Bile is a digestive juice that exists primarily to digest fats. Together with bile, toxic products neutralized by the liver (medicines, metabolic products, etc.) are removed from the body. Bile is produced in the liver, stored in the gallbladder and released into the duodenum along the bile ducts.
The biliary tract is the gallbladder with ducts.
Eat the whole system(special sphincters, contractions of smooth muscles of the gallbladder, etc.), allowing bile to be released not when it wants, but precisely at the moment when food enters the duodenum. But on various reasons coordinated work on the release of bile may be disrupted.
What is dyskinesia? Translated from Latin it means movement disorder (“dis” - disorder, “kinesis” - movement). We come to the conclusion that in the case of DVT there is a movement disorder biliary tract(bladder and ducts), which leads to a disorder of bile secretion: bile is released either too late or too early. May be:
- Accelerated emptying of the gallbladder.
- Slow emptying of the gallbladder.
- Spasm of the sphincter that opens the exit from the gallbladder, as a result of which it cannot empty itself.
- Relaxation of this sphincter: bile is secreted all the time in small quantities, and not in portions.
Causes of biliary dyskinesia in children (BDH)
Biliary dyskinesias are primary and secondary.
Primary VSDs are associated in children with birth defects development of the biliary tract (doubling of the gallbladder and ducts, congenital narrowing, constrictions and septa in gallbladder etc.). Primary VSDs are quite rare in children, occurring in approximately 10% of cases.
Secondary bile ducts are dysfunction (contractions) of the biliary tract associated with various diseases.
Most doctors are inclined to believe that ADHD is not an independent disease, but a consequence of various disorders.
The following factors play a role:
- Hereditary predisposition.
- Poor nutrition (especially eating large amounts of fatty and fried foods).
- As a consequence of various digestive disorders. Accompanies gastritis, gastroduodenitis, peptic ulcer, pancreatitis, cholecystitis, etc.
- Viral hepatitis.
- Worms and Giardia.
- Intestinal infections.
- Hormonal disorders.
- Autonomic disorders nervous system.
- Psycho-emotional stress, stress, and significant physical activity predispose people to ADHD.
IN childhood may be a passing phenomenon, when there is a very rapid growth of the musculoskeletal system, and the internal organs cannot keep up with it. This usually happens in adolescence when the child stretches out very quickly.
Complications of biliary dyskinesia in children (BCD)
Biliary dyskinesia contributes to the development of diseases such as:
- Chronic cholecystitis.
- Cholelithiasis.
- Pancreatitis.
Clinical forms and manifestations of biliary dyskinesia in children (BBD)
Hypermotor (or hyperkinetic) JVP. Occurs when excessive spastic contraction of the gallbladder occurs. Characterized by sharp short-term attacks of pain (colic) in the right side. The pain intensifies with fast running and walking (usually during physical education classes), in stressful situations and when the diet is violated. Patients with hypermotor JVP cannot tolerate fatty, fried and egg yolks.
Hypomotor (or hypokinetic) JVP. The gallbladder contracts sluggishly. Characterized by dull aching pain in the right side, rather similar to a feeling of fullness, heaviness, discomfort. The pain intensifies when the diet is violated or during emotional stress. Constipation is typical for children with hypomotor diarrhea.
Mixed JVP. Combines symptoms of both hypomotor and hypermotor forms. IN different situations behaves unpredictably.
In addition to abdominal pain, ADHD is usually accompanied by:
- Decreased appetite.
- Nausea.
- Intolerance to fatty foods.
- Sometimes vomiting when overeating fatty and sweet foods.
- Bitterness in the mouth.
- Unstable stool (alternating constipation and diarrhea).
- Patients with ADHD usually have signs of a disorder of the autonomic nervous system.
Diagnosis of biliary dyskinesia in children (BID)
If biliary dyskinesia is suspected, the child is usually treated with:
- Ultrasound examination (ultrasound) of the gallbladder and bile ducts. The study shows the volume of the bladder, the condition of its wall, the presence of stones, partitions, congenital deformities, bile sediment (a sign of bile stagnation in the gallbladder, pre-stone formation condition), condition of the ducts, etc.
- Ultrasound with test breakfast. The patient is given a load of various breakfasts, which include fatty foods (butter, sour cream, yolk). An ultrasound is performed before breakfast, and after half an hour and an hour later. The doctor looks at how well and in a timely manner the gallbladder contracts after eating. Using ultrasound with a test breakfast, you can determine the clinical form of JVP (hyperkinetic or hypokinetic).
- Duodenal sounding. This is a study of the functioning of the gallbladder and bile: a probe is inserted into the child’s duodenum, with which he sits for quite a long time. During this time, several portions of bile are taken for examination. By the nature of the bile, you can detect signs of inflammation, a tendency to form stones, worm eggs, lamblia, etc. This method Lately used less and less.
- X-ray examination (not performed on all children, but only if malformations of the ducts and gallbladder are suspected).
- According to indications, EGDS is performed (in everyday life - gastroscopy).
- ERCP (endoscopic retrograde cholangiopancreatography) is a method combining endoscopic endoscopy and x-ray examination. Carried out according to indications.
And other methods.
Dietary nutrition for children with ADHD
The main thing in the treatment of ADHD is diet. No setup proper nutrition The child will not achieve success, no matter what miracle pills you feed him. Children with biliary dyskinesia are traditionally prescribed table No. 5 according to Pevzner or a liver table. True, there are some peculiarities in the diet of children with increased and decreased tone of the gallbladder. This is discussed below. The diet is prescribed to the child for a period of 1.5-2 years, but in the future one should adhere to proper nutrition: do not overeat fatty foods, fried foods, do not get carried away with spices, etc.
Children with biliary dyskinesia are strictly contraindicated: Cola (Pepsi-Cola, Coca-Cola, etc.), chips, McDonald's, mayonnaise, ketchup.
Treatment of hypermotor type JVP in children
I. Diet. In general, children with hypermotor movement disorder should adhere to the dietary principles outlined above. However, there are some peculiarities here. The tone and contractility of the gallbladder are high. Products that reduce its tension are indicated, and those that increase its contraction are not recommended.
- Recommended foods containing magnesium: wheat and buckwheat porridge, millet, bread, vegetables, especially greens.
- Not recommended: chilled foods and drinks (ice cream, soda, cocktails); egg yolk; a large amount of fat; coarse fiber ( Rye bread, wholemeal bread); gas-forming products (beans, peas, cabbage).
II. Drug treatment.
Drugs that relax smooth muscles: no-spa, papaverine, duspatalin, spasmofen, odeston, belladonna preparations.
Drugs that calm the nervous system: valerian, motherwort, bromine preparations, etc.
Magnesium preparations: panangin, asparkam, magne B 6, magnerot, donat-magnesium.
All drug treatment strictly prescribed by a doctor. The doctor may prescribe other drugs at his discretion, depending on the individual characteristics course of the disease.
III. Mineral water. Prescribed outside of exacerbation, in the absence of pain. Admission rules:
- Water intake begins with half the dose for the first 2-3 days, and then gradually increases the amount to the full dose.
- The course of treatment is 30-45 days, 2 times a year.
Take mineral water: Slavyanovskaya, Smirnovskaya, Essentuki No. 4 and No. 20, Narzan, 5-6 times a day in fractional doses according to age.
IV. Physiotherapy:
- Therapeutic physical education (physical therapy).
- Electrophoresis with magnesium, novocaine, etc.
Prescribed by a physiotherapist.
Treatment of hypomotor type DVT in children
I. General activities:
- Children with ADHD very often suffer from disorders of the autonomic nervous system. For such guys it is very important to establish a daily routine. There must be sufficient sleep and rest, and minimal emotional and mental stress.
- A sedentary lifestyle contributes to stagnation of bile, so you need to move more. Morning exercises are very useful.
- Sports activities that require heavy work are not recommended. physical activity and tension.
II. Diet. In general, children with hypomotor LD need to adhere to the dietary principles outlined above. However, there are some peculiarities here. The tone of the gallbladder is reduced, you need to force it to contract. Products that have a choleretic effect are shown.
- It is recommended to increase the amount of fats (cream, sour cream, eggs, butter) to 120-150 g per day, including 60% vegetable fats.
- Increase the amount of fiber (fruits, vegetables, bran, wholemeal bread).
- Egg yolk.
III. Drug treatment.
Tonics: preparations of eleutherococcus, ginseng, leuzea, Chinese lemongrass, aralia.
B vitamins.
Choleretic agents, including plant origin: flamin (immortelle flowers), cholenzym, hophytol (artichoke), artichoke extract, magnesia, sorbitol, xylitol, pancreozymin, etc.
Homeopathic medicines: hepel, galstena.
The choice of drugs and course of treatment is determined only by the doctor. The child may be prescribed other medications, depending on the characteristics of the disease.
IV. Tyubazhi. Tubage improves the outflow of bile from the liver and gallbladder, reduces viscosity and thins bile, eliminates its stagnation, enhances contractions of the gallbladder, and has an anti-constipating effect.
Tubage technique: Performed 1-2 times a week in the morning (preferably at 6-7 o’clock) on an empty stomach.
- Give the child to drink 1/3 glass of hot (40-45 °C) mineral water of high mineralization (without gas). For older children, xylitol or sorbitol (1 tsp), as well as magnesia, Carlsbad salt, etc., can be added to the water, depending on the doctor’s recommendations. Instead of mineral water, infusions of choleretic herbs are also used.
- Place the child on the right side without a pillow on a heating pad (heating pad in the liver area) with legs bent for 30-60 minutes.
Bitterness in the mouth is an indication that the treatment has achieved its goal.
The course of treatment ranges from 4-8 to 10-15 procedures. It is repeated from time to time after a break. Treatment with tubages is best carried out in February-March-April.
V. Mineral water. Rules of administration as in the treatment of hypermotor movement disorder. But there are some peculiarities.
Used mineral water Essentuki No. 17, Arzni, Borjomi at room temperature or slightly warmed in an age-appropriate dose 3-4 times a day 30-60 minutes before meals.
Biliary dyskinesia is a disease as a result of which the flow of bile into the duodenum stops or is significantly reduced due to uncoordinated work (contractions) of the ducts, gallbladder and sphincter of Oddi. Bile is a special liquid that is produced by the liver and promotes the breakdown of fats and the movement of food through the intestines. Before bile enters the intestines, it passes through the bile ducts - the hepatic and bile ducts, the gallbladder, and the sphincter of Oddi. The latter, due to its contractions, ensures its entry into the duodenum.
Dyskinesia is often observed in children, which is expressed painful sensations in the right hypochondrium and disturbances in the digestive tract. As a result of the disorder, the child experiences a deficiency of bile in the intestines, which entails disruptions in the digestive tract and a deterioration in the general condition of the body. The latter is caused by insufficient absorption of many nutrients and vitamins K, E, A and D, which significantly worsens if bile does not participate in the process.
Causes of biliary tract diseases in children
Biliary dyskinesia does not manifest itself in structural changes internal organs- liver, gallbladder, ducts. Its cause is a violation of their function, which is caused by malfunctions of the central nervous system and autonomic system body. The causes of the disease should be sought much deeper than it might seem at first glance - in the vast majority of cases in emotional state child.
Stressful situations, increased emotionality, nervous breakdowns- all this affects the condition of the children’s body and leads to excessive involuntary contractions of the gallbladder. Because of this, excess bile accumulates in the area of the bile ducts, which begins to thicken, losing its antibacterial properties and functionality. At the same time, the formation of stones and blood clots begins inside the biliary tract, which interferes with the natural movement of bile to the duodenum. As a result, the disease itself develops and its complications become probable.
Additional factors psychosomatic reasons the development of the disease can become:
Types of dyskinesia
Depending on the type of functional disorders in the biliary tract in children, several types of disease are distinguished:
- hypotonic - expressed in a decrease in the tone of the sphincter of Oddi;
- hypertensive - manifests itself, on the contrary, in increased sphincter tone;
- hypokinetic - associated with a slowdown in the outflow of bile;
- hyperkinetic - accompanied by sudden releases of bile.
Mixed types of the disease are quite often observed. Functionally, each type of dyskinesia is characterized by different symptoms and requires different approach during treatment. In each specific case, a specialist should prescribe procedures based on the results of tests and examinations.
Symptoms of dyskinesia
Depending on the type of disease, its symptoms manifest differently. In the hyperkinetic course of the disease, when contractions of the gallbladder are enhanced, it manifests itself most intensely. sharp pain in the right hypochondrium. It can spread to the thigh and also radiate to the shoulder blade. Typically, the pain is not constant, but manifests itself when eating fatty, spicy, fried foods, in stressful situations and during high physical activity.
If the hyperkinetics of the gallbladder is combined with hypertension of the biliary sphincters, the pain is expressed somewhat more strongly and can occur without any visible reasons. Often biliary dyskinesia of the hyperkinetic type is accompanied by attacks of nausea and vomiting, worsening after eating.
With the hypokinetic type of the disease, children feel a constant nagging pain in the right hypochondrium. There is also a feeling of heaviness in the stomach, accompanied by loss of appetite. There may be attacks of nausea and a feeling of bitterness in the mouth. Stool disturbances are quite common - diarrhea, constipation or change in the color of stool (it becomes very light).
Symptoms of either type may worsen if children do not eat properly. Therefore, at the first signs and suspicions of the disease, it is necessary to adjust the diet and contact an osteopathic specialist who can diagnose the disease and prescribe effective treatment.
Danger of disease
Diseases of the biliary tract in children are quite dangerous, especially in early age when they are difficult to diagnose - the child is not yet able to talk about symptoms such as nausea or bitterness in the mouth. Although the disease itself is not exclusively dangerous, it entails unpleasant consequences. If children are not treated, then:
- the risk of stones forming in the gall bladder or bile ducts in children increases. This occurs due to the bile accumulating in it, which gradually thickens and hardens. Removing stones is not always possible using non-surgical methods;
- food is not digested properly. Bile helps break down fats and digest sweet foods. If this does not happen due to its lack in the intestines, some of the food begins to be absorbed incompletely or improperly. As a result, the body not only receives less nutrients and minerals, but also begins to accumulate harmful substances;
- metabolism is disrupted. Excess fats and sugars that are not broken down properly due to disruption of the bile ducts lead to weight gain and excess weight, and also increases the risk of developing diabetes mellitus. The latter is a serious and practically incurable disease, the manifestations of which can only be stopped. But it is impossible to do this without restoring the normal functioning of the bile ducts, gallbladder and liver;
- a digestive system disorder occurs. This is expressed in constant unpleasant sensations - nausea, heaviness in the stomach, pain in the intestines. Although, like dyskinesia itself, all this is not fatal, vomiting, diarrhea or constipation can hardly be considered pleasant moments in life.
Diagnosis of the disease
Dyskinesia, as a functional disease of the biliary tract, is quite difficult to diagnose. This group violations do not cause changes in the structure external organs, which is why many conventional diagnostic methods are not so effective. An osteopath can help diagnose diseases of the biliary tract in children using manual techniques to assess the size and shape of the gallbladder. Additionally, an ultrasound may be prescribed, which will confirm the diagnosis. In some cases, it is prescribed functional study, for example, using duodenal intubation.
Biliary dyskinesia in children and its treatment using osteopathic methods
If biliary dyskinesia is detected in children, it should be immediately treated by an osteopathic specialist. Only in this case can you guarantee quick and painless relief from the disease. Manual osteopathic techniques in combination with other physiotherapeutic procedures are quite effective in the fight against functional diseases of the digestive and biliary tract in children.
To activate and normalize the functioning of the biliary tract, children are prescribed manual procedures, which help restore blood circulation in organs. At the same time, they begin to receive good nutrition, which helps to stabilize and synchronize the work of all body systems. As a result, bile does not stagnate in one of the sections of the biliary tract, but travels the entire necessary path to the duodenum.
Normalization of the circulatory system itself is a powerful stimulus for the body, which begins to restore disrupted connections of the central nervous system, which usually cause asynchronous contractions of the biliary organs. Under the supervision of a specialist and following a diet, treatment usually proceeds quite quickly.
Probability Get well soon increases significantly with normalization of lifestyle. During the period when children are being treated for dyskinesia, a strict diet and refusal of physical activity are necessary. Otherwise, there is a risk of rupture or damage to the gallbladder. A full 8-10 hour sleep is also recommended, and if possible, an additional daytime one; refusal to use radio-electronic equipment, which can cause damage to central nervous system cells. During the period of treatment, children should, if possible, be kept away from stressful situations, unpleasant psychological effects.
For biliary dyskinesia in children, it is recommended to take food 4-5 times a day in small, balanced portions. Frequent appointments food in itself is a good stimulating factor that promotes treatment. On the recommendation of an osteopath, various choleretic foods (vegetables and fruits) are introduced into the diet, which also promote recovery. A complete abstinence from sweets and restrictions on the intake of dairy products are recommended. The basis should be food steamed or baked in foil.
When treating diseases of the biliary tract in children, osteopaths advise completely stopping taking medications. Balanced diet and osteopathic techniques are often quite sufficient, while pharmacological preparations may rather complicate the task.
Biliary dyskinesia (BD) is a functional pathology in which there is a violation of the outflow of bile through the biliary tract and its release into the lumen of the duodenum. The disease manifests itself as pain in the right hypochondrium, a bitter taste in the mouth, and abnormal stool. However, an objective diagnosis does not reveal any organic pathology. Basically, biliary dyskinesia in children occurs in the presence of malformations of the hepatobiliary system and is provoked by non-compliance with the diet or frequent stressful situations.
Bile is produced by liver cells and is a brownish-yellow liquid. It is necessary for the normal digestion process; its main function is to emulsify fats, as a result of which they are broken down by lipase and then absorbed in the intestines. In addition, bile plays a certain role in the absorption of protein and carbohydrate substances.
For these processes to occur normally, bile must have a certain concentration. To do this, it gradually accumulates in the gallbladder and is released as needed. If this does not happen, the digestion of food in the intestinal lumen is disrupted, which provokes diarrhea. When bile remains in the bladder for a long time, its concentration increases, which also leads to malfunction gastrointestinal tract.
Anatomically, the biliary system is represented by the hepatic ducts, gallbladder, common bile duct (common bile duct), which opens into the lumen of the duodenum.
The flow of bile from the liver into the intestinal lumen occurs due to the difference in pressure in various departments biliary tract. There is a whole group of sphincters, thanks to which this entire mechanism is carried out:
- sphincter of Oddi;
- Miritsi sphincter;
- Lütkens sphincter.
This process is regulated by the sympathetic nervous system, as well as by specific substances produced by gastric cells and the pancreas.
How does biliary dyskinesia occur in children, its types
Impaired bile flow can occur for the following reasons:
- there is no adequate relaxation of the sphincters bile ducts, which makes it difficult to secrete bile;
- there is no adequate contraction of the sphincters of the bile ducts, which makes it difficult to regulate bile secretion;
- there is a strong contraction of the gallbladder;
- the walls of the gallbladder and biliary tract are hypotonic, which reduces the rate of bile secretion.
Depending on the characteristics of motor function and the tone of the walls of the biliary tract, there is the following classification of dyskinesias:
- hypermotor - characterized increased tone sphincter and active secretion of bile;
- hypomotor (hypotonic)— decreased sphincter tone and slow bile secretion are observed.
Each type of dyskinesia has its own clinical picture. When making a diagnosis, the state of the tone of the gallbladder is also taken into account. Therefore, the type of pathology is expanded to hypertonic-hyperkinetic and hypotonic-hypokinetic.
What leads to the development of pathology
Functional disorders of the hepatobiliary system are in most cases diagnosed in children over 6-7 years of age. Girls are more often affected than boys. There are primary and secondary causes of this pathology. The primary violation of biliary excretion is mainly caused by congenital anomalies development of the biliary tract and gallbladder:
- double ducts;
- congenital hypotension of the gallbladder walls;
- gallbladder diffraction;
- accessory gallbladder.
There are also secondary factors that can trigger the appearance of dyskinesia:
Biliary dyskanesia occurs with periods of exacerbation and remission. Appearance severe symptoms happens after nervous overstrain, violation of the recommended diet or exacerbation of other diseases.
How does the disease make itself known?
Dyskinesia in children is manifested by the following symptoms:
- pain syndrome;
- nausea, less often vomiting;
- bitterness in the mouth;
- heaviness in the right hypochondrium;
- loss of appetite;
- bowel dysfunction (constipation or diarrhea);
- flatulence.
The most characteristic of the functional pathology of bile secretion is pain. The nature of the pain depends on the type of dyskinetic disorders. In the hypertensive variant, the pain can occur in attacks, be cramping, and appear some time after eating. Provoking factors in in this case are eating fried, spicy foods, foods high in animal fats.
Hypotonic dyskinesia in a child manifests itself as dull, nagging pain, which bother us almost constantly. They may intensify after eating and be accompanied by nausea and a feeling of heaviness in the right hypochondrium and upper abdomen.
An increase in body temperature is not typical for functional disorders of the hepatobiliary system. The presence of fever often indicates the addition of inflammatory complications: exacerbation of cholecystitis, cholangitis, pancreatitis. In this case, it is recommended to show the child to a doctor and undergo appropriate treatment.
Necessary laboratory and instrumental studies
A gastroenterologist may suspect a functional disorder of the biliary tract during examination. The diagnosis is confirmed by objective examination data: pain on palpation in the right hypochondrium, the presence of gall bladder symptoms, and the phrenicus symptom. The doctor can also additionally prescribe laboratory and instrumental diagnostics.
- Stool examination (coprogram). If bile secretion is impaired, large quantities of soap and fatty acids are detected in the stool.
- Biochemical blood test. Dyskinesia is characterized by an increase in alkaline phosphatase levels; sometimes there is a simultaneous increase in the levels of amylase and lipases, which indicates concomitant pathology of the pancreas.
- Ultrasound examination of the hepatobiliary system. It is carried out in the morning before meals. Using ultrasound, you can identify abnormalities in the development of the biliary system, determine bile stagnation, concomitant pathology Gastrointestinal tract. In children, kinks of the gallbladder neck are especially often detected, which are usually functional in nature.
- Cholecytography. Because this x-ray method research, it is carried out in children only if there are compelling indications. The technique consists of taking a series of photographs, the first one is taken on an empty stomach, the subsequent ones are taken at intervals of fifteen minutes after a choleretic breakfast. The duration of the study is 1.5 hours. The study allows us to evaluate contractility gallbladder and draw a conclusion about the presence of dyskinesia.
Duodenal intubation today is very rarely used in pediatric practice. It is also extremely rare to use studies such as scintigraphy or cholangiopancreatography to diagnose dyskinesia; these methods are associated with increased radiation exposure.
4 directions in the treatment of dyskinesia
Therapy for functional disorders of bile secretion must necessarily be comprehensive, aimed at eliminating provoking factors and various links in pathogenesis. Treatment of biliary dyskinesia in a child includes:
- diet therapy;
- normalization of work and rest;
- prescription of medications.
Dietary ration
For biliary dyskinesia in children, frequent meals are recommended, at intervals of no more than 2.5-3 hours. Eating should take place in a calm environment, with thorough chewing of food. You need to give your child small portions and avoid overeating. It is advisable to prepare dishes by boiling or baking in the oven; frying in fat, especially animal fat, is excluded.
For biliary dyskinesia, diet No. 5 according to Pevzner is recommended. The menu should mainly include the following dishes:
- vegetable salads, casseroles, purees;
- fresh non-acidic fruits;
- soft-boiled eggs;
- fermented milk drinks, especially homemade;
- lean meat, boiled or baked fish;
- skim cheese;
- soups with vegetable or cereal broth.
Must be added to the menu vegetable oils: olive, corn, rapeseed. They can be used to make salads and purees.
The following foods are excluded from the child’s diet:
- concentrated broths from meat and fish;
- spicy and marinated dishes;
- fatty meat products, lard;
- cold dishes and desserts (jelly, ice cream).
Good sleep, fresh air and exercise
First of all, a good night's rest is recommended. The duration of sleep in a child with dyskinesia should be at least eight to ten hours. If a child gets very tired during the day, then he definitely needs nap(one to two hours).
During the daytime, walks on the fresh air and practicing feasible sports. These measures help restore the regulation of bile secretion by the central nervous system.
Pills
Necessity of application medicines depends on the type of functional disorder of biliary excretion. At hypertensive form pathologies necessarily prescribe antispasmodics:
- "Drotaverine" ("No-shpa");
- "Papaverine hydrochloride";
- "Dibazol".
They are assigned to short term, on average for no more than three to four days. However, these drugs are systemic antispasmodics and can provoke some side effects, such as, for example, lowering blood pressure.
The selective antispasmodic Duspatalina (mebeverine) does not have these disadvantages. It selectively acts on the smooth muscle fibers of the gastrointestinal tract and eliminates sphincter hypertonicity. According to clinical guidelines it is taken twice a day, before meals (15-20 minutes).
Drugs that have a choleretic effect are also used to treat diarrhea in children. Some of them additionally have hepatoprotective and antispasmodic effects. In pediatric practice, the following pharmaceuticals are used for hypermotor or hypomotor biliary dyskinesia:
- "Holagol";
- "Gepabene";
- "Hofitol";
- "Galstena";
- "Hepel."
Most of these medicines consist of plant components, and therefore are safe for children and can be used for a long time. For example, “Galstena” contains extracts of dandelion, milk thistle, and celandine; the drug can be given to children under 3 years of age. "Hofitol" is an extract from artichoke. Usually choleretic agents prescribed for at least two to three weeks.
Herbal infusions
They are also actively used in the treatment of biliary dyskinesias in children. folk remedies. The following herbs that have a choleretic effect are recommended:
- dandelion;
- barberry;
- corn silk;
- chamomile;
- sage;
- immortelle.
These herbs are used in the form of infusions. They are usually prescribed after a course of pharmacotherapy, the duration of treatment is about a month.
Prevention of functional disorders of the hepatobiliary system in children consists of creating an adequate regimen of exercise and rest, healthy and regular nutrition. You should also protect your child from excessive psycho-emotional stress and stress.
Symptoms and treatment of biliary dyskinesia in children have their own characteristics. This pathology rarely leads to serious complications, but can significantly reduce quality of life. Against the background of functional digestive disorders, the processes of absorption and metabolism are disrupted nutrients. This leads to a decrease in the child’s weight, slows down his physical development, causes poor performance at school. Therefore, parents should be attentive to their child’s complaints and promptly contact a gastroenterologist.
Biliary dyskinesia (accepted abbreviation DZHVP) is a dysfunction of the duodenum, ducts, and sphincter system, which entails improper outflow of bile into the duodenum. VHD in a child is a functional disorder, that is, it does not entail changes in internal organs.
There are hypomotor and hypermotor forms of pathology. In the first case, bile stagnates in the gallbladder due to the relaxed muscular layer of the biliary tract. In the second option, frequent spasms of the sphincters and gallbladder are observed, due to which excessively frequent release of bile occurs. There is also a mixed version, which includes the pathologies of hypo- and hypermotor dyskinesia.
Causes
There are many factors that disrupt the normal functioning of the digestive organs and provoke the development of childhood dyskinesia. The main ones are the following:
- disorders in the parocrine and nervous systems, which are responsible for the sequence of contractions of the muscles of the biliary tract,
- lesions of the central nervous system in the perinatal period (these include asphyxia, hypoxia, various injuries received during childbirth),
- changes in the shape of the bile ducts, bending of the gallbladder and disorders in the sphincter apparatus, leading to uneven excretion of bile,
- dyscholia of cytogenic and hepatogenic type,
- past or current infections, such as dysentery, hepatitis A, etc.,
- the presence of such chronic diseases like sinusitis or tonsillitis,
- lamblia and roundworms,
- disruption in production peptide hormones(observed in peptic ulcers of the digestive system),
- problems associated with psycho-emotional state(more often observed in adolescent children),
- poor nutrition and non-compliance with the regime.
Symptoms
Childhood dyskinesia develops slowly and is almost asymptomatic. At the initial stage of the disease, children may complain of mild abdominal pain and lack of appetite. As the disease progresses, the clinical picture will become clearer.
The symptoms of JVP depend on the form of the pathology.
Signs of hypertensive dyskinesia in a child are:
- yellow coating on the tongue,
- nausea and vomiting,
- diarrhea,
- loss of appetite,
- general weakness and headaches,
- pain in the right hypochondrium when lifting weights or other physical activity,
- burning in the abdomen after eating sweets or during anxiety.
The hypotonic form in children is rarely diagnosed; it can be identified by the following symptoms:
- constant feeling of heaviness in the right hypochondrium,
- problems with stool
- complete loss of appetite
- sudden weight loss.
In case of a mixed form of pediatric pathology, the clinic is represented by the following indications:
- feeling of heaviness in the right hypochondrium,
- belching and bitterness in the mouth,
- constipation,
- swelling of the face and other parts of the body,
- weight gain due to lack of appetite.
Diagnosis of biliary dyskinesia
If these signs are present, a number of studies are required to confirm the diagnosis, including:
- FGDS,
- Ultrasound of the gallbladder and liver,
- duodenal sounding,
- bile analysis to detect the presence of inflammation in the body, helminthic infestation and giardiasis.
Complications
Identified on late stage dyskinesia in a child can be eliminated, but by that time a number of pathologies of the digestive system may develop:
- inflammation of the biliary tract,
- cholelithiasis,
- cholecystitis in chronic form,
- pancreatitis.
Treatment
What can you do
If signs of illness are detected in a child, immediately contact a specialist for testing. After making a diagnosis and identifying the cause, it is important to complete the full treatment course of both the dyskinesia itself and the underlying disease.
What does a doctor do
Assigns everything necessary tests and research, based on the results of which a treatment plan is developed.
Therapy is aimed at successful treatment the root causes of dyskinesia and to eliminate the consequences of cholestasis. The most commonly used drugs and sedatives may be prescribed physiotherapy, massage, physiotherapy and psychotherapy.
Prevention
To prevent the disease in children, it is necessary even after a full therapeutic course with positive results be regularly observed by specialists at a dispensary, and undergo a course of choleretic therapy every two years. Visiting sanatoriums, regular morning exercises and gymnastics, massage and swimming lessons - good prevention pathologies of the biliary tract.
As preventive measures To prevent childhood dyskinesia, adhere to proper nutrition standards:
- fractionation - you need to eat in small portions 5-6 times a day,
- Diet - eat at the same time every day,
- exception harmful products, which include smoked, salty, spicy and fatty foods, sweets, carbonated drinks, whole cow's milk,
- cooking food by steaming or using any method other than frying.
Violations of organ activity digestive system –serious violation, interfering proper growth and child development. Biliary dyskinesia is one such disease.
Pathology ranks first among all diseases of the digestive system occurring in children of any age.
The disease causes the child a lot of unpleasant and even painful sensations, which negatively affects his general condition. Therefore, when the first symptoms of biliary dyskinesia are detected in children, it is necessary start treatment urgently.
Characteristics of the disease
Biliary dyskinesia (BID) is a functional impaired motility of the bile ducts, decrease in their tone.
As a result of these negative phenomena, the process of bile outflow from the gallbladder into the duodenum is disrupted.
Normal outflow of bile promotes proper digestion, because bile is a digestive juice necessary for the breakdown of fats and the removal of toxic substances from the body. With JVP, this process is disrupted.
Causes of development and risk groups
The following may lead to the development of ADHD: negative factors How:
Based on the reasons mentioned above, we can conclude that those at risk of developing VSD are: school age children.
A child entering 1st grade experiences stress associated with a sharp change in his usual daily routine.
In addition, modern schoolchildren do not always adhere to the principles of proper nutrition, leading sedentary lifestyle due to the need to work hard educational activities, accordingly, on active games and the student has significantly less time left for walking.
Classification of pathology
JVP can manifest itself as an independent disease (primary form), or as a secondary pathology developing as a result of other diseases of the gastrointestinal tract.
Depending on the location of the disease, pathology of the gallbladder and its ducts, as well as disruption of the biliary sphincters, are distinguished.
Depending on the nature of the lesion and clinical picture illness, JVP can be: hypertonic, hypotonic, combined(mixed).
Clinical symptoms
Manifestations of pathology can be different, depending on its form.
|
Form |
Clinical manifestations |
|
Hypertensive |
|
|
Hypotonic |
|
|
Combined |
|
An infant, due to his limited capabilities, cannot tell his parents what is bothering him. At the same time, unpleasant sensations cause him significant discomfort and anxiety.
Parents should pay attention to changes in the child’s condition and behavior. In particular, during painful attacks, the baby presses his legs to his stomach, this helps reduce pain.
In addition, the baby does not gain weight well, often refuses to eat, cries, and sleeps poorly.
How dangerous is the disease?
Untreated ADHD can lead to chronic inflammatory diseases in the body (cholangitis, chronic cholecystitis), the emergence of a focus of inflammation in the gallbladder itself, the formation of stones, the development of other pathologies of the digestive system (for example,).
In addition, with JVP, metabolic processes in the body, which negatively affects the development of the child and the functioning of all organs and tissues of his body.
What diet should you follow for gastroduodenitis in children? Find out about this from ours.
Diagnostics
Diagnosis of pathology is carried out in several stages. To begin with, the doctor collects an anamnesis of the disease and evaluates the totality of its manifestations. At the next stage, the necessary laboratory research:
- blood test (general, biochemical, for the presence of antibodies to viral hepatitis, lipid content);
- clinical urine analysis;
- stool test for eggs.
Treatment methods
How to treat a child? Treatment of JVP carried out using specially designed medications, in combination with following a therapeutic diet.
As drug therapy The following groups of drugs are prescribed:
- Prokinetics(Domperidone) are necessary to normalize the motility of the biliary system.
- Choleretics(Allohol) help normalize the process of bile formation.
- Cholekinetics(Magnesium sulfate) improves the process of bile discharge.
- Enzymatic drugs (Mezim) improve digestion.
- Hepatoprotectors(Essentiale) allow you to normalize liver function and restore its functionality.
Diet
In addition to taking medications, the child must follow a specially designed diet.
There is a list of products prohibited for use. It includes:
IN basis of the child's diet There should be such products as:
- soups cooked in water;
- milk porridge;
- rye bread (dried);
- lean meat;
- crackers (low fat);
- cheese (low-fat varieties);
- fruits (if not);
- herbal teas, compotes, fruit juices diluted with water (1:1 ratio).
Among sweets, it is allowed to consume marshmallows, marshmallows, marmalade candies, jam, honey (in small quantities for older children).
Rules for the provision of medical qualified assistance children suffering from ADHD have been developed and adopted Russian Gastroenterological Association of Doctors in 2015
The document defines the concept of ADHD, its symptoms, possible reasons development, as well as the procedure for adoption therapeutic measures to achieve faster positive results.
Dr. Komarovsky about JVP
E. O. Komarovsky believes that the symptoms of ADHD are not characteristic of this particular pathology, and may indicate completely different problems, requiring, accordingly, other treatment.
Self-prescribing medications to a child can only worsen the situation, because without making a diagnosis, establishing the cause and characteristics of the pathology, it is absolutely impossible to prescribe treatment.
If signs of a disorder in the functioning of the digestive system are detected The following recommendations must be followed:
- It is recommended to place the child on his right side immediately after eating, so painful sensations will be less pronounced.
- If your baby refuses to eat, there is no need to force him.
- If problems arise in the functioning of the digestive organs, it is necessary to postpone the introduction of complementary foods.
- The child must be seen by a doctor as soon as possible.
You will find pediatricians specializing in the treatment of dysbiosis in children on our website.
Prevention measures
In order to reduce the risk of developing DVT necessary:
- monitor the child’s daily routine and nutrition;
- protect him from overwork and stress;
- visit in a timely manner pediatrician for preventive examination.
JVP represents disruption of the process of bile outflow, developing as a result of impaired motility of the biliary system, decreased tone of the walls of the gallbladder ducts.
Pathology has various shapes course, depending on the form, the manifestations of the disease also change. To eliminate the symptoms and causes of the disease, it is necessary to show the child to a specialist who will identify the problem and prescribe treatment.
Doctor Komarovsky about problems with the functioning of the gallbladder and pancreas in this video:
We kindly ask you not to self-medicate. Make an appointment with a doctor!
