Pathologies of the liver and biliary tract are found in every third adult person. It is impossible to say exactly how many people suffer from diseases of the hepatobiliary system, because, in addition to the episodes recorded in official statistics, there are many cases where patients do not seek this problem for medical help, but know firsthand about dyskinesia. What it is? This is a disease of the digestive system, which may not manifest itself for a long time, but with exacerbation it causes a lot of trouble.
Briefly about what is dyskinesia
This pathology is not life threatening. As a rule, the disease is diagnosed in adult patients, but often occurs in children. Biliary dyskinesia is congenital and acquired. This disease is characterized by the manifestation of complex disorders in the digestive tract.
The essence of this pathological process is to change the motility of the ducts of the gallbladder. With dyskinesia, the tone of the connective tissue that makes up the gallbladder or ducts that remove the bile increases or decreases. Against the background of altered motor activity, the amount of incoming bile into the lumen of the small intestine decreases. Unlike cholecystitis, which is characterized by inflammation of the organ and stagnation of bile, dyskinesia is not accompanied by an inflammatory process, however, the functioning of the system is significantly impaired.
In ICD-10, dyskinesia does not have an independent code, since it belongs to the category of “Other specified diseases of the gallbladder” - k.82.8.0. With this disease, the outflow of bile is difficult, it stagnates in the ducts of the liver, in the bladder itself, but no structural changes occur in these organs. During the diagnosis, one of two types of disorders can be detected: too slow or too fast contraction of the walls of the gallbladder.
According to some reports, dyskinesia is more often found in males in adulthood, as well as in young women and children. People with an asthenic body type are prone to the development of the disease. Scientists have found a connection between the development of dyskinesia and hormonal changes. In women, for example, symptoms of the disease often occur several days before the start of the menstrual cycle.
Probable causes of the disease
After we managed to find out what dyskinesia is, we can proceed to consider the etiology of the disease. It is difficult to say exactly what exactly provokes the disease in a particular case. The causes of pathology of the biliary tract are diverse. The pathogenesis of the disease is the neurohumoral regulation of all elements of the biliary system. According to laboratory results, biliary dyskinesia in some cases is a consequence of neurocirculatory dystonia.
Conventionally, etiological factors can be divided into primary and secondary. Primary occur with abnormalities of fetal development. These include doubling of the gallbladder, congenital narrowing or obstruction of the biliary tract. Secondary causes of dyskinesia are disorders and diseases that directly affect the condition and health of the hepatobiliary system. For instance:
- chronic diseases of the gastrointestinal tract;
- chronic pancreatitis;
- postoperative syndrome after resection of the stomach, the imposition of anastomoses, vagotonia;
- frequent stressful situations;
- autoimmune disorders;
- diabetes;
- hypothyroidism and other endocrine disorders.
In addition to the reasons that are the direct provocateurs of dyskinesia, it is worth noting the favorable conditions for the development of the disease. Risk factors include various conditions that increase the likelihood of a pathology. Most likely to have people who:
- consume harmful foods, eat rarely and in large portions;
- suffer from hypovitaminosis;
- infected with helminths, intestinal infections;
- have hormonal imbalances (for example, pregnant women during menopause);
- lead a sedentary lifestyle;
- have a history of osteochondrosis;
- prone to allergic reactions (bronchial asthma, urticaria).
Forms of the disease
In the International Classification of Diseases (ICD), biliary dyskinesia is not indicated as an independent disease. There are no references to the classification of pathology. Dyskinesia can occur in one of the following types:
- hypokinetic;
- hyperkinetic;
- mixed, that is, hypotonic-hypertonic.
The hypomotor variety of the disease is characterized by a low motor function of the gallbladder and its ducts, which leads to an insufficient volume entering the duodenum. Hypokinetic dyskinesia is most often diagnosed in people over 40 years old. Most of all, patients with neuropathic disorders are prone to its development.
Hyperkinetic biliary dyskinesia is found in young people. The disease is characterized by increased intensity of contraction of the gallbladder, its smooth muscles and adjacent ducts. With the hyperkinetic form of the disease, more than necessary bile enters the small intestine.
With a mixed type of disease, an inconsistent mode of activity of the gallbladder and bile duct occurs. If the muscles contract more intensively than usual, and the ducts are weak, sluggish and inelastic, this leads to a deterioration in the activity of the gallbladder and the appearance of various symptoms. The same thing occurs with a reduced contractility of the gallbladder in combination with increased work of the excretory tract. Mixed dyskinesia, which has signs of both hyperkinetic and hypomotor function, is of two types - gallbladder dysfunction and sphincter of Oddi dysfunction.
Symptoms and signs
You can understand what it is - dyskinesia, according to the clinical manifestations of the disease. Pathology can manifest itself with one or more symptoms. The most characteristic symptoms of biliary dyskinesia in adults and children are:
- pain in the right hypochondrium;
- mild nausea, especially in the morning;
- a feeling of heaviness and discomfort on the right side;
- bitterness and metallic taste in the mouth;
- vomiting with impurities of bile.
In this case, patients do not increase body temperature, which helps to distinguish the disease from cholecystitis, which has similar clinical manifestations. Symptoms of biliary duct dyskinesia can be combined into symptom complexes. Syndromes with dyskinesia are of four types:
- dyspeptic;
- pain
- cholestatic;
- asthenoneurotic.
Not all patients have the same symptoms of dyskinesia. All forms of the disease manifest themselves in different ways, which depends on the mechanisms of impaired motor function. In addition, at first any one symptom of dyskinesia may occur, and after some time other signs of the disease join. The main characteristic feature of the disease is a high intensity pain syndrome. All other signs may be poorly expressed or completely absent.
The nature of pain with dyskinesia
To recognize this disease, it is important to be able to distinguish pain. Its nature and intensity depends on the form of biliary dyskinesia in adults. Symptom in hypomotor dysfunction is a blurred background pain, which is felt on the right side and does not have a clear localization. It is difficult for the patient to indicate a specific place that hurts. Unpleasant sensations arise due to the low contractility of the ducts and bladder, in the lumen of which bile accumulates and stretches its walls. After eating fatty, fried foods, symptoms of dyskinesia become more pronounced. Treatment in this case is based on diet. Mild palpation in the right hypochondrium helps to reduce pain for patients.
With the hypertonic type of dyskinesia, the pain bothers on the right side and radiates to the epigastric, lumbar, atrial zones. In this case, the pain is more intense, often manifested by attacks that last 20-30 minutes and occur repeatedly throughout the day. Relapse of a hypertonic form can last several months. If untreated, dyskinesia can lead to hepatic colic - this complication is very difficult to tolerate by patients of any age, since it is accompanied by tachycardia, heart pain, numbness of the extremities, and general well-being. Symptoms of colic are largely similar to manifestations of myocardial infarction, so during an attack, people often call an ambulance.
Skin rash
Due to the insufficient amount of bile entering the duodenum, the so-called cholestatic syndrome occurs. This violation can be determined during examination of the patient, if he has yellowness of the skin and mucous membranes, itching due to the increased content of bile acids in the blood.
By the way, jaundice is more or less pronounced in all patients with dyskinesia. Treatment of any of the forms of this disease depends on the degree of stagnation of bile, which will be indicated by laboratory tests. Urine with dyskinesia becomes darker, and feces, on the contrary, are lighter.
Most patients with dyskinesia are forced to consult dermatologists, since this disease is often accompanied by dermatitis, dryness and peeling of the epidermis, eczema may develop. Dermatoses that have arisen against the background of dyskinesia usually occur over a long time and progress without complex therapy. Local treatment of skin rashes will not bring the expected effect. Only a systemic treatment of dyskinesia can help the patient. In adults, the manifestations on the skin do not pass until no measures are taken to combat stagnation of bile.
Diagnostic steps
Complaints and descriptions of symptoms are not enough to make a diagnosis. The treatment of dyskinesia in adults and children should be preceded by a comprehensive medical examination, consisting of laboratory tests and functional diagnostic procedures. In addition, we must not forget that this disease has many similar symptoms with cholecystitis, some diseases of the liver, pancreas and pathologies of the gastrointestinal tract. For differential diagnosis, the doctor first prescribes:
- general clinical tests of urine and blood, according to the results of which we can conclude that there is an inflammatory process and infection in the body;
- biochemical analysis of blood, which will demonstrate indicators of bilirubin, transaminase ALT and AST, cholesterol, alkaline phosphatase, pancreatic enzymes;
- a program of feces;
- analysis of feces for the presence of parasites (in the first place, it is important to exclude giardiasis, find out the level of stercobilin).
In addition to laboratory research methods, instrumental diagnostics is of no small importance. The main screening procedure for suspected biliary dyskinesia is ultrasound. This non-invasive examination method, which has no contraindications, is easily tolerated at any age and allows you to:
- get a real idea of the state of all elements of the hepatobiliary system - the gall bladder, liver, biliary tract;
- consider the structure of the pancreas as a whole or its individual fragments;
- detect foci of inflammation, diffuse changes, echoes of stones and pathological neoplasms (polyps, cystic and cancerous tumors).
In addition to ultrasound, patients are recommended to undergo such procedures as:
- duodenal sounding;
- cholecystography;
- cholesintigraphy;
- magnetic resonance cholangiography.
The decision on the feasibility of some of these types of studies is made by the attending physician. Most often, in the diagnosis of dyskinesia, specialists are limited to the results of laboratory tests and ultrasound.
Dyskinesia in children: features
Pathology of the biliary tract at an early age occurs due to a change in the tone of the gallbladder, excretory tracts and sphincters, which regulate the outflow of bile into the duodenum. In children, the disease usually proceeds sluggishly and latently, practically does not manifest pronounced symptoms, except for periodic painful sensations, poor appetite and weakness. In half of the children suffering from dyskinesia, sphincter of Oddi dysfunction is revealed, in which bile arbitrarily enters the small intestine.
Not the last role in the appearance of biliary tract disease in children is played by a hereditary factor. Genetics were even able to identify the DNA gene that is responsible for the development of dyskinesia - this is JAG1. In a family where both parents suffer from this disease, the probability of its occurrence in a child reaches 80%. Under the influence of exogenous and endogenous factors, the risk of developing pathology is even higher.
Another specific cause of dyskinesia is considered to be the growth of the child's body, during which the connective tissue grows more slowly than muscle and bone. Since a rapid jump in growth is observed in children in adolescence, the clinical picture of the disease during this period acquires the greatest severity.
Diet and diet features
Treatment of biliary duct dyskinesia will be ineffective and will not bring significant relief if the patient does not observe a number of dietary restrictions. Diet is of paramount importance in the diagnosed pathology. A mild degree of dyskinesia is sometimes amenable to correction even without drug treatment. In these cases, it is possible to improve the condition of the gallbladder and biliary tract by adhering to a therapeutic diet and avoiding stressful situations. Moreover, any disturbance in the diet can lead to a sudden deterioration, up to the development of hepatic colic.
The optimal dietary regimen for biliary duct dyskinesia is considered Pevzner table No. 5, according to which the use of fatty, fried, spicy and smoked foods is not allowed. It is absolutely necessary to exclude seasonings, products containing flavor enhancers, alcohol, coffee and teas, carbonated drinks from your diet.
Particularly useful for dyskinesia are foods containing magnesium. This trace element is rich in wheat bran, cocoa, oatmeal, unpolished rice, chicken eggs, spinach. Magnesium helps to relax the smooth muscles of the digestive tract, increases stress resistance and lowers blood cholesterol.
With a relapse of the disease, diet is of particular importance. Gastroenterologists recommend eating fractionally and often with dyskinesia, reducing the serving size to 150-200 g and increasing the number of meals. Too cold or hot foods can cause smooth muscle cramps and cause pain. It is necessary to adhere to a diet for several months, up to the complete elimination of the symptoms of the disease and the full restoration of the functionality of the biliary tract.
Drug treatment
With biliary dyskinesia in adults, complex drug therapy is required. Drugs for the treatment of this disease must be taken for a long time. When prescribing a drug course, the doctor aims to stop the pain, prevent the onset of attacks in the future and prevent complications. In addition, the drugs prescribed for dyskinesia are aimed at eliminating signs of intestinal dysbiosis and the prevention of hypovitaminosis.
There are some differences in the treatment of the hyperkinetic and hypomotor forms of the disease, which are caused by dysfunctions of the gallbladder and ducts leading to it. In parallel with the treatment of cholestatic syndrome, any kind of dyskinesia requires the treatment of disorders of the autonomic nervous system. For this, patients are prescribed antidepressant, sedative, and tonic drugs (tincture of valerian, motherwort, eleutherococcus, ginseng).
During an exacerbation of the disease, which is accompanied by colic and intense pain in the right hypochondrium, patients often require hospitalization and treatment in a hospital. Therapy is aimed at stopping pain attacks, restoring normal patency of the biliary tract, relieving inflammation and unhindered outflow of bile. For this purpose, the following drugs are prescribed:
- myotropic antispasmodics (No-Shpa, Mebeverin, Papaverin, Drotaverin, Duspatalin, Gimekromon);
- anticholinergic drugs (Atropine, Platifillin);
- relaxing and reducing the tone of connective tissue to eliminate dysfunction of the sphincter of Oddi;
- vitamin and mineral complexes with blinking;
- mineral water with alkali.
With the hypokinetic form of dyskinesia, choleretic drugs are used. The most popular representatives of this group are Allohol, Cholenzym, Cholecin, Hofitol. All these products are of natural origin. Cholagogue is used only at the stage of remission of the disease, since with biliary colic they can only worsen the condition of the patient. When prescribing choleretic drugs, the doctor must be sure that the patient does not have cholelithiasis and obstruction of the lumen of the bile duct with calculi.
For the relief of pain with dyskinesia and other pathologies of the gallbladder and ducts, analgesics are not used. They have low efficiency and with prolonged use can cause a lot of side effects, including the development of stomach ulcers or duodenal ulcers. Instead of analgesics, the above antispasmodics are used.
In order to prevent the spread of the inflammatory process to the liver, hepatoprotectors are prescribed to the patient. With stagnation of bile, these funds are required to maintain the functions of the gland. Essentially, Gepabene, Karsil are mainly prescribed. The optimal duration of treatment with hepatoprotectors is 4-5 weeks, and it is recommended to take them during remission.
Surgical intervention
The radical method of treatment (cholecystectomy) is considered the only effective in the presence of stones in the cavity of the gallbladder, polyps, malignant neoplasms. Today, an organ removal operation is performed endoscopically and openly. The first method of intervention is considered safer and less traumatic, however, its use is resorted to, as a rule, during planned operations.