dyskinesia, chamomile tea is recommended. It is prepared as follows: soak a small spoonful of dried chamomile flowers for five minutes in 200 ml of boiling water, filter. Drink 3-4 times a day like tea. This decoction reduces swelling of the peritoneum, improves peristalsis, acts as a sedative and hypnotic, anti-inflammatory, regenerating agent, increases appetite.

With pronounced symptoms of dyskinesia, you should definitely contact a medical facility. After all, taking medications for biliary dysfunctions without the advice of a doctor is fraught with a deterioration in well-being, pathological changes especially when it comes to child care.

Dyskinesia of the gallbladder and biliary tract is a disease in which there is a violation of motility (movement) and tone of the gallbladder, as well as its ducts.

Some statistics

Among all diseases of the gallbladder and bile ducts, dyskinesia is 12.5%.

Women are 10 times more likely to suffer from this disease than men. What is associated with the characteristics of hormonal and metabolic processes the female body (for example, changes during pregnancy, taking oral contraceptives). Women of a young age of asthenic physique are especially susceptible to the disease.

Among children, adolescents are most often affected.

In 2/3 of all cases, this is a secondary disease that develops against the background of damage to the gastrointestinal tract (colitis, peptic ulcer of the duodenum and / or stomach, pancreatitis, gastritis).

The most common (about 60-70% of all cases) is the hypotonic form. IN modern medicine the disease was first described by surgeons in 1903-1909, who operated on a patient with severe pain in the right hypochondrium. However, when they opened the abdominal cavity, they did not find any stones or inflammation in the gallbladder. After that, the disease began to be carefully studied by general practitioners.

However, even in antiquity it was noticed that there is a connection between the negative emotions of a person and the disease of the gallbladder, as well as its ducts. Therefore, such people were called "bilious".

In addition, everyone knows about the four types of temperament, which are described in the treatises of medicine by doctors of antiquity.

For example, anger and irritability indicate an excess of energy at the point of the gallbladder - a hypertonic variant of dyskinesia (choleric type of temperament). That is, the wall of the gallbladder is tense and greatly reduced.

While bitterness, lethargy and a tendency to depression indicate a lack of energy at the point of the gallbladder - a hypotonic variant of dyskinesia (a melancholic type of temperament). That is, the wall of the gallbladder is sluggish and poorly reduced.

Anatomy and physiology of the gallbladder

gallbladder- a hollow organ. It is usually located on the right in the upper abdomen, approximately at the level of the middle of the lower hypochondrium (below the last rib).

The length of the gallbladder ranges from 5 to 14 cm, and the width is from 3 to 5 cm. Its capacity on an empty stomach is from 30 to 80 ml. However, with stagnation of bile, its volume increases.

Normally, the gallbladder has an elongated pear-shaped shape (with wide and narrow ends). However, sometimes its shape is rather bizarre: spindle-shaped, elongated, doubled, with an inflection or internal bridges, and so on.

The gallbladder has three parts - the bottom, body and neck (narrow part). The cystic duct leaves the neck, which later joins with the hepatic duct to form the common bile duct. In turn, the common bile duct opens into the cavity of the duodenum (12 PC) in the region of Vater's nipple, which is surrounded by the sphincter (muscular ring) of Oddi.

The structure of the gallbladder wall

• The mucous membrane consists of epithelial and various glandular cells that produce mucus. It forms multiple folds that form the sphincter of Lutkens-Martynov at the neck of the gallbladder, which prevents the release of bile before certain stages of digestion.


• Muscular layer, which mainly consists of smooth muscle fibers arranged in a circular (circular)


• The connective tissue membrane covers the outside of the gallbladder. It contains blood vessels.

Tasks of the gallbladder

• Accumulation, concentration and storage of bile produced in the liver


• Secretion of bile into the lumen of the duodenum as needed

Bile is produced by liver cells continuously (from 0.6 to 1.5 liters per day). Then it enters the intrahepatic ducts, and from them - into the gallbladder. In the gallbladder, bile is concentrated due to the absorption of excess water, sodium and chlorine from it by the epithelial cells of the mucous membrane.

Mechanism of excretion of bile from the gallbladder

The most important neurohumoral factors regulating this complex process are:

• The autonomic nervous system (sympathetic and parasympathetic divisions), which regulates the work of almost all internal organs

  Normally, when the vagus nerve (vagus), which provides sensory and motor innervation to most internal organs, is activated, the gallbladder contracts and the sphincter of Oddi relaxes. If there is a violation of coordination in the work of the sympathetic and parasympathetic divisions of the autonomic nervous system, this mechanism is violated.

• Intestinal hormones (motilin, cholecystokinin-pancreozymin, gastrin, secretin, glucagon) that are produced in the gastrointestinal tract during meals

  When exposed to cholecystokinin in normal doses, the gallbladder contracts, and the sphincter of Oddi relaxes (in large breaths, gallbladder motility is inhibited). Gastrin, secretin, glucagon have the same effect as cholecystokinin, but less pronounced.

• Neuropeptides (neurotensin, vasointestinal polypeptide, and others) are a type of protein molecule that has the properties of hormones.

  They prevent the contraction of the gallbladder.

  As a result of the close interaction of these factors during meals muscle layer gallbladder contracts 1-2 times, increasing the pressure in it to 200-300 mm of water column. Therefore, the sphincter of Lutkens-Martynov relaxes, and bile enters the cystic duct. Next, bile enters the common bile duct, and then through the sphincter of Oddi - into 12 PCs. When diseases occur, this mechanism is disrupted.

The main functions of bile in digestion

• Creates the necessary conditions in 12 PCs for the loss of pepsin (the main enzyme of gastric juice) of its properties
• Participates in the breakdown of fats, contributing to their absorption, as well as the absorption of fat-soluble vitamins (A, E, D)
• Improves motor function (motor skills) small intestine and increases appetite
• Stimulates the secretion of mucus and the production of intestinal hormones: motilin, cholecystokinin-pancreosemin and others
• Activates the enzymes necessary for protein digestion (trypsin and lipase - pancreatic juice enzymes)
• Promotes the proliferation of epithelial cells of the intestinal mucosa
• It has an antibacterial property, which is weakened by stagnation of bile

Causes of dyskinesia of the gallbladder

Distinguish between primary and secondary dyskinesia of the gallbladder and biliary tract (JVP), depending on the causes that led to the disease.

Also, a theory is currently being considered about a violation in the functioning of liver cells, so they initially produce bile, the composition of which has already been changed.

Primary dyskinesia of the gallbladder and biliary tract

At the beginning of the disease, there are only functional disorders that are not detected by research methods (ultrasound, X-ray). However, as the disease progresses, structural changes develop in the gallbladder and its ducts.

The most common causes of primary JVP

Secondary dyskinesia of the gallbladder and biliary tract

Occurs against the background of already developed diseases or conditions. Changes are clearly visible with the input methods of research.

The most common causes of secondary JVP

Symptoms of dyskinesia of the gallbladder

Depend on the type of violation of the motor activity of the gallbladder and its ducts.

Types of JVP

• Hypotonic (hypomotor) dyskinesia develops with insufficient contractility of the gallbladder and its ducts. It occurs in patients with a predominance of the tone of the sympathetic nervous system (normally dominates during the day), which lowers the tone and motor activity of the gastrointestinal tract, as well as the gallbladder and its ducts. Most often, this form of the disease affects people over 40 years old.
• Hypertensive (hypermotor) dyskinesia develops with increased contractility of the gallbladder and biliary tract. It occurs in people with a predominance of the parasympathetic nervous system (normally dominates at night), which enhances the motor function and tone of the gastrointestinal tract, as well as the gallbladder and its ducts. Most often this form of the disease affects adolescents and young people.
• Hypotonic-hyperkinetic dyskinesia is a mixed variant of the course of the disease. The patient has symptoms of both hypotonic and hypertonic forms of dyskinesia in varying degrees of severity.

Signs of dyskinesia of the gallbladder

Symptom	Manifestations	Development mechanism
Hypotonic dyskinesia
Pain	Constant, long, dull, bursting, aching. It is located in the right hypochondrium, but does not have a clear localization. As a rule, it increases during a meal or immediately after it.	The bottom of the gallbladder is stretched, which is caused by stagnation of bile due to insufficient production of cholecystokinin in the gastrointestinal tract.
Belching - involuntary release of gas from the stomach into the mouth with a characteristic sound, and sometimes smell	It usually occurs after meals, but sometimes between meals.	The regulation of the gallbladder by the nervous system is disrupted, so the patient makes more swallowing movements, swallowing air while eating. As a result, the pressure in the stomach increases. Therefore, the muscular wall of the stomach contracts, and the tone of the output sphincter decreases - and the air is expelled.
Nausea and / or vomiting (sometimes with an admixture of bile, if there is a reflux of bile from 12 PCs into the stomach)	More often occurs after eating and nutritional errors: eating fatty foods, fast food, overeating and others	Due to impaired motor skills, the nerve receptors of the gastrointestinal tract are irritated, which send an impulse to the vomiting center (located in the brain). From it, impulses are sent back to the gastrointestinal tract and diaphragm, leading to contraction of their muscles and the occurrence of reverse movements. Also for bacterial and viral infections, helminthiases, the vomiting center is irritated by the products of their vital activity (toxins).
Bitterness in the mouth (most characteristic of the hypotonic variant of dyskinesia)	Mostly in the morning, after eating or exercising.	Motility is disturbed, and the sphincters of the gastrointestinal tract also relax. As a result, anti-peristaltic movements appear (food moves in the opposite direction). Therefore, bile from 12 PCs enters the stomach, then into the esophagus, then into the oral cavity.
Bloating (flatulence)	There is a feeling of fullness of the abdomen at the height of digestion, which is often accompanied by pain. After the passage of gases, the pain subsides.	Digestion is disturbed due to insufficiency of bile. As a result, the processes of putrefaction and fermentation in the lumen of the small intestine are intensified. Therefore, gases are released in large quantities.
Decreased appetite		Bile stagnates due to poor contractility of the gallbladder. Therefore, it is not sufficiently allocated to the lumen of 12 PCs.
Diarrhea (rare)	It usually occurs shortly after eating.	With bile deficiency, digestion is disturbed: proteins, fats and carbohydrates are poorly broken down. As a result, the cells of the mucous membrane of the small intestine are irritated, which increase the excretion of water, sodium and chlorine. At the same time, their absorption decreases. Therefore, the volume of the food bolus increases, and its progress through the intestines is accelerated.
Constipation (common)	There is no stool for more than 48 hours or there is a systematic insufficient bowel movement.	It occurs due to a slowdown in the movement of the food bolus through the intestines due to spasm or relaxation of the tone of the intestinal wall. Therefore, water reabsorption is increased. At the same time, fecal masses decrease in volume, and their density increases. In addition, there is a lack of bile acids (found in bile), which normally have a stimulating effect on the intestinal muscles.
Obesity	Develops with a long course of the disease or is the cause of its occurrence	Due to the insufficiency of bile, the process of digestion and the breakdown of fats is disrupted. Therefore, the production of insulin by the pancreas increases. As a result, the synthesis of fats and their accumulation in the fat cells of the subcutaneous fat, as well as on the internal organs, are enhanced.
	Decreased heart rate, decreased blood pressure, redness of the skin of the face, sweating, increased salivation.	The mechanism of development is complex and not fully understood. However, it is believed that there is a low resistance of the heart and blood vessels to stress. Therefore, during it, less oxygen enters the brain, organs and tissues. As a result, the balance between the sympathetic and parasympathetic nervous systems is disturbed, and the internal organs receive the wrong commands to work.
Hypertensive dyskinesia
Pain	The pain is intense, colicky, occurring acutely in the right hypochondrium after stress or emotional stress (most often), dietary errors, physical activity. The pain lasts from 20 to 30 minutes, repeats several times during the day. Often she gives the right side to the back, shoulder blade or arm. However, sometimes the pain radiates to the left (to the region of the heart), simulating an attack of angina pectoris. In the period between attacks, as a rule, there is a feeling of heaviness in the right hypochondrium.	The pain is associated with a sharp contraction of the gallbladder with an increased tone of the sphincters of Oddi and Lutkens-Martynov, so the bile does not depart.
Decreased appetite	Bile is a stimulant of appetite, intestinal motility and the production of intestinal hormones.	The gallbladder is in a spasmodic state and is excessively reduced. However, at the same time, the sphincters responsible for the timely flow of bile in 12 PCs do not work or relax between meals. Therefore, bile in insufficient or large quantities enters 12 PCs.
Weight loss (common)	The subcutaneous fat layer becomes thinner, decreases muscle mass.	Due to the release of bile between meals, food is poorly broken down. Therefore, proteins, carbohydrates, fats, vitamins and minerals are absorbed in insufficient quantities. In addition, due to reduced appetite, patients do not eat enough.
Nausea and vomiting	Often accompanied by an attack of biliary colic, and outside the attack, they are usually absent.	Gastrointestinal receptors are irritated due to impaired motility, so nerve impulses are sent from them to the vomiting center (located in the brain). Back from it, impulses are sent to the receptors of the gastrointestinal tract and diaphragm, intercostal muscles, so they contract, spewing gastric contents.
Diarrhea (common)	As a rule, it occurs shortly after a meal or during an attack.	Bile enters the lumen of the small intestine in large quantities between meals (asynchronously). As a result, bile acids found in bile inhibit absorption, and also increase the secretion of water and salts (sodium, chlorine), causing an increase in the volume of feces and accelerating their movement through the intestines.
Symptoms of a violation in the work of the autonomic nervous system (the center is located in the brain)	During an attack, sweating, palpitations, general weakness appear, headache, blood pressure rises. Outside the attack, irritability, fatigue, sleep disturbances, increased blood pressure, the occurrence of aching pain in the heart, palpitations and other symptoms are noted.	The development mechanisms have not been fully established. It is assumed that the disease is based on the lability of the nervous system due to the weakness of the heart and blood vessels, which at the time of stress poorly supply organs, tissues and the brain with blood. Therefore, the autonomic nervous system gives the wrong commands to the vessels, the gastrointestinal tract, internal organs as well as the gallbladder and its ducts.
Signs that can develop in both forms of JVP with the same manifestations
Jaundice of the skin and visible mucous membranes (rarely develops)	Appears with a pronounced violation of the outflow of bile (stone, narrowing of the common bile duct). In this case, the feces are colorless, and the urine is colored dark.	With stagnation of bile, bilirubin (a pigment contained in bile) is absorbed into the blood and spreads throughout the body, settling in the skin and mucous membranes, giving them an icteric tint. Since bile does not enter the digestive tract, the feces become colorless.
Plaque on the tongue (may develop with other diseases: colitis, gastritis and others)	It may be white or with a yellowish tinge in case of reverse bile reflux (most often occurs with hypotonic variant of dyskinesia). If the plaque is pronounced, then patients may experience a feeling of discomfort on the tongue and a dulling of taste sensations.	It appears as a result of a violation of the processes of keratinization (the transformation of mucosal cells into scales) and desquamation of the epithelium from the surface of the tongue. It occurs due to a violation of the transfer of nutrients to the tongue.

Diagnosis of dyskinesia of the gallbladder and biliary tract

Tasks - to determine the type of biliary dyskinesia and identify concomitant diseases that can support their dysfunction.

Ultrasound examination (ultrasound)

Allows you to determine the shape and presence of congenital anomalies in the development of the gallbladder, as well as the degree of its emptying.

Basic X-ray examinations

They are the leading methods in the diagnosis of diseases of the gallbladder, as well as the biliary tract.

1. Cholecystography

   It is based on the ingestion of preparations containing iodine (Biliselectan, Cholevid, Yodobil and others).

   Indications

   • The study of the structure and detection of the presence of stones in the gallbladder
   • Study of the excretory and storage (concentration) function of the gallbladder, as well as its extensibility.
   Flaw

   The impossibility of determining the state of the biliary tract, since they are not visible on the pictures.

   Methodology

   The patient on the eve of the study at 19.00 takes two raw eggs. Starting from 21.00, he takes a contrast agent with an interval of 30 minutes, drinking water. The contrast agent is absorbed in the intestines into the blood, and then excreted by the liver cells.

   In the morning on an empty stomach, several overview shots of the right side of the abdomen are taken. Then the patient is offered a choleretic breakfast (as a rule, it is the yolk of an egg) and a series of shots is taken again.

   Interpretation of results

   In the hypertonic form, the gallbladder sharply and rapidly decreases from its original volume: by 75% in the first 5-15 minutes, by 90% in the next 1.5-2 hours. Then for a long time it is in this state, not being emptied due to the fact that there is a spasm of the sphincter of Oddi.

   In the hypotonic form, the gallbladder is enlarged, and its contraction after a choleretic breakfast is very slow from the initial volume: by 20-30% within 15 minutes and remains so for three to four hours.



2. Infusion cholecystography

   The method is based on intravenous administration a contrast agent containing iodine, which accumulates in the gallbladder and its ducts.

   Indications

   Determination of the tone of the sphincter of Oddi.

   Methodology

   The patient in the morning on an empty stomach in the X-ray room on the table is intravenously injected with Bilignost solution for 15-20 minutes. And at the same time, a morphine solution is injected to artificially contract the sphincter of Oddi. After 15-20 minutes, a picture is taken, which shows the gallbladder and its extrahepatic ducts. The normal width of the common bile duct is 3-7 mm.

   Interpretation of results

   In case of insufficiency of the sphincter of Oddi, the contrast agent enters 12 PCs at 15-20 minutes after injection with a width of the common bile duct of 9 mm or more.



3. Cholangiography

   It is carried out to study the bile ducts after the introduction of a contrast agent into them.

   Indications

   • Suspicion of pronounced narrowing of the bile duct
   • Jaundice of the skin and mucous membranes caused by blockage of the bile duct by a stone or compression by a tumor
   • Pronounced and prolonged pain syndrome
   Basic methods for diagnosing dyskinesia
   
   
   If necessary, during the procedure, small stones are removed from the lumen of the common bile duct, and a tube is inserted into it to facilitate the outflow of bile.
4. duodenal sounding

   The goal is to study bile, as well as the function of the gallbladder and its ducts,

   On an empty stomach to the patient, through the mouth and stomach, a probe is inserted into 12 PCs. Then it is laid on the right side and bile is received in portions:

   • The first phase (“A” portion) is a mixture of pancreatic juice and 12 PCs. It is collected from the moment the probe is inserted until the stimulant is introduced (magnesium sulfate solution). Normally, 15-20 ml of golden yellow secretion is obtained in 10-20 minutes.
   • The second phase is the period of time from the moment the stimulant (choleretic) is introduced until the next portion of bile appears (the phase of the closed sphincter of Oddi). Normally, the duration is from 3 to 6 minutes.
   • The third phase is obtaining the contents of the cystic duct. Normally, about 3-5 ml of secretion is obtained in 3-5 minutes.
   • The fourth phase (portion "B") - obtaining the contents of the gallbladder. Bile is thick dark brown. Normally, 30 to 50 ml of bile is secreted in 15-25 minutes.
   • The fifth phase (portion "C") is hepatic, during which light yellow liquid bile is obtained from the intrahepatic bile ducts.
   Interpretation of results

   Treatment of diseases that led to the development of dyskinesia is carried out:

   • Worm infestation (for example, giardiasis or opisthorchiasis)
   • Peptic ulcer (use of two or three component schemes)
   • Fighting infection (prescribing antibiotics)
   • Removal of stones from the gallbladder and treatment of other ailments
   Outside the period of exacerbations:
   • Mineral waters are used: in the hypertonic version - waters of low mineralization (Slavyanovskaya, Narzan, Essentuki 2 or 4), in the hypotonic version - waters of high mineralization (Arzani, Essentuki 17).
   
   
   • It is recommended to stay in a sanatorium with a slope for the treatment of diseases of the digestive system.

   Diet for dyskinesia of the gallbladder

   Compliance with the diet is the basis for success in the treatment of the disease; it is prescribed for a long time (from 3-4 months to a year).

   Target- sparing the liver, biliary tract and gastrointestinal tract, as well as the normalization of their function.

   During an exacerbation of the disease with any type of dyskinesia, the following are excluded:

   • Fatty meats (goose, duck) and fish (sardine, sturgeon, halibut)
   • Smoked, fried, fatty, salty, sour and spicy foods
   • Alcohol, rich broths, seasonings, onion, garlic, radish, sorrel
   • Cream confections, muffins, chocolate, carbonated drinks, cocoa, black coffee
   • Foods that increase gas formation: peas, beans, rye bread
   • Cream, whole milk
   • Canned foods and marinades
   It is recommended to eat fractionally (5-6 times a day) and in small portions.

   Culinary processing:

   • Products are boiled, baked or steamed: meatballs, steam cutlets and so on.
   
   
   • In the first days of an exacerbation, it is recommended to consume foods in liquid mashed or minced form. As acute symptoms disappear, this is not required.
   Features of the diet for hypomotor dyskinesia

   Allowed for consumption

   • Yesterday's bread made from rye or wheat flour of the second grade
   • Lactic acid products not more than 6% fat: sour cream, cottage cheese, kefir
   • Lean meats (beef) and fish (hake, pollock, pike perch), poultry (chicken)
   • Vegetables in any form
   • No more than one yolk per day
   • Boiled low-fat varieties of sausages and sausages
   • Vegetable fats and butter
   • Honey, sugar, caramel, marmalade, marshmallow
   • Fruit and vegetable juices, as well as fruits and berries of non-acidic varieties (apples, apricots, etc.)
   • Tea, coffee with milk
   • Any cereals and pasta
   • Soups with vegetable broth
   Features of the diet for hypermotor dyskinesia

   It is allowed to use the same products as for hypomotor dyskinesia, but the following are excluded:

   • Sausages and sausages (even boiled)
   • Sugar, caramel
   • Pork, veal
   • Egg yolk
   • Fresh berries, vegetables and fruits

   Alternative methods of treatment of dyskinesia

   A good addition to the main treatment with medicines, especially after reducing the acute symptoms of the disease.
   
   

   Infusions and decoctions	How to prepare and take	What effect to expect
   Hypotonic dyskinesia
   Decoction of immortelle flowers	3 tbsp pour flowers into an enamel bowl, pour a glass of boiling water. Then heat in a water bath for 30 minutes, stirring constantly. Remove from heat, let cool, and then strain. Take half a glass 20-30 minutes before meals. Course - 2-3 weeks.	Strengthens the contraction of the gallbladder and improves the outflow of bile Normalizes the composition of bile Improves the work of the digestive tract Locally disinfects
   Infusion of corn stigmas	1 tsp crushed raw materials, pour a glass of boiling water and let it brew for 30 minutes. Then express and take 3 tbsp. l. three times a day for half an hour before meals. Course - 2-3 weeks.	Liquefies bile and eliminates its stagnation Lower blood bilirubin and cholesterol levels
   Oregano herb infusion	Pour 2 tbsp. crushed raw materials 200 ml of boiling water. Express after 20-30 minutes. Take the entire infusion throughout the day in three doses 30 minutes before meals. Course - 1 month or more.	Enhances the motor activity of the intestines and biliary tract Has a local anti-inflammatory and choleretic effect Normalizes the functioning of the nervous system
   Hypertensive dyskinesia
   Peppermint infusion	2 tsp peppermint and pour 200 ml of boiling water. Let it steep for 30 minutes, then strain. Take 1/3 cup 20 minutes before meals twice a day. Course - 3-4 weeks.	Reduces pain and nausea Relaxes the muscles of the bile ducts and sphincters, promoting the outflow of bile Improves digestion and appetite Has a local anti-inflammatory effect
   Decoction of licorice root	2 tsp crushed raw materials, pour 200 ml of boiling water, place in a water bath for 20 minutes. Let cool, then strain and bring to the original volume with boiled water. Take 1/3 cup 30 minutes before meals three times a day. Course - 2-3 weeks.	Relaxes the smooth muscles of the gallbladder and its ducts
   For both types of dyskinesia
   Decoction or tea from chamomile flowers	1 tsp dry chamomile flowers pour 200 ml of boiling water. Express after 3-5 minutes. Consume for a long time three times a day, like tea.	Reduces bloating Improves the work of the digestive tract Helps reduce or eliminate belching Normalizes the functioning of the nervous system, helps fight insomnia Accelerates the healing of wounds on the mucous membranes (ulcers, erosions) Fights locally with pathogenic microbes Increases appetite

   
   

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 disorders of the gallbladder function 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

1. Bogoutdinov M. Sh. Features of the morphofunctional state of the upper gastrointestinal tract in cholelithiasis: author. dis. … cand. honey. Sciences 14.00.05? 14.00.19. - Tomsk, 2009. - ¬23 p.

2. Volkov, V. S. Duodenogastric reflux and duodenal ulcer – let’s dot the “i” / V. S. Volkov, I. Yu. Kolesnikova // Upper Volga Medical Journal. - 2010. - T. 8. - Issue. 1. - S. 26-29.

3. Galiev Sh. Z., Amirov N. B. Duodenogastric reflux as a cause of reflux gastritis // Bulletin of modern clinical medicine. - 2015. - No. 8(2). - S. 50-61.

4. Ilchenko A. A. Contractile function of the gallbladder in normal and pathological conditions // Diary of Kazan Medical School. - 2013. - No. 1(1). - S. 15-21.

5. Razarenova T. G. Functional state of the biliary system and upper gastrointestinal tract in patients with duodenal ulcer / T. G. Razarenova, A. P. Koshel, S. S. Klokov et al. // Experimental and clinical gastroenterology. - 2010. - No. 4. - P.21-27.

6. Chen, T.-F. Comparative evaluation of intragastric bile acids and hepatobiliary scintigraphy in the diagnosis of duodenogastric reflux / T.-F. Chen, P. K. Yadav, R.-J. Wu et al. // World J Gastroenterol. - 2013. - Vol. 19(14). – P. 2187–2196.

7. Kuran, S. Bile reflux index after therapeutic biliary procedures / S. Kuran, E. Parlak, G. Aydog et al. // BMC Gastroenterol. - 2008. - Vol. 8. - P. 4.

8. Sj?vall, H. Meaningful or redundant complexity - mechanisms behind cyclic changes in gastroduodenal pH in the fasting state // Acta Physiol (Oxf). – 2011 Jan. – Vol. 201(1). – P.127-31.

9. Sobala, G. M. Bile reflux and intestinal metaplasia in gastric mucosa / G. M. Sobala, H. J. O "Connor, E. P. Dewar et al // J Clin Pathol. - 1993 - Vol. 46 - P. 235–240.

10. Ugwu A. C., Agwu K. K., Erondu O. F. Variabilities of gallbladder contraction indices and a simple regression model for gallbladder and gastric emptying ratio // Pan African Medical Journal. - 2011. - No. 9 (11). - R. 1-7.

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 (BIS), it was found that in 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 (the score is multiplied by a factor of 3), chronic inflammation (coefficient of 4) minus the score characterizing the density of H. pylori colonization (coefficient of 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, no differences were found 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 compared with 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, GDR mainly affects the antrum of the stomach, then in patients who have undergone the above operations on the biliary tract, including after CE, GDR affects both the antrum and on the body of the stomach.

In our work, we investigated the presence of pathological DGR and reflux gastritis at the level of various parts of the stomach in 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. Possibly, 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, it may be necessary laboratory research, and also takes into account the information received by the gastroenterologist during the examination.

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 bad smell- often occurs after meals, 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;
• complete lack of 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;
• menstrual disorders in 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;
• the use of traditional medicine, but only after consulting with your doctor, since using 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 symptoms or self-treatment 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.

Biliary dyskinesia is not an independent disease - it is a consequence of improper flow of bile into the duodenum for digestion. JVP is accompanied by aching, dull, sharp pains in the abdomen, an indirect sign is considered bad smell from the oral cavity. 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 emergence of JVP according to hypertonic type 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- disregard for the rules healthy eating, infrequent 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

Types of dysfunction	Hypomotor dyskinesia	Hypermotor dyskinesia
Symptoms	Dull pain in right hypochondrium. Belching - after eating, between meals. Nausea. Vomiting with bile. Bitterness in the mouth - in the morning, after eating. Flatulence. Decreased appetite. Violation of bowel movements - often constipation. Obesity. Bradycardia. Hypersalivation. Hyperhidrosis.	During an exacerbation, the pain is intense, reminiscent of colic. Lack of appetite. Thinness. Nausea and vomiting - against the background of an attack of colic. Rarely occur on their own. Diarrhea. Attacks of tachycardia. Increase in blood pressure. Irritability. fatigue. Sleep disturbance.
	Yellowness of the skin, sclera due to a violation of the outflow of bile. The coating on the tongue is white or yellowish in color.

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.

Take Eleutherococcus tincture to stabilize the nervous activity of the body

The drugs stimulate the 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. Main side effect tincture 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.

Tyubazhi - with mineral water, sorbitol, magnesia - only during the period of 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.

Typical representatives:

• 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. From side effects only episodic cases of diarrhea have been observed. Medicines 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 belongs to folk methods 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 to get effective remedy in the fight against JVP

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 omelet, 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 inflammatory diseases 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 medications 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 drug treatment- This is the reception of phytocollections. 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 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.