Impaired contractile function of the gallbladder. Functions of the gallbladder and nucleation processes. Symptoms of biliary dyskinesia of the hypomotor type

Gallbladder dyskinesia (gallbladder dysfunction) is a functional disorder in which the contractile function of the gallbladder is disrupted, as a result of which the flow of bile into the lumen of the duodenum no longer meets the needs of the digestive process, i.e. bile enters either in insufficient quantities or in excessive.

With dyskinesia, no pathological changes in the gallbladder and bile ducts are observed. Thus, this disorder is not an independent disease, but is considered a functional disorder.

Although the pathology is chronic, proper and timely treatment, maintaining a healthy lifestyle and following a diet help prevent exacerbations.

Dyskinesia of the gallbladder is often observed in the practice of gastroenterologists and therapists. Among all diseases of the biliary tract, it accounts for approximately 15%. In women it occurs 10 times more often than in men, affecting mainly young people suffering from neurosis and/or asthenic syndrome. According to statistics, in 30% of cases, attacks of biliary colic are caused not by organic changes in the hepatobiliary system, but by dyskinesia of the gallbladder and ducts.

Forms of the disease

Depending on the cause, gallbladder dyskinesia is divided into two types:

primary– caused by congenital anomalies of the bile ducts and/or gallbladder;
secondary– develops as a complication of a number of diseases and hormonal disorders.

Depending on the characteristics of the muscle tone of the gallbladder walls, the following forms of dyskinesia are distinguished:

hypermotor (hyperkinetic)– characterized by increased contraction of the walls of the gallbladder, as a result of which an excessive amount of bile enters the duodenum, characteristic of young people;
hypomotor (hypokinetic)– the tone of the walls of the gallbladder is reduced, which causes insufficient flow of bile into the duodenum. It is usually observed in people over 40 years of age and those suffering from neuroses.

Causes and risk factors

The causes of primary dyskinesia of the gallbladder are congenital anomalies:

doubling of the gallbladder;
narrowing of the gallbladder cavity;
the presence of a septum in the gallbladder.

Source: yogatherapy.ru

Secondary dyskinesia of the gallbladder is caused by:

peptic ulcer of the stomach and duodenum;
viral hepatitis;
stress, neurosis;
vagotonia;
condition after surgery on the abdominal organs;
severe course of certain diseases (dystrophy, myotonia, diabetes mellitus).

In the absence of treatment, gallbladder dyskinesia can be complicated by the development of cholangitis, calculous cholecystitis, and intestinal dysbiosis.

There are a number of factors that increase the risk of developing biliary dyskinesia. These include:

genetic predisposition;
insufficient intake of plastic substances, minerals and vitamins from food;
irrational and unhealthy diet (poor chewing, frequent consumption of fatty foods, snacks on the go, dry food);
changes in hormonal balance (premenstrual syndrome, obesity, hormonally active tumors, hormonal therapy, pregnancy and the postpartum period);
inflammatory diseases of the abdominal cavity and pelvis (appendicitis, solar syndrome, pyelonephritis, adnexitis);
asthenic physique;
physical or mental stress;
chronic diseases of an allergic nature (allergic rhinitis, urticaria, bronchial asthma);
muscle weakness.

Symptoms of gallbladder dyskinesia

All forms of dyskinesia are characterized by a number of common syndromes:

dyspeptic;
painful;
asthenovegetative;
cholestatic.

Their severity varies in different patients.

The development of cholestatic syndrome is caused by insufficient flow of bile into the duodenum. It manifests itself with the following symptoms:

icteric staining of the skin and mucous membranes;
dark color of urine;
lighter color of stool;
skin itching;
hepatomegaly (increase in liver size).

Source: traffic-moscow.ru

Cholestatic syndrome develops in approximately every second patient with gallbladder dyskinesia.

With dyskinesia, no pathological changes in the gallbladder and bile ducts are observed.

The development of dyspeptic syndrome is associated with digestive disorders due to an inadequate amount of bile entering the intestines. Its signs:

belching air;
decreased appetite;
bad breath;
nausea and vomiting;
white or yellowish coating on the tongue;
constipation (with hypermotor form) or diarrhea (with hypomotor form);
dryness and bitterness in the mouth.

Dyskinesia of the gallbladder in almost all patients is accompanied by the development of asthenovegetative syndrome, manifested by the following symptoms:

irritability, mood lability;
general weakness, fatigue;
increased sweating (hyperhidrosis);
low blood pressure;
attacks of tachycardia;
decreased libido.

Another symptom of gallbladder dyskinesia is pain, the severity of which differs in hyperkinetic and hypokinetic forms of dysfunction.

With hyperkinetic dyskinesia of the gallbladder, pain is localized in the right hypochondrium and can radiate to the right clavicle, scapula and/or arm. The pain is paroxysmal, acute, sharp in nature. Painful attacks occur repeatedly throughout the day, but last no more than 30 minutes. Their development can be provoked by errors in nutrition, physical or mental overload. After the end of the attack, a feeling of heaviness remains in the area of the right hypochondrium.

Intense contraction of the walls of the gallbladder with a hyperkinetic form of dyskinesia against the background of closed sphincters leads to the development of biliary colic. It begins suddenly with sharp pain, accompanied by fear of death, tachycardia, and numbness of the upper extremities.

In women, biliary dyskinesia occurs 10 times more often than in men, affecting mainly young people suffering from neurosis and/or asthenic syndrome.

With hypokinetic dyskinesia of the gallbladder, pain is localized in the epigastric region and right hypochondrium, and can spread to the right side of the back. It is bursting, dull, aching in nature and lasts for several days.

Dyskinesia of the gallbladder in children

According to medical statistics, gallbladder dyskinesia occupies a leading place in the structure of general morbidity of the biliary system in children. About 80-90% of children registered with a gastroenterologist suffer from this functional disorder.

Dyskinesia of the gallbladder in children develops under the influence of the same reasons as in adults, but is more often associated with disorders of the neurohumoral regulation of muscle tone in the walls of the gallbladder. Such disorders are usually observed against the background of neurocirculatory dystonia, so this condition is considered the main cause of gallbladder dyskinesia in pediatric practice.

The main clinical manifestation of gallbladder dyskinesia in children is the development of right hypochondrium syndrome. It is characterized by heaviness and pain localized to the area. The nature of the pain is determined by the form of the disease. In the hypokinetic form, the pain is provoked by dietary violations and is dull in nature, lasting for quite a long time (up to several weeks). The hyperkinetic form is manifested by an acute pain attack, the development of which can be provoked by strong psycho-emotional overload.

There are usually no other signs of gallbladder dyskinesia in children.

Diagnostics

The diagnosis is made on the basis of characteristic clinical symptoms, physical examination, laboratory and instrumental examination.

According to statistics, in 30% of cases, attacks of biliary colic are caused not by organic changes in the hepatobiliary system, but by dyskinesia of the gallbladder and ducts.

For gallbladder dyskinesia, the following laboratory tests are performed:

biochemical blood test (the activity of aspartate aminotransferase, alanine aminotransferase, gamma-glutamyl transpeptidase, alkaline phosphatase, the level of magnesium, calcium, sodium, potassium, bilirubin, total protein and its fractions, uric acid, creatinine is determined);
lipid profile;

Instrumental diagnostic methods are also used:

Ultrasound of the liver and gallbladder with a test breakfast - allows you to assess the size of the gallbladder, the condition of its walls, contents, and also determine the form (hypomotor or hypermotor) of dyskinesia;
duodenal intubation - insertion of a probe into the duodenum, through which portions of bile are collected and sent for laboratory analysis;
FEGDS (fibroesophagogastroduodenoscopy) – is performed in cases where there is an assumption that gallbladder dyskinesia arose as a complication of a disease of the esophagus, stomach or duodenum;
oral cholecystography - the patient is given a contrast solution to drink, and then an x-ray of the gallbladder is taken. This allows you to evaluate its shape and size, identify possible structural anomalies, and determine the form of dyskinesia;
intravenous cholecystography - the method is similar to oral cholecystography and differs only in that the contrast agent is administered intravenously;
ERCP (endoscopic retrograde cholangiopancreatigraphy) is a method that combines X-ray examination and endoscopy; allows you to identify stones in the gallbladder and determine the form of dyskinesia;
hepatobiliary scintigraphy - the patient is intravenously injected with a technetium isotope, which accumulates well in the gallbladder and bile ducts, after which the liver is scanned.

Source: traffic-moscow.ru

The main clinical manifestation of gallbladder dyskinesia in children is the development of right hypochondrium syndrome.

Therapy for gallbladder dyskinesia is aimed at improving the outflow of bile from it. For this purpose it is recommended:

normalization of work and rest regimes;
drinking mineral waters;
diet;
drug treatment (choleretic, antispasmodics, enzymes, tranquilizers);
carrying out tubing tests;
physiotherapy (paraffin baths, diadynamic currents, electrophoresis);
massage;
Spa treatment.

Diet for gallbladder dyskinesia

Diet therapy plays a primary role in the complex treatment of gallbladder dyskinesia. Patients are prescribed diet table No. 5 according to Pevzner (the modification is determined by the form of the pathology and the characteristics of its clinical course). Food should be taken frequently, at least 5 times a day in small portions. All food and drinks should be warm, as too hot or cold food temperature can trigger a painful attack. When preparing dishes, dietary heat treatment methods are used: baking, boiling, steaming. Exclude from the diet:

fried, fatty and spicy foods;
pickles and marinades;
fatty meats and fish;
cocoa and chocolate;
confectionery, baked goods;
alcohol;
strong tea and coffee, carbonated drinks;
vegetables that irritate the mucous membrane of the gastrointestinal tract (sorrel, radishes, onions, garlic);
products that stimulate gas formation in the intestines (rye bread, cabbage, legumes);
fresh milk.

Probeless tubing is indicated only for hypokinetic forms of gallbladder dyskinesia in remission.

The diet for biliary dyskinesia allows the consumption of the following products:

dried bread made from second grade flour;
lean varieties of meat, poultry, fish;
fermented milk products (cottage cheese, kefir, yogurt, natural yogurt, fermented baked milk);
boiled or fresh vegetables, except those included in the list of prohibited foods;
any cereals in the form of a dressing for soup or porridge;
vegetable oil;
butter (no more than 20 g per day);
weak broths;
coffee or tea with milk;

The diet must be followed for a long time, at least 6 months, which allows you to achieve stable remission. It is advisable for patients suffering from gallbladder dyskinesia to adhere to the stated principles of dietary nutrition throughout their lives.

Treatment of gallbladder dyskinesia with mineral water

For gallbladder dyskinesia, it is recommended to drink one glass of mineral water warm 3 times a day half an hour before meals. For the hypokinetic form, mineral water with a high degree of mineralization is indicated (Mashuk, Borjomi, Batalinskaya, Essentuki No. 17). For hypokinetic, on the contrary, water with low mineralization is prescribed (Smirnovskaya, Narzan, Lipetskaya, Karachinskaya, Darasun). The duration of therapy with mineral waters is 3-6 months.

Dyskinesia of the gallbladder is a pathology of the tone and functioning of the organ and the ducts extending from it. This disorder consists of improper excretion of bile into the duodenum, as a result of which problems with intestinal digestion develop.

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

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

To completely cure dyskinesia, timely treatment and a properly selected diet are necessary. .

Organ structure

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

The role of the gallbladder is:

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

During this process, the bubble contracts. In addition, at this moment the sphincter relaxes, thereby promoting the movement of bile.

This process depends on:

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

These components affect the muscles of the bladder when eating food and contract it, which leads to increased pressure. Then the sphincter relaxes and allows bile to flow into the ducts and duodenum.

When there is inconsistency in the activity of parts of the nervous system and other pathological disorders, outflow disturbances occur.

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

Reasons for the development of pathology

Dyskinesia of the gallbladder is of primary and secondary types. Their difference lies in the reasons for the development of the disease and the timing of its appearance. The initial symptoms of primary dyskinesia are dysfunction, which can be detected by ultrasound or x-ray. Typically, such disorders are associated with congenital pathologies of duct development.

As the disease progresses, the structure of the entire biliary system changes.

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

Dyskinesia of the secondary type is a deformation with signs of pathologies in the structure of the organ and biliary tract as a result of existing diseases. These changes can be detected during medical examinations.

Secondary dyskinesia can develop due to the following factors::

Types of disease

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

Hypermotor(hypertensive). It develops with increased tone of the bladder and the tracts extending from it. It occurs in people with a parasympathetic nervous system, which increases the tone of the organ. Children and adolescents are most susceptible.
Hypomotor form (hypotonic), appearing with decreased tone. People over 40 years of age, in whom the sympathetic system dominates, are most susceptible.
Hyperkinetic form (hyperkinesia) with active bile outflow;
Hypokinetic form (hypokinesia) with a slow outflow of secreted substances.

Symptoms

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

Symptoms of the hypomotor type of disease include:

With hypermotor dyskinesia, the patient experiences the following symptoms::

These two forms of dyskinesia also have common symptoms:

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

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

Diagnosis methods

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

Then laboratory tests are being carried out:

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

Therapy

Use of medications

To treat biliary tract disease of the hypotonic type, medications such as:

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

The following medications are used to treat hypertensive dyskinesia::

Physiotherapy

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

In some cases, other procedures are also prescribed:

massage, including acupressure, which can normalize the functioning of the gallbladder;
acupuncture (acupuncture);
hirudotherapy (treatment using leeches).

Also, in some cases, treatment of diseases that cause the development of dyskinesia (infections, helminthic infestation, ulcers and cholelithiasis) is required. To maximize the effect of therapy, it is necessary to maintain the correct daily routine, combining work and rest.

If gastrointestinal dyskinesia is detected, the patient must:

go to bed before 23:00;
daily sleep of 8 hours;
adhere to a proper diet;
regularly walk in fresh air;
combine mental and physical stress.

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

Proper nutrition

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

This diet involves the exclusion of certain foods.:

You need to eat small portions several times a day, i.e. fractionally During an exacerbation, for the first time you should only eat liquid or ground food in a meat grinder. After eliminating acute symptoms, you can switch to steamed, boiled and baked dishes. It is recommended to reduce your salt intake to avoid swelling.

With this diet The following products are allowed to be consumed:

Development of the disease in children

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

Note! If a child has even a suspicion of gastric dyskinesia, then his parents should immediately consult a doctor.

Treatment can be carried out either on an outpatient or inpatient basis, depending on the child’s condition. The disease can last a long time, but if medical instructions are strictly followed, a positive result will still be achieved.

Judging by the fact that you are reading these lines now, victory in the fight against liver diseases is not yet on your side...

Have you already thought about surgery? This is understandable, because the liver is a very important organ, and its proper functioning is the key to health and well-being. Nausea and vomiting, a yellowish tint to the skin, bitterness in the mouth and unpleasant odor, dark urine and diarrhea... All these symptoms are familiar to you firsthand.

But perhaps it would be more correct to treat not the effect, but the cause? We recommend reading the story of Olga Krichevskaya, how she cured her liver...

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

The clinical picture will also depend on the type of disease. This disorder has nonspecific symptoms, for example, pain in the area under the right ribs, attacks of nausea and vomiting, and an unpleasant taste in the mouth.

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

Methods for treating dyskinesia are always limited to conservative methods, such as taking medications, 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 disease are:

doubling or narrowing of this organ or cystic ducts;
formation of scars and constrictions;
improper motor activity of smooth muscle cells;
dysfunction of the ANS, which can develop due to acute or chronic;
increased or decreased production of cholecystokinin;
congenital incompetence 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 gentle nutrition for dyskinesia plays an important role in treatment;
the presence of a person at any stage or, conversely, lack of body weight;
sedentary lifestyle.

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

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

In a child, this disease can be caused by:

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

Classification

According to the time and reasons for development, gallbladder dyskinesia is divided into:

primary- this type is associated with either congenital anomalies or disorders that affect only the functioning of this organ, and not its structural integrity. In such cases, no disturbances will be observed during instrumental examinations;
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., muscle contraction 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 people;
hypomotor dyskinesia of the gallbladder– has the opposite picture and is characterized by reduced activity of the biliary system. 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 occurs. 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 worsen during meals or immediately after eating;
belching, which in some cases is accompanied by an unpleasant odor - 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 a consequence of overeating or eating a large amount of fatty foods;
a feeling of bitterness in the mouth is the most characteristic sign of the disease. 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 food;
violation of the act of defecation - constipation is more common than diarrhea and occurs a short period of time after a meal;
weight gain – in cases with dyskinesia of the hypokinetic type, obesity is not only a cause, but also a symptom;
a decrease in blood pressure, which occurs against the background of a decrease in heart rate;
increased secretion of saliva and sweat;
pathological redness of the skin of the face.

The hyperkinetic type of dyskinesia is represented by the following symptoms:

pain syndrome – the pain is 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 throughout the day;
radiating pain to the right side of the back, shoulder blade or upper limb. Pain associated with angina pectoris or scoliosis is less common;
constant feeling of heaviness under the right ribs;
a 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 dyskinesia of the gallbladder of the hypotonic type, in the hypertonic form diarrhea predominates;
rapid heartbeat;
increased sweating;
headache;
irritability and sleep disturbances;
increase in blood tone;
aching pain in the heart;
rapid fatigue.

Signs that are observed regardless of the type of disease:

acquisition of a yellowish tint by the skin, oral mucous membranes and sclera;
coating of the tongue with a white-yellow coating;
discoloration of feces;
darkening of urine;
increase in liver size;
severe itching of the skin;
decreased sexual activity;
menstrual irregularities in women.

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

Diagnostics

A gastroenterologist knows what dyskinesia is, how to diagnose it and prescribe treatment. 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 cannot be excluded;
a thorough examination aimed at palpating the anterior wall of the peritoneum in the area under the right ribs, assessing the condition of the skin and measuring blood pressure;
conducting a detailed survey of the patient - to draw up a complete symptomatic picture, since each type has characteristic symptoms.

Laboratory diagnostic measures are limited to:

Instrumental diagnostics is based on 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 intubation;
RCP;
CT scan of the bile ducts.

Treatment

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

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

frequent and fractional food consumption;
complete rejection of spicy and fatty foods, smoked foods and preservatives;
reducing daily salt intake to 3 grams;
cooking food only by boiling and stewing, baking and steaming;
drinking large amounts of mineral water without gas.

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

Drug treatment is carried out by taking the following medications:

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

Dyskinesia of the gallbladder and biliary tract is successfully eliminated using physiotherapeutic procedures, including:

diadynamic therapy;
electrophoresis;
acupuncture;
hirudotherapy.

Conservative treatment in children and adults also includes:

duodenal intubation;
closed tubes;
acupressure;
the use of traditional medicine, but only after consultation with the attending physician, since the use of medicinal herbs is necessary depending on the course of the disease. For hypotonic dyskinesia, oregano, immortelle and corn silk are useful, and for hypertensive dyskinesia, mint, licorice and chamomile are useful;
spa therapy.

Surgical intervention is not advisable for gallbladder dyskinesia.

Possible complications

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

and cholecystitis;
gastritis and cholelithiasis;
duodenitis;
severe loss of body weight to the point of exhaustion.

Prevention and prognosis

To reduce the likelihood of such a disease occurring, you must adhere to these simple rules.

In the body of a healthy person, processes of accumulation and release of bile into the digestive tract regularly occur. In case of serious disturbances in the functioning of the gallbladder, the bile secretion stagnates, accumulates in excess or is oversaturated with cholesterol. One of the common pathologies of the organ is dyskinesia, or dysfunction.

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

Classification

Pathology occurs in 2 variants:

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

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

Causes

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

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

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

Clinical picture

A typical sign indicating gallbladder dysfunction is pain. Pain with dyskinesia is paroxysmal in nature, localized in the right side, under the ribs. The attacks are long, from 20 minutes or longer. The nature of the pain depends on the form of motor impairment:

with dysfunction of the hypotonic type, pain is not intensely expressed, but is aching in nature; discomfort increases when changing body position;
hypermotor type dysfunction is characterized by acute pain (biliary colic) that occurs 1–1.5 hours after eating food; There is irradiation of pain to the left shoulder or left upper chest.

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

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

Dyskenesia with hypermotor course is characterized by other manifestations:

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

Often, patients with dyskinesia experience jaundice due to stagnation of bile. At the same time, the feces become colorless, and the urine darkens, acquiring the color of beer. With prolonged dyskinesia, the likelihood of developing cholecystitis increases. This may be indicated by alarming symptoms in the form of frequent loose stools, increased body temperature and moderate pain on the right side under the ribs.

The course of pathology in children

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

force feeding;
overeating, which creates excess stress on the digestive system;
lack of fiber in the diet;
early introduction to “adult” food, including untimely introduction of complementary foods to infants.

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

Diagnostics

The examination for suspected gallbladder dysfunction is complex. At the initial stage, the gastroenterologist finds out the patient’s complaints, eating behavior and lifestyle, and a history of chronic gastrointestinal pathologies. During diagnosis, it is important to differentiate dyskinesia from other diseases of the biliary system.

From laboratory tests, a blood test for biochemistry is indicative. With its help, gall dysfunction is distinguished from clinically similar diseases. Characteristic changes in the blood in the presence of dyskinesia are an increase in the concentration of bilirubin, cholesterol (as a sign of bile stagnation), and white blood cells. However, shifts in blood biochemistry occur during prolonged stagnation and indicate gall dysfunction in the later stages.

Among the methods of functional diagnostics, ultrasound provides the most information. With dysfunction of the hypokinetic type, an enlarged gallbladder is visualized, displaced downward. Hypermotor dyskinesia is indicated by a reduced organ volume with tense walls and frequent contractions. In addition to ultrasound, to clarify the diagnosis the following is prescribed:

duodenal intubation;
cholecystography;
endoscopy.

Treatment

The primary goal of treatment for biliary dyskinesia is to restore the organ’s motility, eliminate bile stagnation, and relieve negative dyspeptic symptoms. In the acute period, the patient needs complete rest, which is ensured by bed rest. Treatment of gallstone dysfunction comes down to medication and diet.

Conservative therapy is selected based on the type of disorder:

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

To relieve symptoms of dyspepsia in the form of nausea, bloating and flatulence, prokinetics (Motilium, Domperidone) are prescribed. Attacks of pain can be relieved by taking antispasmodics (Papaverine, Baralgin). Gastroenterologists often prefer herbal-based medications or prescribe herbal medicine with folk remedies - decoctions and infusions of sage, knotweed, lemon balm, leaves and dandelion root. Herbal medicine is more often used to get rid of dysfunction in children and in the early stages of the disease.

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

Surgical treatment is indicated when the contractility of the organ decreases by more than 40%. Complete excision of the gallbladder is performed - cholecystectomy. After the operation, the patient's recovery lasts at least a year. Further, lifelong adherence to the diet is mandatory.

Principles of nutrition

Diet for gallstone dysfunction is an integral part of treatment. Nutrition for patients is gentle, the best option is treatment table No. 5. Spicy and fatty foods, alcohol, spices, onions and garlic are excluded from the diet. It is important to follow the principle of fractional meals, up to 6 meals a day, with the last one before bed. This avoids stagnation of bile.

A diet in the acute period involves avoiding solid foods. The patient is allowed fruit and vegetable juices diluted with water, or liquid homogenized puree from apples, peaches, and plums. Warm mineral water is beneficial; the degree of mineralization is selected taking into account the type of disorder. Such nutrition helps relieve inflammation, reduce stress and restore organ function.

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

Prognosis and prevention

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

Preventive measures are aimed at maintaining a diet, proper eating behavior, and a healthy lifestyle. An important role is played by daily moderate physical activity, which contributes to the proper functioning of the biliary system. The first signs of gallbladder illness require seeking medical help.

This is a functional disorder of the contractility of the muscular layer of the gallbladder wall, complicating the evacuation of bile. Manifested by biliary pain, dyspepsia, icteric syndrome, asthenovegetative disorders. Diagnosed using sonography, dynamic scintigraphy, MRI of the hepatobiliary zone, duodenal intubation, retrograde cholangiopancreatography. For treatment, myotropic antispasmodics, choleretics, cholekinetics, tricyclic antidepressants, NSAIDs are used in combination with diet therapy and physiotherapy. In case of complicated course and severe pain syndrome, cholecystectomy is performed.

ICD-10

K82.8 Other specified gallbladder diseases

General information

Kinetic dysfunction of the gallbladder is a common hepatobiliary disease, detected in 20.7% of adult women and 7.6% of men with a preserved organ without ultrasound signs of its organic damage. Dyskinesia is diagnosed in 53-60% of preschool-school children with gastroenterological pathology; boys are affected 3-4 times less often than girls. The pathology is often combined with bile duct dyskinesia. According to the observations of specialists in the field of gastroenterology and hepatology, up to a third of cases of biliary colic are caused by functional disorders of the contractile activity of the gallbladder wall. The risk group includes patients of asthenic physique with signs of astheno-neurotic disorders.

Causes

The development of gallbladder dyskinesia is associated with a primary or secondary disorder of the contractile activity of the muscular lining of the organ. It is extremely rare that motor-kinetic dysfunction is congenital, caused by contractile failure of smooth muscle fibers or impaired sensitivity to neurohumoral influences. In most patients, dyskinesia is secondary in nature, caused by reasons such as:

Changes in hormone levels. Suppression of bladder motility during pregnancy and taking combined oral contraceptives occurs under the influence of progestins that relax smooth muscle fibers. The contractility of the organ also decreases due to an increase in the level of somatostatin with somatostatinomas or taking a pharmaceutical form of the hormone.
Systemic diseases. Dysfunction caused by decreased secretion of cholecystokinin by intestinal epithelial cells occurs in celiac disease. In scleroderma, myasthenia gravis, and amyloidosis, the disorder is caused by morphological changes in the fibromuscular layer. Gallbladder dystonia is also observed in diabetes mellitus.
Hepatobiliary pathology. Dyskinesia can be provoked by inflammatory processes, changes in the composition of bile, irritation with stones due to cholelithiasis, cholecystitis, cholangitis. Discoordination of bladder contractions is observed with spasm of the sphincter of Oddi, increased resistance in the bile ducts.

An important role in the development of the disorder is played by frequent stress, leading to an imbalance of parasympathetic and sympathetic stimulation, dietary errors - eating fatty foods, irregular meals, quick snacks with high-calorie foods. Dyskinesia can also be complicated by gastritis, enteritis, diseases of the operated stomach, and other gastrointestinal diseases in which, as a result of digestive disorders, the secretion of factors affecting the tone and contractile activity of the gallbladder wall changes.

Pathogenesis

The occurrence of clinical symptoms characteristic of gallbladder dyskinesia is due to impaired bile evacuation. With discoordinated contraction of the muscle fibers of the fundus and neck, insufficient contractility of the muscular layer, the organ is stretched, which leads to the appearance of characteristic biliary pain. The situation is aggravated by a decrease in the threshold of pain sensitivity when a motor-kinetic disorder is associated with autonomic dysfunction caused by stress. Periodically developing stagnation of bile provokes secondary inflammatory processes, cholelithiasis, and intestinal digestion disorders.

Classification

When systematizing the clinical forms of bladder motor dysfunction, the etiology of the disease and the type of contractile activity disorders are taken into account. This approach allows us to develop optimal patient management tactics. Taking into account the origin, primary forms of dyskinesia are distinguished, caused by congenital local disorders of motor skills and innervation, and secondary forms, which arise against the background of other diseases, special physiological conditions or as a result of treatment. Depending on changes in the contractility of smooth muscle cells, the following variants of the disorder are distinguished:

Hypermotor (hypertensive) dyskinesia. More often observed in children and young adults. It is caused by increased contraction of the gallbladder, leading to the appearance of acute spastic pain and the entry of excess bile into the duodenum.
Hypomotor (hypotonic) dyskinesia. Usually diagnosed in patients over 40 years of age with neurotic disorders. Characterized by a decrease in the tone of the gallbladder wall with stagnation of bile and an increase in the volume of the organ.

Symptoms

The main symptom of gallbladder dyskinesia is biliary pain that bothers the patient for at least 3 months within six months. With the hypertensive variant of dysfunction, severe pain occurs in the right hypochondrium with irradiation to the back and shoulder blade, lasting no more than 30 minutes. Pain syndrome is often associated with anxiety and stressful situations; in the most severe cases, its intensity corresponds to the degree of biliary colic - sudden acute pain accompanied by nausea and vomiting, the relief of which requires the prescription of medications.

The hypotonic variant of the disease is characterized by dull biliary pain of varying intensity, which intensifies with changes in body position and can last for several days. There is a feeling of fullness and pressure in the projection of the organ. Due to stagnation of bile, almost half of the patients experience jaundice, discoloration of stool, dark urine, and itchy skin. Dyspeptic disorders are typical for dyskinesia: bitterness in the mouth, flatulence, unstable stool. With a long course of the disease, the general condition is disturbed - weakness, emotional lability, and insomnia are noted. Autonomic disorders often manifest as sweating and palmar hyperhidrosis.

Complications

If the evacuation of the contents of the gallbladder is impaired, favorable conditions are created for the sedimentation of insoluble particles with the formation of microliths. In the future, this condition turns into cholelithiasis. A frequent complication of dyskinesia is chronic cholecystitis, which appears as a result of the addition of a secondary infection against the background of pathological changes in the organ wall. When bile stagnates, obstructive jaundice syndrome is formed, accompanied by intoxication of the body and hepatic encephalopathy. As a result of infection of the bile ducts, cholangitis develops. Insufficient flow of bile into the intestines leads to the occurrence of malabsorption and maldigestion syndromes.

Diagnostics

Determining the nosology is difficult, since the disease belongs to the functional class and is usually not accompanied by organic pathology. Gallbladder dyskinesia is diagnosed by excluding other diseases with a similar clinical picture. A diagnostic search involves a comprehensive examination of the patient’s hepatobiliary system. The most informative are:

Ultrasound of the gallbladder. Sonography reveals changes in the volume of the bladder and the presence of hyperechoic suspension. To assess the motor-evacuation function, ultrasound cholecystography is performed - with dyskinesia after taking a choleretic breakfast, a contraction of the organ by less than 40% is observed.
Dynamic scintigraphy of the hepatobiliary system. A study with the introduction of a radiopharmaceutical to the patient is performed to assess the excretory function of the liver, the degree of contraction of the bladder, and the patency of the bile ducts. Supplemented with a test with cholecystokinin.
Duodenal sounding. Using sequential sampling of several portions of bile through a probe, the nature of secretion and the rhythm of bile secretion are clarified. With hypomotor dyskinesia, an increased amount of bile in portion B is observed, with a hypermotor form - a reduced amount.
Retrograde cholangiopancreatography. The technique is used to assess the condition of the biliary system, detect stones, dilated bile ducts, and visualize BDS stenosis. Allows you to effectively differentiate functional disorders from organic pathology.
MRI of the liver and biliary tract. It is recommended as a clarifying method when other instrumental studies are insufficiently informative. During high-resolution layer-by-layer scanning, it is possible to qualitatively visualize the bile ducts and bladder.

Laboratory techniques are of auxiliary value. In a general urine test in obstructive jaundice syndrome, an increase in bilirubin and a decrease in urobilinogen are observed. A biochemical blood test may reveal a slight increase in AST, alkaline phosphatase, cholesterol, and, less commonly, direct bilirubin and lipoproteins. When manometry of the sphincter of Oddi is performed, 60% of patients experience an increase in pressure of more than 40 mmHg. Art. Differential diagnosis of dyskinesia is carried out with inflammatory diseases of the biliary tract (cholecystitis, cholangitis), congenital anomalies of the organ (duplication, hypoplasia, constrictions and kinks), strictures of the sphincter of Oddi, and malignant neoplasms. In addition to examination by a gastroenterologist, the patient is recommended to consult an infectious disease specialist, hepatologist, and oncologist.

Treatment of gallbladder dyskinesia

Therapeutic tactics depend on the type of motor dysfunction. Drug therapy is usually prescribed, supplemented by diet and lifestyle adjustments. The course of the disease is favorably affected by frequent small meals, normalizing weight, quitting smoking, dosed physical activity, and eliminating stressful situations. Taking into account the characteristics of contractile dysfunction, the following are recommended:

With hypermotor dyskinesia. To reduce the tone of the muscle wall, myotropic antispasmodics and choleretic agents with a selective antispasmodic effect in relation to the bile ducts and sphincter of Oddi are used. Products that stimulate muscle contraction are excluded from the diet: spicy and fatty foods, extractive substances, alcohol.
With hypomotor dyskinesia. The use of prokinetics, cholekinetics, natural and synthetic choleretics is indicated. To improve the flow of bile, weak protein broths, fermented milk products, eggs, and vegetable oils are introduced into the diet. To prevent constipation, increase the amount of vegetables and other dishes that stimulate intestinal motility.

In the presence of an inflammatory process, non-steroidal anti-inflammatory drugs are additionally used. To relieve severe visceral hyperalgesia, tricyclic antidepressants are used in small dosages. Patients with secondary forms of gall bladder dysfunction undergo etiopathogenetic treatment of the underlying disease according to recommended protocols. Pharmacotherapy is combined with physiotherapeutic techniques (prolonged tubing, electrical stimulation, pulsed magnetotherapy), spa treatment (mineral water intake, peloid therapy). Cholecystectomy is performed in exceptional cases with intense pain and complicated dyskinesia.

Prognosis and prevention

Since complex treatment usually achieves stable remission, the prognosis is considered favorable. Complications arise in case of late diagnosis of the disease or if the patient has severe intercurrent pathology. To prevent dyskinesia, it is recommended to identify and eliminate diseases that interfere with the flow of bile, maintain a healthy lifestyle (following the principles of a balanced diet, doing physical exercise, avoiding stress), and maintaining normal body weight. Taking into account the high effectiveness of timely therapy, when the first signs of pathology appear, it is necessary to consult a doctor as soon as possible.