- This functional disease biliary system, which is based on impaired motility of the gallbladder and bile ducts, as well as the process of bile drainage. Pathology can develop according to the hyperkinetic or hypokinetic type; manifested by pain in the right hypochondrium, nausea, dyspepsia, and neurosis-like symptoms. Diagnostics includes ultrasound of the biliary system, cholecystography, cholangiography, duodenal intubation, scintigraphy. Treatment is conservative: diet, taking choleretic drugs and antispasmodics, sanatorium-resort therapy, herbal medicine, hirudotherapy, physiotherapy.
General information
The basis of biliary dyskinesia is motor-tonic dysfunction of the gallbladder and bile duct sphincters. In this case, the emptying of the gallbladder and the flow of bile into the duodenum. Dyskinesia is the most common functional disorder of the hepatobiliary system and is the leading cause of cholestasis, as well as the formation of stones in gallbladder and ducts. The pathology occurs predominantly in women. Young people (from 20 to 40 years old) with an asthenic constitution and low nutrition are most susceptible to the development of functional disorders of the biliary system.
Reasons
According to the etiological mechanism, primary and secondary biliary dyskinesia are distinguished. Primary dysfunction is caused by a violation neurohumoral regulation activity of the hepatobiliary system due to neuroses, autonomic-vascular dysfunction and dietary errors. Secondary dyskinesia develops according to the mechanism of the viscero-visceral reflex against the background of other diseases of the digestive system.
Based on the nature of the violation of the motor-tonic function of the gallbladder and sphincters, dyskinesias are distinguished, occurring according to the hypertonic-hyperkinetic and hypotonic-hypokinetic type. Hypertensive-hyperkinetic (spastic) dyskinesia develops with increased tone of the parasympathetic autonomic nervous system; hypokinetic-hypotonic (atonic) – with a predominance of the tone of the sympathetic nervous system.
In both cases, as a result of inconsistency in the work of the gallbladder and the sphincters of the bile ducts, the flow of bile into the lumen of the duodenum is disrupted, which leads to disruption of the digestive process. Depending on the type of dyskinesia (hyperkinetic or hypokinetic), various clinical manifestations develop.
Symptoms of dyskinesia
In the hypertensive-hyperkinetic variant of the pathology, the leading symptom is acute colicky pain in the right hypochondrium, radiating to the right shoulder blade and shoulder. A painful attack usually develops after an error in diet, excessive physical activity or psycho-emotional stress. The pain syndrome may be accompanied by nausea, sometimes vomiting, constipation or diarrhea, and polyuria. The pain goes away on its own or is easily relieved with antispasmodics.
Outside of attacks, the state of health is satisfactory, there are periodically occurring, short-term pain sensations of a spastic nature in the right hypochondrium, epigastrium, umbilical region. Hypertensive dyskinesia is often accompanied by vasomotor (tachycardia, hypotension, cardialgia) and neurovegetative (irritability, sweating, sleep disturbance, headaches) manifestations. Palpation of the abdomen during a painful attack reveals Ker's symptom - maximum pain in the projection of the gallbladder. There were no signs of intoxication or signs of inflammation in blood tests.
Hypokinetic-hypotonic dyskinesia is characterized by constant, low-intensity, dull, aching pain in the right hypochondrium, a feeling of heaviness and stretching in this area. In the background strong emotions and eating, dyspeptic disorders develop - bitterness in the mouth, belching of air, nausea, loss of appetite, flatulence, constipation or diarrhea. Palpation of the abdomen reveals moderate pain in the projection of the gallbladder, a positive Ortner's sign. Neurosis-like manifestations are noted: tearfulness, irritability, mood swings, increased fatigue.
Diagnostics
The purpose of diagnosis is to verify the disease, determine the type of biliary dyskinesia, and exclude concomitant diseases that support dysfunction. Ultrasound of the gallbladder and biliary tract is aimed at determining the shape, size, deformation, congenital anomalies, stones of the biliary system. To determine the type of dyskinesia, ultrasound is performed on an empty stomach and after taking a choleretic breakfast, which makes it possible to evaluate contractile function gallbladder.
An informative diagnostic method is fractional duodenal intubation with examination of duodenal contents. By probing the duodenum, the tone, motility, reactivity, and state of the sphincter apparatus of the extrahepatic bile ducts are determined. With hyperkinetic dyskinesia of the gallbladder, the level of lipoprotein complex and cholesterol in portion B decreases; with hypokinetic it increases.
X-ray examination includes cholecystography and cholangiography. With their help, the architectonics and motility of the biliary tract are assessed. IN comprehensive examination Manometry of the sphincter of Oddi, cholescintigraphy, MRI of the liver and biliary tract can be used. It is advisable to study the coprogram, feces for dysbacteriosis and helminth eggs.
Treatment of biliary dyskinesia
Restoring the function of bile formation and bile drainage for different types of dyskinesia is also carried out differently. For hyperkinesia, choleretics (dry bile, cattle pancreas extract, flamin, hydroxymethylnicotinamide, oxafenamide), low-mineralized mineral waters in heated form, antispasmodics (drotaverine, papaverine, platiphylline), herbal infusions (decoctions of chamomile, peppermint, licorice root, dill fruits) are indicated. .
From non-drug methods For patients with hypertensive-hyperkinetic biliary dyskinesia, courses of psychotherapy, acupuncture, hirudotherapy, ozokerite and paraffin applications, diathermy, inductothermy, microwave therapy, electrophoresis with antispasmodics, acupressure, massage of the collar zone are recommended.
For the hypotonic variant, cholekinetics (xylitol, magnesium sulfate, sorbitol), highly mineralized water at room temperature, herbal medicine (decoctions of immortelle flowers, nettle leaves, rose hips, oregano, St. John's wort) are prescribed. If there are signs of intrahepatic cholestasis, blind probing (tubage) is indicated. To increase the overall tone, exercise therapy is prescribed, stimulating water procedures, toning massage.
Physiotherapy methods include diadynamic therapy, electrophoresis with magnesium sulfate on the liver area, low-intensity ultrasound, SMT therapy, impulse currents low frequency. Patients with gastrointestinal dyskinesia are advised to be monitored by a gastroenterologist and neurologist, as well as annual health courses in balneological sanatoriums.
Prognosis and prevention
The course of the pathology is chronic, however, subject to diet, healthy lifestyle, timely and proper treatment the disease can proceed without exacerbations. Otherwise, complications from the hepetobiliary system – calculous cholecystitis and cholangitis – may develop. Prevention of primary dyskinesia requires adherence to the principles healthy eating, timely correction of psycho-emotional disorders; prevention of secondary dyskinesia - elimination of the underlying disease.
Update: November 2018
Dyskinesia is not a curvature or bending of the gallbladder or the ducts leading from it, as most people believe. This term comes from Greek word"kinesis" means "movement" and the prefix "dis-" means "disturbance". Thus, biliary dyskinesia is a condition in which the tone or motility of the system that carries bile from the liver to the duodenum is impaired. This causes pain in the right hypochondrium, problems with stool, and sometimes bitterness in the mouth, but upon examination no damage to these organs is noted.
Most often, dyskinesia occurs in people who have anomalies in the development of the biliary organs, who have a love for an unbalanced diet, as well as in people who are often exposed to various psychologically traumatic situations. There are other reasons for this condition. Women are most susceptible to this pathology. Treatment of dyskinesia is aimed at eliminating symptoms, and also - especially if the biliary tract has a slow movement speed or poor contractility - at preventing the formation of stones.
A little about anatomy and physiology
Bile is a brownish-yellow liquid essential for digestion. Her main function– separate fats from food from each other, increasing their surface area. Then they are well processed by the enzyme lipase, as a result of which the components of fats - fatty acids - are absorbed into the blood. In addition, bile affects the absorption of proteins and carbohydrates. Under the influence of this substance, produced by the liver by ¾, and ¼ by the hepatic ducts, it works normally small intestine: processes of absorption of nutrients occur in it, as well as the division and death of its own cells.
For all of the above processes to occur correctly, bile must have a normal concentration. This is done by the gallbladder, which “gives” excess water to the vessels. If bile is not retained in the bladder, it enters the intestines in a diluted form and irritates it, causing diarrhea. If bile stays in the bladder for too long, it comes in too concentrated, which is also not beneficial.
Bile is formed in the liver. Next, it must reach the gallbladder through the bile ducts, and from there enter the duodenum. The movement of secretions is ensured by the difference in pressure in the biliary tract, which occurs due to the work of the circular muscles - sphincters. So, the sphincter that allows bile to enter the gallbladder is closed - it drains from the liver. Then it opens, and the secretion flows into the bladder, which was almost empty, and in which the pressure was less than in the duct. When does it enter the duodenum? fatty foods, the gallbladder, which is an organ equipped with muscles, contracts. In this case, the sphincter in the neck of the bladder opens, and the one with which the entrance to the duodenum begins is closed, and it opens when the first one closes. Contractions of the biliary tract are regulated by the sympathetic nervous system and certain substances produced in the stomach and pancreas.
What is dyskinesia, its types
Having examined the anatomy, we can explain the essence of the pathology in more detail. So, dyskinesia is a condition:
- if the sphincters (one or more) located in the bile ducts do not relax in time;
- or, conversely, despite eating, the sphincters do not want to relax;
- if there is a strong contraction of the gallbladder;
- if the gallbladder or ducts contract very sluggishly, reducing the rate of bile outflow.
Depending on the violations motor function and tone dyskinesia can be:
- hypertensive: sphincter tone is increased;
- hypotonic: tone, on the contrary, is reduced;
- hypokinetic: the movement of the biliary tract is slowed down, bile is released slowly;
- hyperkinetic: the outflow of bile is active, its portions are released sharply.
Usually increased tone is combined with enhanced motor skills, forming a hypertonic-hyperkinetic (or spastic) type of dyskinesia. The same thing happens in the opposite situation: with weak motor skills, the tone of the biliary tract is weakened - hypotonic-hypokinetic (atonic) type. There is also a mixed type.
Spastic dyskinesia is characteristic of increased tone parasympathetic division. The atonic type of the disease develops when the influence of the sympathetic part of the autonomic nervous system predominates.
Causes of the disease
The following reasons lead to disruption of the tone or movement of the bile ducts:
- Congenital malformations of the biliary tract and gallbladder:
- doubling of the bile ducts;
- congenital weakness of the bladder wall;
- intrahepatic gallbladder;
- inflection of the gallbladder;
- gallbladder divided by a septum;
- valves in the bile duct;
- accessory gallbladder;
- mobile bubble;
- abnormally located bubble.
All these pathologies cause dyskinesia called “primary”. Next, we list acquired diseases (occurring during life) that can cause secondary biliary dyskinesia.
- Eating Habits: long periods fasting, refusal vegetable fats or, conversely, eating large amounts of fatty, smoked and spicy foods.
- Constant stress or traumatic situations.
- Past pancreatitis or other inflammatory pathology Gastrointestinal tract or female organs.
- Chronic cholecystitis.
- Neurocirculatory dystonia, when the control of the normal sequence of contractions of the biliary tract is disrupted.
- Constantly existing foci of infection in the body (caries, chronic tonsillitis).
- Diseases endocrine organs: obesity, diabetes mellitus, thyrotoxicosis.
- Food allergies.
- Previous viral hepatitis.
- Worm diseases.
- Giardiasis, in which flagellated protozoa colonize the gallbladder.
- The period of menopause, when the regulation of contractility of the biliary tract is disrupted.
- Dysbacteriosis.
- Past intestinal infections.
Signs of the disease
Symptoms of biliary dyskinesia differ depending on the type of pathology: whether it is hyperkinetic or hypokinetic.
The main difference between the main types of the disease is pain with dyskinesia:
| Characteristics of pain | Hyperkinetic type | Hypotonic type |
| Localization | In the right hypochondrium | In the hypochondrium on the right |
| Character | Acute, colicky | Dull, aching, non-intense. May be described as heaviness or stretching of the area under the rib |
| Where does it give | In the right shoulder blade and shoulder | Feels only under the rib |
| What provoked | Physical activity, stress, after fatty foods | Strong emotions, errors in diet |
| What other symptoms accompany the pain? |
Nausea, vomiting, large amounts of urine, constipation/diarrhea. During an attack there may be: irritability, sweating, decreased blood pressure, headaches |
Bitterness in the mouth, nausea, loss of appetite, belching of air, feeling of “bloating” in the abdomen, constipation/diarrhea |
| What eliminates | Preparations "No-shpa", "Buscopan" | Goes away on its own |
| During the period outside the attack | Nothing worries you, only short-term pain may appear in the right hypochondrium, “in the pit of the stomach”, near the navel | The disease reversibly changes a person’s personality: he becomes whiny, irritable, gets tired quickly, and has mood swings. Outside of an attack, nothing hurts |
Both types of dyskinesia can cause other symptoms:
- irritability;
- increased sweating;
- recurrent headaches;
- bad breath;
- bloating;
- decreased appetite;
- bitterness in the mouth;
- yellow coating on the tongue;
- decreased libido in men;
- Some women experience menstrual irregularities.
An extreme manifestation of the hyperkinetic variant is biliary colic. It manifests itself as sudden severe pain on the right under the rib, which is accompanied by an attack of panic, numbness of the limbs.
The maximum manifestation of hypokinetic dyskinesia is cholestasis - stagnation of bile in the bile ducts. The following symptoms indicate this:
- severe itching of the entire skin;
- yellowing of the skin and whites of the eyes;
- darkening of urine;
- the stool takes on a light yellow or even grayish color.
Diagnostics
Symptoms alone are not enough to make a diagnosis, because similar signs can develop with more serious liver diseases. Secondly, it is necessary to establish the cause (for example, malformations of the biliary tract) that caused the disease in order to subsequently eliminate it.
Biliary dyskinesia is a condition in which the structure of these organs is not impaired. That is, the diagnosis is made based on the violation of contractility or tone on the way from the liver to the duodenum. How to see it?
Ultrasound
After performing an ultrasound of the gallbladder with a choleretic breakfast. First, after following a three-day diet, a “regular” ultrasound of the abdominal cavity is performed. With its help, volumes, sizes, deformations, and anomalies of the biliary tract are assessed, and an examination is performed for gallstones. Next, the person takes foods that should cause the release of bile into the duodenum (this could be: 100 grams of cream or full-fat sour cream, full-fat yogurt, chocolate or a couple of bananas), and the doctor looks at the sequence and how the movement of bile occurs.
Duodenal sounding
By assessing portions of the contents of the duodenum. To do this, a study called “duodenal intubation” is carried out: a person needs to swallow thin probe, from which, upon reaching the duodenum, its contents will be obtained. The study is carried out on an empty stomach. First, a portion of the usual intestinal contents is obtained from the probe, which consists of bile, fluid secreted there by the pancreas and the juice of the duodenum itself. Next, a choleretic drug, magnesium sulfate, is injected into the probe. The gallbladder contracts and the bile contained in it enters the intestine. She is also taken for research. Over time, bile, which was previously in the intrahepatic bile ducts, flows here. She is also taken for analysis. To establish the diagnosis of dyskinesia, the time that passes from the moment of administration of the choleretic drug to the receipt of the second and then the third portion is important. The content of various lipids in the last two servings is also important.
Cholecystography
Using contrast radiography methods - cholecystography (extrahepatic bile ducts are examined) and cholangiography (intrahepatic bile ducts are examined). In the first case, a person needs to take an X-ray contrast agent through the mouth, after which X-rays will show how the contrast reaches the gallbladder, how it comes out of it, and in what sequence the sphincters contract and relax. The second method involves an injection: a radiopaque substance is injected directly into the bile ducts, and then a radiologist monitors its progress along the bile ducts.
ERCP
When performing ERCP (endoscopic retrograde cholangiopancreatography), when a probe with an optical fiber is inserted into the duodenum, and through it a contrast agent is injected directly into the biliary tract, the retrograde (that is, opposite to the normal flow) movement of which is examined using X-rays.
Cholescintigraphy
Through a radiological study - cholescintigraphy, in which a radioisotope drug is introduced into the body, and in the light of special radiation, it is visualized how it passes into the liver, is released into the bile ducts, is sent to the gallbladder, and then reaches the duodenum.
Magnetic resonance cholangiography
IN difficult cases Magnetic resonance cholangiography is indicated - a non-invasive research method when a contrast agent is injected into the body, and its path is observed in a magnetic resonance imaging scanner. To carry out such a diagnosis, a person will need to stay in the device’s chamber for about 40-50 minutes, keeping still.
Blood tests for lipids and bilirubin with its fractions, stool analysis for dysbacteriosis, helminth eggs and coprogram - methods that allow you to determine the integrity of the function of the biliary tract, as well as exclude possible reason diseases - worms. These tests do not make a diagnosis.
Treatment
Treatment of biliary dyskinesia consists of:
- diet therapy: it differs in hypo- and hyperkinetic forms of pathology;
- taking decoctions or infusions of various herbs: it is prescribed by a gastroenterologist, taking into account the type of disease, and is an integral part of treatment;
- drug therapy: prescribed in courses, aimed at stopping an attack, preventing their occurrence in the future, as well as to prevent complications.
Diet therapy
Nutrition for dyskinesias is the main “whale” of treatment. Only he, with strict adherence to the rules, allows you to avoid attacks and prevent such surgical complications, How acute cholecystitis and cholelithiasis.
The diet for dyskinesia contains general nutritional rules, but there are also points that are radically different in the hypokinetic and hyperkinetic variants.
General rules
You need to eat food so that the gallbladder is completely emptied, but no pain attacks occur. To do this:
- eat little by little, 4-5 times a day;
- eat food in small portions;
- maintain 3-4 hour intervals between meals;
- eat dinner 2-3 hours in advance, but do not gorge yourself on meat at night;
- morning and evening eat low-fat fermented milk products;
- avoid eating cold or too hot foods;
- Do not heat food with animal or trans fats: margarine, pork, goose or lamb.
| Eliminate completely | Exclude only in case of exacerbation | You can eat |
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Features of nutrition for hypomotor dyskinesia
The diet must contain foods that stimulate biliary motility:
- fruits;
- vegetables (baked, stewed, boiled);
- butter and vegetable oils;
- sour cream;
- black bread;
- eggs;
- cream.
Features of nutrition for hypermotor dyskinesia
With this form of the disease, it is imperative to exclude from the diet foods that stimulate bile formation and secretion: animal fats, brown bread, fatty dairy and fermented milk products, fresh vegetables, broths and soda.
Drug therapy
It also has general purposes, and is also based on the type of dyskinesia.
Since dyskinesia is considered a disease, the main cause of which is nervous regulation, which depends directly on the psyche. Therefore, before treating the disorder motor activity biliary tract with the help of choleretic drugs, you need to start with restoration mental background. If the pathology occurs against the background of a depressive state, a course of mild antidepressants is prescribed. If the violation of bile secretion was provoked by neuroses, expressed anxiety, it is advisable to start with tranquilizers or antipsychotics.
Such prescriptions are made by a psychotherapist or psychiatrist.
In addition, the cause that caused dyskinesia is treated: anthelmintic therapy, allergy treatment, elimination of hypovitaminosis, correction of dysbiosis.
Hypotonic-hypokinetic form
In this case you need choleretic drugs, which:
- will increase the tone of the gallbladder: magnesium sulfate, xylitol;
- improve motility of the biliary tract: for example, cholecystokinin, pancreozymin.
In addition to choleretic drugs, tonic preparations are also needed: ginseng tincture, Eleutherococcus extract, Schisandra tincture.
Hypertonic-hyperkinetic form
Here we need drugs that increase the formation of bile: there will be more of it, the bile ducts will work longer, and not contract quickly, causing an attack of pain. These are medications such as ocafenamide, flamin, nicodin.
Also, if the sphincters are overstrained, they are relaxed. This is done with antispasmodic drugs: no-spa, buscopan.
In addition, we need such means that normalize the balance of parasympathetic and sympathetic systems: valerian tincture, potassium bromide, motherwort tincture.
Treatment with traditional methods
Biliary dyskinesia is a pathology in the treatment of which folk remedies– an excellent addition to drug therapy, and sometimes its only component (for example, in children).
If tests show the presence of cholestasis (stagnation of bile), and the liver tissue is not damaged (the levels of ALT and AST are not increased in the “liver test” analysis), blind soundings are performed: a sorbitol solution is drunk on an empty stomach, mineral water high mineralization or magnesium sulfate. Then you need to lie on your right side and put it under it. You need to lie down like this for 20-30 minutes.
Additional treatments
In the treatment of biliary dyskinesia the following are used:
- physiotherapy: diadynamic currents, electrophoresis, microwave;
- acupuncture;
- acupressure;
- treatment with leeches;
- treatment in gastroenterological sanatoriums, which provide therapy with mineral waters.
Complications of biliary dyskinesia
This functional disorder can lead to the following consequences:
- formation chronic inflammation gallbladder walls (chronic cholecystitis);
- inflammation of the intrahepatic bile ducts (cholangitis);
- cholelithiasis;
- inflammation of the pancreas;
- gastritis, gastroduodenitis - inflammation of the stomach or stomach, or duodenum. This is due to the fact that in this disease, unconcentrated bile is often thrown into the stomach and duodenum, which leads to their inflammation;
- allergization of the body, which manifests itself as a skin rash;
- weight loss, metabolic disorders, which occurs due to malabsorption necessary substances without proper treatment with bile.
Prevention of the disease and its prognosis
To prevent pathology from developing, follow these rules:
- sleep at least 8 hours;
- go to bed no later than 11 pm;
- alternate mental and physical work;
- walk outside in the fresh air;
- eat well: eat more plant food, cereal products, boiled animal products, less - fried meat or fish;
- exclude psychologically traumatic situations.
If the pathology has already developed, you should follow the recommendations of your gastroenterologist and pay attention to the psycho-emotional background.
Biliary dyskinesia does not reduce life expectancy, but affects its quality.
Dyskinesia in children
Biliary dyskinesia in children younger age develops due to their abnormal structure. Most often this is a bend in the gallbladder or the presence of septa in it, less often - doubling or an abnormal location of the biliary tract.
In older children, the cause is emotional stress. These include quarrels between parents, family relocation, staff at kindergarten and school, and a heavy academic load.
Other causes of dyskinesia are:
- hypoxia or;
- frequent sinusitis, chronic tonsillitis;
- past hepatitis A, dysentery, salmonellosis;
- helminthic infestations: giardiasis, roundworms;
- allergic diseases;
- vegetative-vascular dystonia;
- neuroses;
- neuro-arthritic diathesis.
Dyskinesia in children is a more dangerous disease: without normal emulsification of fats, the absorption of sufficient amounts needed by the body will not occur. fatty acids and other substances, as well as fat-soluble vitamins - A, D, E and K, each of which is important for a growing body.
If parents notice that the child is withdrawn, irritable, gets tired quickly or cries at the slightest provocation, it is worth contacting pediatric gastroenterologist to exclude biliary dyskinesia. If on at the moment even if it is not detected, this does not mean that the danger has passed; this suggests that there is a predisposition to it, but the pathology has not yet had time to debut. In this case, it is worth paying special attention to the child’s diet and daily routine in order to prevent its formation.
The following symptoms indicate that pathology has developed:
- alternating constipation and diarrhea;
- periodically - especially after eating fatty or fried foods - pain in the right hypochondrium;
- itching of the skin that appeared for an unknown reason, not after an injection, not after a bite, taking a new food or taking a new medicine.
Diagnosis of pathology is carried out according to ultrasound data with a choleretic breakfast. X-ray contrast, and even more so, radioisotope techniques in children are carried out according to strict indications, and with the advent of magnetic resonance cholangiography they are almost never performed.
Treatment in children
For therapy in children, preference is given to herbal preparations. They are selected depending on the type of pathology.
So, for hypomotor dyskinesia the following are prescribed:
- drugs that stimulate the formation of bile: holagol, holosas, allohol, lyobil;
- medications that increase the tone of the biliary tract: magnesium sulfate, sorbitol or xylitol;
- herbal therapy: decoctions of dandelion, rose hips, corn silk, mint;
- “blind probes” with sorbitol or xylitol;
- mineral waters: “Essentuki 17”.
For hypermotor dyskinesia, treatment is carried out:
- antispasmodic drugs: aminophylline, riabal;
- herbal therapy: decoctions of St. John's wort, chamomile, stinging nettle;
- low-mineralized waters: “Slavyanovskaya”, “Smirnovskaya”;
- electrophoresis with novocaine on the gallbladder area.
After the attack is stopped, rehabilitation is carried out in a sanatorium, where mineral waters and other physical procedures are prescribed:
- Microwave therapy;
- galvanic collar according to Shcherbak;
- sodium chloride baths;
- to eliminate spasm of the biliary tract: magnetotherapy, electrophoresis of antispasmodics (no-shpa, ) on the area of the biliary tract;
- for sedative purposes: pine baths, bromelectroson;
- to improve the motor activity of the biliary tract: SMT therapy, magnesium sulfate electrophoresis.
The diet described above fully applies to children. A strict diet is prescribed for a year, then - in the absence of attacks of biliary colic - you can gradually expand the diet.
Children with dyskinesia are registered with a pediatric gastroenterologist, neurologist and pediatrician. They are scheduled for scheduled ultrasound twice a year. Also, courses of choleretic therapy are conducted every 6 months. Once or twice a year, the child is given referrals for sanatorium treatment.
The biliary tract is a system of ducts through which bile is drained from the liver and gallbladder to the proximal small intestine (duodenum). Bile is a dark yellow, brown or olive viscous liquid with a specific odor and bitter taste, synthesized by the structural elements of the parenchymal liver tissue - hepatocytes. It is necessary for proper digestion and maintenance metabolic processes, therefore, insufficient flow of bile into the duodenum can lead not only to persistent digestive disorders, but also to serious diseases caused by a lack of certain elements. One of the factors that negatively affects the removal of bile into small intestine, is a violation of the motility of the gallbladder and its ducts, which is called biliary dyskinesia.
Bile has a rather complex chemical composition, the bulk of which (more than 60%) is bile acids. They can be primary (formed in liver cells during the synthesis of hepatic bile) and secondary. Secondary acids (ursodeoxycholic, allocholic, etc.) are formed during primary digestion in the duodenum under the influence of microbial flora and digestive enzymes. They are absorbed in the intestine, after which they again enter the liver through the portal vein. Bile, saturated with secondary acids, is called mature and accumulates in the gallbladder, from where it enters the intestine and participates in the digestion and breakdown of chyme.
A sufficient supply of concentrated (mature, cystic) bile is of great importance for proper operation gastrointestinal tract, since such bile contains several times more organic matter, ions and phospholipids compared to hepatic bile. It also contains plant steroids and immunoglobulins, which take part in the formation of the body's immune defense.
The main functions of bile are:
- removal from the body of toxic pigments (bilirubin), cholesterol crystals and other substances that cannot be filtered by the renal system;
- creating favorable conditions for enzymatic activity by inhibiting pepsin, which can interfere with the production of digestive enzymes;
- stimulation of intestinal motor function (prevention of constipation);
- preventing the adhesion of bacterial pathogens and certain complex proteins;
- participation in the synthesis of mucus necessary for proper digestion and protection of the intestinal mucous membranes (in particular, the duodenum) from the aggressive action of pepsin, hydrochloric acid and some hormones, such as gastrin.
If only hepatic bile enters the small intestine, all main stages of digestion are disrupted, which is a prerequisite for the development of many serious diseases digestive system: inflammation of the gallbladder and ducts, cholelithiasis, gastritis, duodenitis, etc.
Important! Long-term dyskinesia of the bile ducts is one of the main factors in the development of bacteriocholia. This is a pathology in which opportunistic and pathogenic bacteria accumulate and multiply in the bile, some of which can be dangerous to humans. Stagnation of bile, which characterizes up to 95.3% of all biliary dyskinesias, creates favorable conditions for the growth of pathogenic flora and is a catalyst for acute inflammatory processes in the gallbladder and its ducts.
Biliary dyskinesia: what is it?
Biliary dyskinesia (biliary dyskinesia) is a disorder of the motor function of the bile ducts, characterized by the simultaneous closure of the muscular sphincters located in the neck of the gallbladder and the mouth of the common bile duct.
The disease leads to the impossibility of drainage of gallbladder bile and its stagnation, which is the main pathogenetic factor in the development of cholelithiasis, trophic changes in the muscular lining of the gallbladder (mainly by type of hypertrophy), as well as inflammatory processes in the biliary and digestive organs. In 60% of cases, biliary dyskinesia is accompanied by the formation of a crystalline precipitate or suspension consisting of cholesterol, calcium salts and bile pigments.
Dyskinesia is the main cause of inflammatory processes in the gallbladder and the development of cholelithiasis
When they talk about biliary dyskinesia, they mean a violation contractile activity not only the gallbladder, but also the bile ducts, consisting of various ducts. Innervation (control, regulation of basic functions) is carried out by the branches of the hepatic nerve plexus, formed by nerve fibers coming from the celiac plexus. The hepatic nerve plexus belongs to the autonomic nervous system, so vegetative-vascular disorders and stress factors are of great importance in the mechanism of dyskinesia formation.
There are four groups of bile ducts:
- common bile duct;
- cystic duct;
- hepatic ducts;
- general hepatic duct.
The blood supply to the biliary tract is carried out by the hepatic artery and its branches, therefore, with liver diseases, the risk of motor disorders in the biliary system increases several times. The outflow of lymphatic fluid occurs in the liver lymph nodes located along the portal vein.
Biliary tract (ducts)
| Name | Anatomy and characteristics |
|---|---|
| Hepatic ducts | They leave the liver and perform a drainage function. Located on the right and left sides (a person has two hepatic ducts in total). |
| Common hepatic duct | It is formed by two hepatic ducts and performs the function of excretion (the common hepatic duct drains bile into the duodenum and gall bladder). |
| Cystic duct | It starts from the cervical part of the gallbladder and intersects with the gallbladder artery. Performs the function of draining bile from the gallbladder. |
| Common bile duct | It is formed at the connection of the common hepatic and cystic duct, and its segments can be in close proximity to the duodenal part of the small intestine and the pancreas. |
Causes of dyskinesia
Many people think that the cause of digestive dyskinesia (biliary and intestinal hypotension or hypertension) is only diseases of the digestive system. This is wrong. One of the main causes of impaired motor function of the biliary tract is autonomic disorders nervous system (neurocirculatory dysfunction). Chronic stressful situations, depressed, mental disorders, neuroses negatively affect the functioning of the nervous apparatus that forms the hepatic nerve plexus, which innervates the functioning of the bile ducts. If a person often experiences increased anxiety, fear, or suffers from panic attacks, the risk of impaired peristalsis of the stomach, intestines, gallbladder and other organs will be very high.
Neuroses, panic attacks, anxiety - all this has the most negative impact on the functioning of the entire digestive tract, including the biliary system
A fairly significant factor determining the mechanism of development of dyskinesia is a violation eating behavior, manifested by overeating (or, conversely, prolonged fasting), increased consumption of fatty, spicy, smoked and refined foods, as well as abuse of alcoholic beverages. It has been proven that the motor function of the organs of the digestive and hepatobiliary system in patients who monitor their diet is stable, and the risk of constipation not associated with diseases of the stomach and intestines is minimal in this category of patients.
Other causes of biliary dyskinesia in different age groups of patients may be:
The risk of genetically determined dyskinesia, provided that at least one of the parents suffered from this disease, is at least 19.1%. In women important factor risk is the use of oral contraceptives, therefore drugs in this group should be prescribed strictly by the attending physician.
Important! Spasm of the sphincter of the hepatopancreatic ampulla, characteristic of hypotonic dyskinesia, occurs mainly against the background of increased tone of the sympathetic nervous system (the part of the nervous system that regulates the functions of respiration, digestion and circulation). The cause of common bile duct hypertension in most cases is inflammation of the vagus nerve.
Classification and features of the clinical course
Pathology can occur in two forms. With hypotonic (hypokinetic) dyskinesia, weak or absent peristalsis is noted. Dyskinesia of the hyperkinetic type, on the contrary, is characterized by increased tone of the smooth muscle muscles of the gallbladder, muscle spasms and chaotic contractions, in which the uniform drainage of bile into the duodenal space of the small intestine is disrupted.
Forms of biliary dyskinesia and their features
| Type of motor impairment | What is it characterized by? | Possible symptoms |
|---|---|---|
| Hypokinetic | Weak muscular peristalsis of the bile ducts and gallbladder, leading to stagnation of bile in the cavity of the gall sac. | Pain due to hypotension of the biliary tract is usually aching or dull in nature, occurs in the area of the right hypochondrium, and can radiate to the chest, forearm and arm (the localization of pain is always on the right side). Of the digestive disorders, the most typical are: stool instability (sudden attacks of constipation or diarrhea), belching, bitterness and metallic taste in the mouth, nausea, flatulence. In severe cases, dark olive-colored vomit with pungent odor and an admixture of bile acids. |
| Hyperkinetic. | Spasm of the biliary tract and too active contraction of the gallbladder, in which bile is released into the intestines in uneven portions. | The nature of pain in hyperkinetic dyskinesia is determined by pathogenetic features. Spasm of the bile ducts causes sharp, cutting, dagger-shaped or stabbing pain V epigastric region right. Typical symptom is constant nausea, not related to food intake. |
A characteristic symptom of functional disorders of the gallbladder and ducts is the short duration of pain and its connection with food intake. Body temperature is normal in almost all cases (with the exception of dyskinesias complicated by cholecystitis, cholangitis and other diseases of the biliary system). The liver and spleen in this pathology have normal sizes, and their increase indicates secondary pathologies developing against the background of prolonged stagnation of bile.
Pay attention! The appearance of symptoms of intoxication ( high temperature, chills, sweating, headache, fever) indicates the development of bacteriocholia. To destroy pathogenic flora with confirmed growth of pathogenic and opportunistic bacteria, the patient is prescribed penicillin antibiotics (mainly amoxicillin and ampicillin).
Diagnosis of functional disorders of the biliary tract
List of diagnostic manipulations and procedures necessary to identify possible violations, assessment of motor and secretory function, as well as determination of the chemical composition of bile, is compiled by a therapist or gastroenterologist based on an initial physical examination and anamnesis. The standard diagnostic scheme for suspected gallbladder dyskinesia includes the following tests and examinations:
- biochemical blood test. Allows you to define content total lipids, cholesterol (cholesterol), phospholipids and bilirubin in the blood. Diagnostic sign disturbances in the removal of bile from the gallbladder is an increase in the activity of liver transaminases (enzymes) and alkaline phosphatase;
- Ultrasound of the hepatobiliary system(including the liver, hepatic ducts and common hepatic duct). Ultrasound diagnostics is necessary to identify symptoms of cholelithiasis;
- duodenal sounding. The procedure is performed using a special flexible probe, which is inserted into the duodenum. Probing the liver and gallbladder in this way allows not only to collect bile for research, but also to inject medicines, as well as carry out drainage to facilitate bile secretion;
- cholecystography. X-ray examination of the gallbladder using contrast solutions.
The most common diagnostic method for gallbladder dyskinesia is cholecystography.
If the diagnosis of “biliary dyskinesia” is confirmed, the doctor will prescribe treatment, which, in addition to drug correction, also includes a special diet, physiotherapeutic methods and other conservative techniques.
How to restore gallbladder motility: treatment and diet
Assessing the motor function of the biliary organs is of great importance in drawing up an individual treatment protocol. Incorrectly selected medications can not only reduce the effectiveness of treatment, but also harm the body, so only a doctor should prescribe any medications.
Hyperkinetic form
To treat this form of dyskinesia, drugs that relax smooth muscles (“Drotaverine”, “No-shpa”) and choleretic drugs (“Holosas”, “Allochol”) are used. As auxiliary component The doctor may prescribe therapy medicinal fees(corn silk, immortelle, rose hips, etc.). To enhance the effectiveness of treatment, lavage of the liver and gallbladder with heating (tubage) is indicated.
"Holosas": instructions for use
A diet for increased tone and spasm should include a sufficient amount of coarse plant fiber, which is found in vegetables, fruits, herbs, cereals and berries. Persons with chronic diseases of the gastrointestinal tract should consume them pureed or baked.
All dishes and products that can stimulate contraction of the gallbladder and ducts should be completely excluded from the patient's diet. These include:
Meals are fractional. Portions are limited to 220-250 g per meal.
Hypokinetic form
If the contractile activity of the biliary system organs is insufficient, a diet with sufficient lipid content is indicated. Sources of healthy fats can include:
It is recommended to consume 50-70 g of black or rye bread daily, as well as salads from fresh vegetables and fruits. Drug correction includes choleretic drugs (“Cyqualon”, “Cholenzim”), herbal treatment (sandy immortelle, peppermint), the use of solutions of xylitol or sorbitol 10%, as well as Carlsbad salt, which is obtained by evaporation from water mineral springs Czech Republic.
To increase smooth muscle tone, herbal tinctures (Eleutherococcus, Rhodiola rosea, Schisandra, ginseng root) can be prescribed.
The use of mineral waters for dyskinesia
Treatment of liver and gall bladder diseases with mineral waters has been practiced since Soviet times. Mineral water with a certain degree of mineralization can improve the flow of bile and restore normal motility of the biliary tract, but it must be consumed correctly. Before starting treatment with mineral water, you must consult a doctor, since not all waters are equally suitable for the treatment of hypokinetic and hyperkinetic forms of dyskinesia.
The rules for using mineral water for the treatment of peristaltic disorders of the biliary tract are given in the table below.
How to treat dyskinesia with mineral water
| Options | Hypokinetic form | Hyperkinetic form |
|---|---|---|
| Which water to choose | ||
| Water temperature when drinking | Cold (room temperature). | Hot (about 40°C). |
| Amount of water per dose | 100-200 ml. | 100-200 ml. |
| Number of appointments per day | 3-4 times. | 3-4 times. |
| When to take | 1 hour before meals. | 30 minutes before meals. |
The total duration of therapy is 3-4 weeks.
Prevention
Prevention of dyskinesia consists of following a diet, controlling the psycho-emotional state, and increasing the level of physical activity. You need to eat regularly, at least 4-5 times a day, and the serving size should not exceed 250 ml. If you are prone to digestive disorders or have chronic diseases, you should avoid frying and baking with the addition of vegetable oils: all dishes are best consumed boiled or stewed.
Steamed cutlets are the best option for liver and gall bladder diseases
As a preventative measure for patients from the group increased risk You should also follow the recommendations below.
- The emotional health of a person is of great importance in the functioning of the biliary tract, therefore it is important preventive factor dyskinesia is the elimination of the stress factor (if necessary, taking antidepressants and sedatives).
Herbal infusions - excellent remedy for stress and emotional overload
- The work and rest regime must correspond to the physiological and age standards. The duration of sleep during the day is at least 7-8 hours. Before going to bed at night, ventilate the room for a long time (about 30 minutes).
- Fasting days for gallbladder diseases are indicated for persons with overweight body (once every 7-10 days).
- Exercise therapy, health-improving gymnastics, and swimming should be regular – 3-4 times a week.
Of great importance in the prevention of biliary dyskinesia is also timely treatment chronic diseases (primarily pathologies of the digestive system).
It is very important not to neglect gastrointestinal diseases and consult a specialist in a timely manner. Also, do not forget about preventive examinations - this will avoid many health problems.
Biliary dyskinesia is a pathology that in itself is not very dangerous for human health, but if measures are not taken in time to correct it, it may occur. serious consequences, for example, infectious and inflammatory diseases of the gallbladder or cholelithiasis. Treatment of the disease should be carried out under the supervision of a specialist, since incorrectly selected therapy can worsen the patient’s condition and negatively affect the overall dynamics of treatment.
Video - Biliary dyskinesia
The gallbladder is a hollow organ of the digestive system, the main function of which is to collect bile and direct it, if necessary, to the small intestine, namely the duodenum.
Diseases of the gallbladder and biliary tract occupy leading positions in the structure of pathology of the digestive tract. Moreover, gallbladder pathology occurs more often in women than in men.
Considering the prevalence of this problem, we propose to consider in this topic the most common gallbladder diseases, symptoms and treatment individual species pathology. But first, we want to introduce you to the anatomy and functions of the gallbladder.
The gallbladder is a hollow, pear-shaped organ with a wider base and a narrow distal end that merges into the cystic bile duct. Normally, the length of this organ is 80-140 mm, and the diameter is 30-50 mm.
The gallbladder is usually divided into three parts: neck, body and fundus. This organ is located on the lower surface of the liver in the fossa of the same name.
The wall of the gallbladder consists of three layers - serous, muscular and mucous. The mucous layer has many longitudinal folds.
The unchanged gallbladder cannot be palpated through the abdominal wall. The projection zone of this organ is located at the point of intersection of the outer edge of the rectus abdominis muscle and the right costal arch, which is called Ker's point. In cases where the gallbladder is enlarged, it can be palpated.
Gallbladder: functions
The gallbladder functions as a reservoir in which bile is stored. Liver cells produce bile, which accumulates in the gallbladder. When a signal is received, bile enters the cystic duct, which flows into the common bile duct, and the latter opens into the duodenum.
In addition to the reservoir function, the organ has other purposes. Thus, mucus and acetylcholecystokinin are produced in the gallbladder, and nutrients are also reabsorbed.
Healthy people produce up to one liter of bile per day. The maximum capacity of the gallbladder is 50 ml.
Bile consists of water, bile acids, amino acids, phospholipids, cholesterol, bilirubin, proteins, mucus, some vitamins, minerals, and metabolites of medications that the patient is taking.
The following tasks are assigned to bile:
- neutralization of gastric juice;
- activation of the enzymatic ability of intestinal and pancreatic juice;
- neutralization pathogenic microorganisms in the intestines;
- improvement of motor function of the intestinal tube;
- removal of toxins and drug metabolites from the body.
Gallbladder diseases: causes and mechanism of development
All causes of diseases of this organ can be divided into groups, namely:
Gallbladder: brief description of diseases
- Gallstone disease. This disease most often affects fair-haired women who have given birth over 40 years of age, who are overweight or obese. Stones are cholesterol, bilirubin brown and black, which can form in all parts of the biliary system. Rarely, only the gallbladder is affected. Gallstone disease is a long-term chronic disease with periods of exacerbation and remission. In the acute period, stones obstruct the cystic duct, as a result of which patients experience acute pain with other unpleasant symptoms. This combination of symptoms is commonly called hepatic colic.
- Chronic noncalculous cholecystitis. In this case, there are no stones, and inflammation of the mucous layer of the gallbladder is caused by an infectious agent, reflux of intestinal juice, diseases of the pancreas (pancreatitis), liver (hepatitis) or cholestasis.
- Biliary dyskinesia. This disease is characterized by the absence of organic changes in the gallbladder and ducts and occurs against the background of impaired innervation. Chronic stress, excessive physical and mental stress, and neurasthenia contribute to the development of dyskinesia. There are two types of dyskinesia - hyperkinetic, when intestinal peristalsis is too active, but chaotic, and hypokinetic, when bladder peristalsis is weakened.
- Acute cholangitis, or inflammation of the bile ducts. Almost always to this disease cause other diseases of the liver and gallbladder (cholecystitis, cholelithiasis, hepatitis, postcholecystectomy syndrome and others).
- Carcinoma. Malignant tumors in the gallbladder develop against the background of chronic inflammation. This type of tumor is characterized by high malignancy and the appearance of screenings in the early stages of the disease.
What are the symptoms of gallbladder disease? Most gallbladder diseases have common symptoms.
Patients may experience the following symptoms:
- pain that is localized in the right hypochondrium. Moreover, the intensity of the pain syndrome with various diseases different. For example, polyps are completely painless, but calculous cholecystitis or cholelithiasis cause acute severe pain.
- dyspepsia, such as nausea, vomiting, bloating, diarrhea, or constipation;
- bitterness in the mouth. In this case, it is necessary to carry out a thorough differential diagnosis, since this symptom may also accompany liver disease;
- redness of the tongue. This symptom commonly called “raspberry tongue”;
- change in urine color. Due to cholestasis, it accumulates in the urine large number urobilinogen, which gives it the color of dark beer;
- discoloration of stool. As a result, stercobilin, which gives the stool a natural brown color, does not enter the stool;
- jaundice. With cholestasis, bile begins to be reabsorbed into the blood, as a result of which bile acids and bilirubin are deposited in the skin and mucous membranes. The sclera and oral mucosa turn yellow first, and only then the skin.
The listed symptoms and signs are the main ones for gallbladder diseases. But depending on the nosological form and course of the disease, other symptoms may also appear, such as increased body temperature, general weakness, malaise, loss of appetite and others.
Diagnosis and treatment of gallbladder diseases is carried out by a general practitioner, gastroenterologist, surgeon or hepatologist. First of all, if symptoms of diseases of this organ appear, you need to contact a general practitioner, who, if necessary, will refer you to related specialists.
At objective examination The doctor must palpate the liver and gallbladder, with the help of which you can determine pain points, that is, bladder symptoms, namely:
- Ker's sign– pain when palpating the gallbladder while inhaling;
- Georgievsky-Mussi symptom - the appearance of painful sensations when pressing on a point located between the legs of the right sternocleidomastoid muscle;
- Ortner-Grekov symptom– pain is provoked by tapping the edge of the palm on the right costal arch.
But complaints, anamnesis and objective data will not be enough to make an accurate diagnosis, so patients are prescribed the following additional studies:
- general blood test, which is used to determine blood changes characteristic of the inflammatory process in the body;
- general and biochemical urine analysis allows us to identify increased level urobilinogen;
- coprogram will show disturbances in digestive function;
- duodenal sounding. This method is performed using a thin rubber probe, which is placed through the oral cavity into the duodenum to collect portions of bile.
- chemical analysis of bile used to study its composition.
- bile culture suggests the etiology of the disease;
- Ultrasound examination of the abdominal organs. By using this method can be studied anatomical features gallbladder and identify organic changes, inflammation and the presence of stones.
- biopsy, which is performed with a thin needle under ultrasound guidance. The resulting material is examined under a microscope for the presence of cancer cells.
- cholangiography– this is an X-ray contrast examination of the gallbladder and bile ducts;
- computed tomography used mainly in gallbladder cancer to estimate the prevalence of dropouts.
Treatment of gallbladder diseases
All patients are required to be prescribed a diet, the principles of which we will discuss below.
Etiotropic treatment consists in the use of drugs that are aimed at eliminating the cause. For cholecystitis, antibacterial therapy is indicated; for stones, carcinoma or polyps of the gallbladder, surgical intervention is indicated.
Pathogenetic treatment consists of using drugs that normalize the functioning of the gallbladder. For this purpose, antispasmodic, detoxification, anti-inflammatory and enzymatic drugs can be used.
Symptomatic treatment involves the prescription of painkillers, choleretic, antipyretic and other drugs. For pain, drugs such as Ketonal, Baralgin, Drotaverine, Spazmolgon and others can be used.
Folk remedies will be an excellent complement to traditional therapeutic measures.
Even experts often traditional therapy gallbladder pathologies are supplemented with herbal medicine. We bring to your attention the recipes of the most effective means and indications for their use.
Rosehip decoction: Grind 3 tablespoons of rose hips in a mortar, pour in 300 ml of boiling water and boil over low heat for 5 minutes. Then remove from heat, allow to cool and filter through a fine sieve. The prepared decoction is taken orally, 100 ml three times a day, 10 minutes before meals. This decoction has choleretic, analgesic and anti-inflammatory effects and is an analogue of the drug "Holosas". This medicine is used for non-calculous cholecystitis, cholangitis, hepatitis, biliary dyskinesia and other diseases in which the outflow of bile is slowed down.
Beetroot decoction: Wash two medium beets, peel and cut into small pieces, then add 10 glasses of water, bring to a boil and cook over low heat for about five hours. When the beets are ready, grate them, place them in cheesecloth and squeeze out the juice, which is combined with the broth. Take this medicine 60 ml half an hour before meals three times a day. For cholecystitis, the course of treatment is from 7 to 10 days.
Herbal collection: mix 1 tablespoon of herbs such as celandine, tansy (flowers), mint (leaves), calendula (flowers), wormwood, fennel seeds, dandelion (root), corn silk, immortelle (flowers). After this, 10 grams of the resulting mixture is poured with two glasses of boiling water, covered with a lid and left for 40 minutes. The finished infusion is filtered through a fine sieve and taken orally 100 ml 3 times a day before meals. This medicine has analgesic, choleretic and anti-inflammatory effects, so it is prescribed for cholangitis and cholecystitis.
Infusion of lingonberry leaves: 10 grams of crushed lingonberry leaves are poured into 200 ml of boiling water, covered with a lid and left for 40 minutes. The finished medicine is stored in the refrigerator and taken 30-40 ml 4-5 times a day before meals. An infusion of lingonberry leaves dissolves stones in the gall bladder and ducts. Olive oil has the same effect, which should be consumed in a dose of 15 ml before each meal.
Dietary nutrition for gallbladder diseases
For gallbladder diseases, the diet is mandatory component treatment. All patients are assigned to table No. 5 according to Pevzner.
The diet for gallbladder pathology is as follows:
- eat fractionally, that is, in small portions 5-6 times a day;
- you need to drink enough fluid (at least 1.5 liters);
- during remission, it is recommended to reduce the proportion of fried, spicy and smoked foods in the diet;
- limit the proportion of fats in the diet, including those of plant origin;
- stop drinking alcohol and smoking;
- during an exacerbation, it is forbidden to consume food and water. As the symptoms subside, food is resumed (50 ml of vegetable puree soup, 100 ml of unsweetened tea or fruit juice), gradually expanding the diet;
- exclude from the menu fresh bread and baked goods, as well as ice cream, sweets, sweet soda and caffeinated drinks;
- the menu must be composed of pureed soups with vegetables, cereals, low-fat varieties meat, cereals, vegetable purees and stews, fruits, berries, vegetable salads, low-fat fermented milk products.
As a result, we can say that gallbladder diseases have similar symptoms, so put correct diagnosis and appoint effective treatment Only a specialist can.
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Bile has two very important functions for the normal functioning of the body - promoting the absorption of fats contained in food, and cleansing the body of components of metabolic processes and toxic substances, which are not excreted in the urine. Disruption of the process of secretion production by the liver and its removal into the duodenum can provoke diseases of the biliary tract. Symptoms indicating the occurrence of pathological phenomena are characteristic enough for the doctor to quickly make a preliminary diagnosis.
Why does the body need bile?
The secretion produced by the liver - bile - is involved in the digestive process and is its most important element. The composition of bile is very rich. This includes acids, cholesterol, phospholipids, protein, and various metals. The importance of bile for the body is enormous. The acids contained in the liquid are involved in the process of emulsifying fats - mixing them with water. This is necessary to activate lipase, an enzyme that breaks down fats. After this, active absorption of fat and fatty acids formed by the intestinal walls occurs, followed by entry into the lymphatic system. In addition, bile can reduce the irritating effects of pepsin, activates gastrointestinal motility, and promotes the formation of mucus.
The excretory function of bile is to remove substances such as cholesterol, bilirubin and some others from the body. The kidneys are not able to filter them to be excreted in the urine. Bile is involved in the formation of feces, along with which toxic substances leave the body. In addition, bile has absorbent properties. Its ability to act as an antiseptic prevents the formation of putrefaction processes in the intestines.
How are the pathways arranged and how is bile formed?
The biliary tract (or biliary tract) begins as a network of small bile ducts inside the liver, where fluid secreted by the cells of the organ collects. Then the bile through the common hepatic duct enters the gallbladder, which serves as a kind of reservoir for the accumulation of secretions. Between meals, the bladder fills, and when food from the stomach passes into the duodenum, it contracts and throws out the contents.
The process of bile secretion occurs constantly, and during the day from 800 to 1500 ml of secretion is formed. The intensity of the process depends on the signals entering the body at the sight, smell of food or when it is absorbed. When partially digested food enters the duodenum, it is expelled from the gallbladder. maximum quantity secret.
What contributes to the development of diseases and how do they manifest themselves?
Improper nutrition can contribute to the occurrence of diseases of the gallbladder and biliary tract: foods with increased content fats, fried foods, overeating and poor diet, soda, sweet drinks, alcohol. The disease can be caused by: sedentary lifestyle life, and increased physical activity. The causes may be liver and gastrointestinal diseases, pathologies of the female genital organs, worms and lamblia.
The main indicators of problems with the biliary tract are:
- heaviness and pain in the right hypochondrium;
- nausea (often vomiting);
- bitter taste in the mouth;
- general weakness.
In some cases, the pain is felt in the back and chest. In the process of development of disorders with the secretion of bile, other phenomena appear: belching, diarrhea, palpitations, sweating, fever, increased temperature, jaundice.
Women are much more likely to suffer from diseases of the bile excretion pathways. But renal colic is mainly experienced by men. Problems can occur at any age, although older people predominate at risk.
It is necessary to treat diseases of the biliary tract, as their complications can cause irreparable damage to health.
Diseases associated with the outflow of bile
Diseases of the liver and biliary tract can lead to a significant decrease in quality of life, and if left untreated, they take on a more severe form. Among the diseases caused by pathologies of the biliary tract, the most common are:
- dyskinesia;
- cholelithiasis;
- hepatic colic;
- cholecystitis;
- cholangitis.
Dyskinesia
A functional change in the activity of the gallbladder and sphincter apparatus, causing interruptions in the outflow of bile. Contraction of the muscles of the ducts and the walls of the bladder contribute to the promotion of secretion. The speed is regulated by sphincters - ring muscles around the ducts.
Slowing or accelerating the flow of bile leads to disruption of digestion processes. That's why on the basis of JVP is divided into two types: hyperkinetic and hypokinetic. The first form occurs mainly in young people. After 40 years, the process slows down more often. Symptoms appear periodically, alternating with improvements. As the disease progresses, inflammatory processes may occur and stones may form.
Gallstone disease
The formation of stones (calculi) in the gallbladder and ducts is a consequence various reasons: changes in the metabolism of bile components, inflammation of the walls or stagnation of bile in the bladder, disorders of lipid metabolism. The danger of this disease lies in the development serious complications(peritonitis, fistulas, cholecystitis), some of which can cause death. A characteristic feature GSD is the appearance of hepatic colic.
Liver colic
Stones and sand in the ducts and gallbladder can move, sometimes causing blockages. As a result, acute paroxysmal pain occurs. It is caused by a sharp disruption of the outflow of bile, spasms of muscles irritated by stones, and stretching of the walls of the ducts. Colic affects mainly men, although stones are more often formed in women.
Cholecystitis
Inflammatory disease of the gallbladder. It is provoked by a violation of the outflow of bile and the presence of microflora. Most common complication Housing and communal services But it can develop even in the absence of stones. The course of the disease can be acute or chronic. The acute form is sometimes complicated by perforation of the bladder walls, peritonitis, fistulas, abscess, cholangitis. It is often accompanied by acute pancreatitis - inflammation of the pancreas. In the chronic form, inflammation develops gradually. It can occur against the background of diseases such as pancreatitis, hepatitis.
Cholangitis
Inflammatory processes in the biliary tract, in most cases occurring against the background of gallbladder diseases. Manifests itself in acute and chronic forms. It occurs mainly due to the entry of pathogenic bacteria into the ducts.
The appearance of signs of biliary tract diseases should not be ignored. Although in most cases they do not pose a threat to life, the absence of treatment is fraught with the development of complications and chronic conditions. Following a diet for liver and biliary tract diseases is one of the main ways to reduce the frequency and severity of symptoms.
