Gallbladder diseases most often occur as a result of pathological processes in neighboring organs (liver, pancreas). Their symptoms have much in common - pain in the right hypochondrium, digestive disorders, changes in the color and consistency of stool, changes in appetite, icteric syndrome. The gallbladder performs an important function - it is responsible for the accumulation and distribution of bile, and any disturbances in the functioning of the organ negatively affect the state of the digestive system as a whole.

Bile is constantly produced in the body, and it is also constantly secreted through the hepatic bile duct. But in the process of digestion, it is required only when there is food in the intestines. If bile is supplied without intestinal contents, it can damage the intestinal lining.

The gallbladder is necessary to ensure that the constantly secreted bile does not enter the intestines when there is no food in it. The regulation of the flow of bile into the intestines or into the gallbladder is quite simple - if the sphincter that ends the common bile duct is open, bile flows into the intestines. If it is closed, bile enters the gallbladder. It can accumulate there long time. The water contained in bile is partially absorbed, so bladder bile is thicker and more viscous than liver bile.

When the sphincter of the major duodenal papilla opens, cystic bile enters the intestinal lumen first, then hepatic bile. If for some reason the sphincter remains closed for a long time, stagnation of bile, formation of stones and other disturbances in the outflow of bile are possible.

Gallbladder diseases - main causes

Regardless of the causes of occurrence and the mechanism of development, gallbladder pathologies have similar symptoms. The main symptom is constant aching, bursting pain in the right hypochondrium, which cannot be relieved by taking analgesics. For cholecystitis or cholelithiasis the pain syndrome is the most intense. Typically, painful sensations occur after eating food (especially fatty, spicy or fried food). When stones leave the gallbladder, sharp, cutting pain appears. In addition, other characteristic symptoms appear:

• febrile state (chills, temperature) with acute course process;
• dyspeptic manifestations (nausea, vomiting, belching);
• bowel disorders (diarrhea, constipation);
• bloating, flatulence;
• lack of appetite, weight loss;
• bitterness and dry mouth;
• change in urine color (to intense yellow) and discoloration of feces;
• yellowness of the skin;
• itchy skin, rashes on the body;
• insomnia, irritability.

The appearance of a jaundiced color of the skin and sclera indicates that inflammatory process spread to the liver. This threatens the development of severe complications and can lead to liver failure, cirrhosis or internal bleeding. Let's look at the main symptoms and treatment methods for the most common gallbladder diseases.

Gallbladder dyskinesia

This pathological condition is a prerequisite for the development of many diseases of the gallbladder and biliary tract. It can be asymptomatic for a long time. The essence of the disease is that the motor activity of the gallbladder is impaired. Most often, it is weakened, therefore, when the sphincter of the major duodenal papilla opens, the bladder contracts insufficiently, and when food enters, it does not expel the required volume of bile into the intestine. Part of it remains in the bladder, stagnates, and conditions arise for the development of the inflammatory process.

Symptoms of gallbladder dyskinesia are impaired digestion of fats, primarily from animals. The patient may notice a slight deterioration in well-being after eating fatty foods or overeating, occasional discomfort in the right hypochondrium, and sometimes dull, nagging pain. Diarrhea may occur after eating a large fatty meal.

This condition is treated with choleretic drugs, as well as drugs that increase smooth muscle tone - eleutherococcus, ginseng and others. Diet and physical activity are also recommended.

Cholelithiasis

The formation of gallstones is a direct consequence of bile stagnation. This can be caused by irregular eating, lack of physical activity and other factors. In addition, biliary dyskinesia in most cases precedes cholelithiasis.

Stones are clumps of hardened bile that form due to excess absorption of water. Among all diseases of the liver and gallbladder, cholelithiasis is the most common. Its course is paroxysmal - during the period of remission, symptoms are almost completely absent or insignificant (as with dyskinesia), but attacks of the disease manifest themselves very clearly.

An exacerbation of cholelithiasis (biliary colic) can be triggered by physical exertion, overeating, shaking while driving, or even sudden movement. Most clear symptom – sharp pain in the right hypochondrium. The attack may go away on its own, but this does not mean a cure for the disease. A few days after it, yellowing of the skin and sclera, itchy skin, and whitish feces are possible. These symptoms are a consequence of the entry of bile acids into the blood.

To relieve an attack, antispasmodics are used to relieve spasm of the biliary tract and relieve pain. During an acute attack of cholelithiasis, you should not move, eat food (especially fatty foods), or use choleretic drugs. This condition requires medical intervention, so you need to call an ambulance.

Outside of exacerbation it is prescribed therapeutic nutrition, moderate physical activity, choleretic agents and antispasmodic drugs. The patient is advised to undergo regular examinations to prevent new exacerbations.

Cholecystitis is an inflammation of the gallbladder. Most often it is aseptic, that is, it occurs without infection, and has a chronic course. Its development is preceded by many reasons, including hereditary predisposition.

The most dangerous form is considered to be acute calculous cholecystitis, which occurs against the background of cholelithiasis. During an attack, the temperature rises, bitterness appears in the mouth, empty belching, severe weakness, pain in the right hypochondrium, vomiting bile, which does not bring relief.

Acalculous chronic cholecystitis without exacerbation manifests itself as periodic nagging pain in the right hypochondrium, appetite disturbances, discomfort and diarrhea after eating fatty foods. Symptoms of the disease during an exacerbation resemble biliary colic, but can last much longer.

First aid during an attack is the same as for biliary colic. During remission, anti-inflammatory drugs are used. With acalculous cholecystitis, it is less common than with gallstone disease to resort to surgical intervention; in treatment, greater emphasis is placed on anti-inflammatory therapy.

Jaundice due to gallbladder diseases

Jaundice syndrome occurs in many liver diseases. Based on its origin and laboratory signs, jaundice is divided into suprahepatic, hepatic and subhepatic. Diseases of the gallbladder are characterized by subhepatic (mechanical) jaundice, caused by stagnation of bile. It occurs 2-3 days after an attack of cholelithiasis; small manifestations of icteric syndrome can also be observed outside of an exacerbation due to errors in diet or improper use of medications.

Jaundice in in this case caused by the entry into the blood of large amounts of bile acids and bilirubin. The skin, mucous membranes and sclera acquire a yellowish tint. It is the yellow color of the sclera that is a reliable diagnostic criterion, since the skin can have a different natural tone. Another characteristic symptom– skin itching. It is caused by the irritating effect that bile acids have on nerve endings located in the upper layers of the epidermis. 1-2 days after the skin turns yellow, changes in the color of urine and stool appear. Urine becomes dark due to the appearance of bilirubin in it, and feces, on the contrary, become light due to its deficiency.

Laboratory tests reveal an increase in the level of bilirubin in the blood due to the bound fraction, the appearance of bile acids, an increase in the level of transaminases and alkaline phosphatase, indicating liver damage. Bilirubin is detected in the urine, and a sharp decrease in its level (acholia) is detected in the feces.

Diagnostics

To make a correct diagnosis, describing the symptoms is often not enough - they are often vague and the patient may often not attach importance to them until an attack occurs. General blood and urine tests, as well as biochemical blood tests, can be completely normal without exacerbation of diseases. During an attack, the number of leukocytes in the general blood test increases. In a biochemical analysis, 1-2 days after the attack, bile acids are detected and bilirubin increases. Its increase is also observed in urine, and in feces it, on the contrary, decreases.

Much more valuable information is provided by laboratory and instrumental methods for examining the function of the biliary tract. Ultrasound abdominal cavity allows you to see stones in the gall bladder, anatomical anomalies that predispose to them. For more accurate diagnosis, angiographic methods are used, which make it possible to track the dynamics of bile outflow. Duodenal intubation shows how bile enters the duodenum. For diseases of the gallbladder in children, this research method is rarely used.

Drug treatment of gallbladder diseases

Taking medications is prerequisite preventing attacks of the disease. Which medications the doctor will select depends on the characteristics of the disease, the patient’s ability to take medications regularly, and many other factors. Types of drugs used for gallbladder diseases:

• choleretic agents (cholesecretics);
• antispasmodics;
• hepatoprotectors;
• anti-inflammatory;
• tonic.

It is not recommended to use painkillers for the treatment of gallbladder diseases, since their effectiveness in this case is quite low, but there is a risk of provoking gastric ulcers and complicating diagnosis. To relieve pain, it is much more effective to use antispasmodics (No-shpu, Drotaverine, Mebeverine)..

Choleretic drugs are used only outside of exacerbation, since their use during biliary colic can lead to a worsening of the patient's condition.

Hepatoprotectors (Gepabene, Karsil, Essentiale, Hofitol) are prescribed for all diseases of the gallbladder, as well as the liver to maintain its functions. They are taken in courses during the period of remission. Also, tonic drugs are taken in courses to improve the functions of the gallbladder.

Cholecystectomy

Surgical treatment of the disease is removal of the gallbladder. Most often it is used for gallstone disease. The operation can be performed endoscopically (without an incision) or laparotomy. The use of endoscopic methods today is considered more progressive, and in most cases the operation is performed this way.

Indications for laparotomy (an incision in the abdominal cavity) are the impossibility of endoscopic surgery, suspected complications of cholecystitis. This operation is more traumatic, and has been used quite rarely lately and strictly according to indications.

Surgery to remove the gallbladder can be performed electively or urgently. Indication for emergency surgery– an attack of cholelithiasis that cannot be treated with medication (and if this is not the first attack, then in most cases surgery is required). It can be performed as planned for cholecystitis, cholelithiasis or other lesions during remission, if therapeutic measures have little effect, and exacerbations occur frequently. For gallbladder diseases in women during pregnancy, elective cholecystectomy is not performed.

After surgery, you must follow a diet and take medications. It is especially important to monitor the intervals between meals, since there is a risk of developing liver damage due to the reverse outflow of bile, which normally enters the gallbladder.

Diet and proper nutrition

Diet for gallbladder diseases is critical. It is the errors in it that provoke exacerbations. During the period of remission, it is necessary to limit the consumption of fatty, smoked, spicy foods - those that require the release of bile. The liquid can be consumed without restrictions. It is very important to observe intervals between meals - you should eat in small portions, but often. The time interval between meals should not exceed four hours. This is especially important for those who have undergone cholecystectomy. The restriction on fatty foods applies not only to animal fats, but also to vegetable fats. Alcoholic drinks are completely prohibited.

During an exacerbation, you should not eat until the attack of biliary colic is eliminated. You should also not drink liquid. If you are really thirsty, you can moisten your lips with warm water or tea. After relieving the condition and reducing the pain, you can eat a few tablespoons of pureed vegetable soup, drink a little unsweetened tea or diluted juice. Semi-liquid viscous porridges can be added to the menu only on the third day after the attack. And after about a week, switch to a special therapeutic diet 5A.

A proper diet should be based on limiting fats (animal and vegetable), heavy foods, hot and spicy foods. You cannot include pickles, canned food, smoked meats, fatty meats and fish in the menu. It is recommended to avoid baking, muffins, and fresh bread. Ice cream, sweets, sweet carbonated drinks, coffee, chocolate, cocoa are prohibited. You will have to completely give up alcohol and smoking.

The diet includes pureed vegetable and cereal soups, porridge (rice, buckwheat, oatmeal), lean meat, seafood, boiled, baked or steamed vegetables. For cholelithiasis, a vegetarian, fruit diet, consumption of dried fruits (dried apricots, raisins), berries, and vegetable salads are especially useful.

Prevention

Many factors play a role in the development of gallbladder diseases, all of which cannot be prevented. However, a healthy lifestyle, giving up alcohol and smoking, moderate physical activity, limiting fatty and spicy foods (what nutritionists call heavy) will prevent the development of the disease, even if there are anatomical abnormalities (constrictions, adhesions, etc.)

Nutrition for gallbladder diseases is extremely important - it helps reduce the frequency of exacerbations and allows the patient to feel good. It is necessary to strictly follow the doctor's recommendations regarding diet and medication. In this case, the patient has the opportunity to lead a full life, despite the chronic disease.

It is important to remember that chronic diseases must be treated by a doctor, and treatment of gallbladder diseases with folk remedies is permissible only after consultation with a specialist, so as not to harm your health.

The gallbladder, given its small size, is a fairly important organ of the digestive system. It is a container for bile entering it, releasing it into the intestinal lumen.

Also in this organ, resorption (reabsorption) of protein, important salts, amino acids into the blood occurs, mucus and a special hormone, anticholecystokinin, are secreted. The gallbladder can hold approximately 50 ml of fluid.

Bile is formed in liver cells, then through special bile ducts, which form a complex network, and enters the gallbladder, where it is stored until a person eats food. After food enters the duodenum, the gallbladder contracts and bile, along with pancreatic juice, moves into the intestines.

per day healthy person 500 to 1000 ml of bile can be formed. Its composition is quite diverse: water, bile acids, inorganic substances, vitamins A, B, C, D, amino acids, phospholipids, cholesterol, bilirubin, proteins, mucus and drug residues.

The functions of bile are quite diverse:

• neutralizes gastric juice
• activates intestinal and pancreatic enzymes
• inhibits the growth of harmful bacteria in the intestines
• improves intestinal motility
• removes toxic substances and medications.

Characteristics of the main pathologies of the gallbladder

Cholelithiasis

This is a disease of the biliary system associated with a violation of bilirubin metabolism and cholesterol, characterized by the formation of stones inside the liver, in the common bile duct and in the gallbladder. There are 5F criteria for people most susceptible to cholelithiasis:

• Female – women
• Fat – overweight
• Fair - fair-haired
• Forties – over 40 years old
• Fertile - giving birth

According to the mechanism of formation, there are 3 types of stones: cholesterol, pigment bilirubin, brown and black.

Cholelithiasis can be asymptomatic for a long time, and clinically manifest itself in the form of an attack of “hepatic colic”, when the stone gets into the narrow bile duct.

Chronic acalculous cholecystitis

This is a long-term inflammatory process that affects the inner lining of the bladder and is not accompanied by the formation of stones. Main causes of the disease:

Biliary dyskinesia

This is a functional disease of the biliary tract associated with changes in the tone of the gallbladder or ducts, accompanied by periodic pain in the right hypochondrium and.

This pathology usually occurs under constant stress, psycho-emotional stress, and neuroses. Depending on the change in bladder tone, hyperkinetic (or pain) and hypokinetic (dyspeptic) types of the disease are distinguished.

Acute cholangitis

This is an acute inflammatory process that affects the bile ducts. Usually occurs as a complication chronic cholecystitis, cholelithiasis or after removal of the gallbladder. The development of infection is facilitated by stagnation of bile, compression of the ducts by tumors and stones. There are obstructive, recurrent, bacterial, and secondary sclerosing cholangitis.

Gallbladder cancer

In most cases, cancer is the result of a chronic inflammatory process in the organ. There are: adenocarcinoma, mucinous, solid and squamous cell carcinoma. Gallbladder cancer is characterized by high malignancy, early metastasis and invasion into neighboring organs.

Main symptoms

Symptom	Gallstone disease (attack of hepatic colic)	Chronic cholecystitis		Acute cholangitis	Gallbladder cancer
Description of pain	Acute paroxysmal pain after dietary violations; the patient is on the right side with his legs pressed to his chest, any movement only intensifies the pain.	Mostly, patients are bothered by a feeling of heaviness, constant aching pain, which intensifies after consuming fatty, spicy foods, carbonated drinks, and alcohol.	Hyperkinetic type: acute short-term paroxysmal pain lasting up to 20 minutes. Hypokinetic type: dull, aching, arching pain, feeling of heaviness in the right side	Acute paroxysmal unbearable pain up to a drop in blood pressure	It may not cause pain for a long time, but then it appears. dull pain, poorly controlled by analgesics
Localization of pain	On the right side	In the right hypochondrium, sometimes in the epigastric region		On the right side
Radiation of pain			IN right shoulder, shoulder blade, collarbone, back, left half of the body	In the right shoulder, shoulder blade, collarbone, back, left half of the body	In the right shoulder, scapula, collarbone
Dyspepsia		Nausea, vomiting mixed with bile, bitterness in the mouth, bitter belching, heartburn, loss of appetite, diarrhea, flatulence may occur.	Hyperkinetic type: nausea, vomiting. Hypokinetic type: nausea, vomiting, bowel dysfunction	Repeated vomiting without relief, nausea	Rapid weight loss, food aversion, constant nausea, periodic episodes of vomiting
Itchy skin	Characteristic		Not typical	Characteristic	Not typical
Fever, chills		An inconsistent symptom, observed in 40% of patients	Low fever	High fever up to 40º C, accompanied by chills and heavy sweats	Low fever
Signs of peritoneal irritation	Sharply expressed in the right side	Slight tension in the abdominal muscles in the right hypochondrium		Sharply expressed in the right hypochondrium	Slight abdominal muscle tension on the right side

Diagnosis of gallbladder diseases

Painful symptoms of gallbladder pathology:

• Ker's point - the point of projection of the gallbladder onto the anterior wall of the abdomen - is located at the intersection of the right edge of the rectus abdominis muscle with the right costal arch;
• Georgievsky-Mussi sign– pain when compressed between the legs of the sternocleidomastoid muscle on the right (the reference point is the inner edge of the right clavicle);
• Ortner-Grekov symptom– the occurrence of painful sensations in the right side when tapping the edge of the palm along the edge of the costal arch.

Changes in laboratory parameters in diseases of the biliary system

Index	Norm	What is he talking about?	What diseases does it indicate?
Level increase total bilirubin due to unrelated	The normal level of total bilirubin is 8.5-20.8 µmol/l indirect bilirubin – 1.7-17.1 µmol/l	More often indicates a violation of the outflow of bile (obstructive jaundice)	Cholelithiasis, cancer of the gallbladder, common bile duct, papilla of Vater, acute cholangitis, chronic cholecystitis, etc.
An increase in the level of total bilirubin due to bound	total bilirubin – 8.5-20.8 µmol/l direct bilirubin – 0.85-5.1 µmol/l	Indicates decreased conjugation (binding) of bilirubin	Hemolytic anemia, Minkowski-Choffard disease, Crigler-Nayjar syndrome
Increased levels of transaminases (AST and ALT)	AST – 0.1-0.45 mmol/l ALT – 0.1-0.68 mmol/l	Talks about the inflammatory process and destruction of liver cells	Hepatitis, cholelithiasis, chronic cholecystitis, gallbladder cancer
Increased cholesterol levels in the blood	3.3-5.5 mmol/l	Indicates increased fat metabolism	Vascular atherosclerosis, obesity, cholelithiasis, chronic cholecystitis
Reducing blood cholesterol	3.3-5.5 mmol/l	Indicates a decrease in the building function of the liver	Acute hepatitis, acute cholangitis, acute cholecystitis, liver and gall bladder cancer
Increased alkaline phosphatase activity	0.5-1.3 mmol/h*l	Indicates stagnation of bile in the liver and bladder	Gallstone disease, chronic cholecystitis
Appearance of C-reactive protein	not detected	Speaks of an acute inflammatory process	Acute cholecystitis, cholelithiasis, acute cholangitis

Instrumental methods for diagnosing diseases of the biliary system

Diagnostic method	Cholelithiasis	Chronic cholecystitis	Biliary dyskinesia	Acute cholangitis	Gallbladder cancer
Ultrasound of the abdominal organs	Stones, gall sand, and “porcelain” gallbladder are detected		Hyperkinetic type: intense shadow of the bubble, its size is reduced. Hypokinetic type: enlargement and descent of the bladder	Signs of hypertension in the bile ducts, their expansion	Increasing bubble density
Fractional duodenal intubation			Hyperkinetic type: bile evacuation is accelerated, its quantity is reduced. Hypokinetic type: bladder emptying is delayed	Decrease in the amount of gallbladder bile, changes in the biochemical composition of bile, presence of bacteria	Tumor cells are found in bile
Radiography	Calcium-containing stones are detected	Thickening, deformation of the gallbladder wall, signs of inflammation	No changes	Not used	When using contrast, a filling defect with uneven contours is revealed
CT scan	Used as an additional research method to make a diagnosis				Used to detect metastases and tumor growth into neighboring organs
ECG	Carried out to exclude acute heart attack posteroinferior wall of the myocardium
Fibrogastrodudodenoscopy	Superficial gastritis

Principles of treatment

Diet No. 5 (see in more detail, and gallstones).

• food is taken 4-6 times a day in small portions
• warm drink: weak tea, juices from fruits and berries diluted with water, rosehip decoction 3-6 glasses a day
• porridges: semolina, oatmeal, rice
• vegetable soups
• lean fish and meats
• dairy products: cottage cheese, sour cream, fermented baked milk, butter
• vegetable fats

Cholelithiasis

• bed rest
• normalization of body weight
• ursodeoxycholic acid preparations: ursofalk, ursosan, ursolizin, choludexan (to improve the outflow of bile)
• antibacterial therapy - 3-4 generation cephalosporins (Fortum, cefotaxime, cefazolin) or aminoglycosides (tobramycin, amikacin) or fluoroquinolones (ciprofloxacin, levofloxacin)
• hepatoprotectors – for the prevention of reactive hepatitis (essentiale, heptral, see full)

For frequently recurring attacks of hepatic colic, it is indicated surgery– removal of the gallbladder (cholecystectomy).

Chronic cholecystitis

• Diet No. 5 – excluding fatty, high-calorie and cholesterol-rich foods
• bed rest for 7-10 days
• broad-spectrum antibacterial drugs: 3-4 generations (Fortum, cefotaxime, cefazolin) or aminoglycosides (tobramycin, amikacin) or fluoroquinolones (ciprofloxacin, levofloxacin)
• myotropic antispasmodics (mebeverdine, duspatalin) – to relieve muscle spasm for colic
• enzyme preparations - Creon, Pancreatin, Festal, Panzinorm, Enzistal, Penzital, Ermital, Mezim, Gastenorm, Microzim, Pangrol, etc.
• antisecretory drugs: Almagel, Maalox, Omez, Controloc, rhinitis, Kvamatel

Acute cholangitis

• broad-spectrum antibiotics: semi-protected penicillins (amoxiclav), 3-4 generation cephalosporins (ceftriaxone, cefepime), fluoroquinolones (moxifloxacin, gatifloxacin)
• myotropic antispasmodics (mebeverdine, duspatalin) – to relieve muscle spasms during colic
• enzymes - Festal, Mezim, Creon, etc. see above.
• antipyretic drugs - acelysin, infulgan
• narcotic and non-narcotic analgesics – nalbuphine, ketanov, promedol

Gallbladder cancer

Cancer treatment depends on the extent of the tumor process. Typically, removal of the gallbladder and partial removal of the liver and adjacent lymph nodes are performed. Therapy must be combined, that is, combine both surgical treatment and chemotherapy, radiation therapy.

Most often, the disease comes unexpectedly, so it is recommended to know not only the symptoms of emerging biliary dyskinesia, but also treatment methods.

Dyskinesia and its types

Dyskinesia is a disease of the digestive organs, in the presence of which negative changes occur in the functioning of the motility of the biliary tract, as well as the appearance of the tone of the gallbladder. The condition provokes a disruption in the flow of bile into the duodenum, where the process of food digestion is inhibited.

But you shouldn’t refuse treatment. In the absence of treatment, the disease tends to develop into more serious illnesses, for example, cholelithiasis or similar very unpleasant ailments of the body.

Bile is an essential component in the body that helps in the digestion process. It is the main substance that separates fats from the total mass of food, thereby making their area larger. As a result of excretion, they are absorbed into the blood.

In order for these actions to be carried out correctly, the bile consistency must have a suitable composition. This issue is dealt with by the gallbladder; if there is a large amount of water in the bile, it eliminates it, transferring it into the vessels.

If the motility of the gallbladder is impaired, and the internal fluid, without being filtered, enters the intestines, a disorder is observed and, as a result, diarrhea. In another variant, if bile, on the contrary, undergoes processing for a long time, then water is removed from it in increased quantities, which also negatively affects the work internal organs.

The movement of internal fluid from the liver, where it is formed, to the duodenum is influenced by the work of the sphincters (circular muscles). The latter regulates the flow of bile: first into the gallbladder, and then into the duodenum.

Violation of a coherent system leads to the appearance of dyskinesia. The disease is distinguished based on the activity of muscle contractions (features of motor skills):

1. Hypokinetic - there is a decrease in contractions of the muscles of the biliary tract, the movement of internal fluid is difficult. It usually appears in people who have crossed the threshold of 40 years or in individuals with mental disorders.
2. Hyperkinetic - the activity of muscle contractions, on the contrary, is significantly increased. Caused by a sedentary lifestyle, usually occurs either in children school age, or among the younger generation.

In addition, the disease is classified depending on the causes of occurrence and time of manifestation into primary and secondary forms. Primary dyskinesia manifests itself during the formation of important internal organs, that is, in utero. While secondary is provoked based on the consequences of previous diseases.

Causes of the disease

It is impossible to determine the main cause for different cases. In each individual case, the disease develops individually. A person forms his own habits, eats unhealthy foods, which undoubtedly has an impact on the deterioration of general well-being, and can also cause an inflammatory process in the regulatory system.

One of the factors of occurrence is a stressful situation. It is frequent angry tension, nervousness, and bad mood that affect the motility of the biliary tract, narrowing the patency of the ducts.

The causes of improper functioning of the bladder and ducts in the primary form of the disease are congenital malformations of the fetus:

• The bladder is located inside the liver
• Bile ducts are doubled
• The bubble has kinked
• Formation of valves inside the ducts
• An additional gallbladder has formed
• A bubble has formed divided into two parts by a septum
• Weak bladder walls
• The bubble is quite mobile or incorrectly located

Factors that can influence the development of secondary forms of dyskinesia are identified:

• Genetic predisposition
• Diseases that the patient had previously (viral hepatitis, cholecystitis in various forms)
• Dysbacteriosis of the large intestine
• Mental disorders
• Allergic reactions to foods
• Respiratory tract infections
• Inflammatory processes of the digestive tract
• Stones in the kidneys
• Spasmodic condition of the passages through which internal fluid circulates
• Helminths
• Bad habits (excessive consumption of alcoholic beverages, smoking abuse)
• Negative influence of external environmental factors (environmental pollution)

In addition, obesity or, conversely, prolonged unsuccessful diets contribute to the emergence of a painful problem.

If you experience pain, you should immediately seek advice from a qualified specialist. Treatment should begin by identifying the initial causes that led to this condition.

Symptoms of pathology

Signs of the disease do not immediately make themselves felt. The disease develops for a long period without any symptoms. The first manifestation of discomfort is bad breath, pain in the right hypochondrium or biliary colic. Pain varies with different types of dyskinesia.

In the hyperkinetic form, pain occurs in short-term attacks, but quite intensely, with acute contractions. Unpleasant feelings appear in the area of ​​the right shoulder or shoulder blade, especially during physical exercise, stressful situations or after eating fatty foods.

During the hypokinetic stage, sensations of aching, unpleasant pain appear that are constantly present. Periodically it disappears, but soon appears again. There is also a feeling of fullness in the right hypochondrium.

Colic attacks occur suddenly, with sharp pain. At the same time, the heartbeat sharply increases, the pulse goes off scale, a feeling of cardiac arrest and wild fear appear. Added to this is numbness in the arms and legs.

The main symptoms of the pathology are:

• Severe itching all over the body
• Stool becomes lighter in color
• The skin and mucous membranes become yellow (jaundice)
• Urine appears darker in color
• When diagnosed, liver enlargement is observed
• Appetite decreases
• There is nausea, profuse vomiting
• Presence of dryness and burning in the mouth in the morning
• Irritability, nervous agitation
• Fatigue, lack of performance
• Increased sweating
• Frequent headaches

Men experience a sharp decrease in sexual desire, and women suffer from menstrual cycle. In any condition, depression, emotional weakness and physical disability are observed.

The disease can occur in hidden form, flowing into a chronic condition, or may flare up with an unexpected exacerbation. After the attack, there is a slight relief of symptoms.

An increase in body temperature at the time of acute occurrence is not detected; in addition, no general analysis blood, nor clinical does not reveal any pathological changes. A long period of presence of the disease tends to provoke serious complications.

Diagnosis of the disease

If any symptoms appear that indicate the body is not working properly, it is recommended to seek advice from a qualified specialist. An experienced specialist can determine dyskinesia at the first examination by palpation and by the patient’s appearance.

The patient looks unhealthy, weakened, the skin is dry, and dermatitis is often present. The doctor conducts general question on the topic of the time of onset of abdominal discomfort, the duration of staining of the epidermis.

During the consultation, the causes of such symptoms are identified. What are the signs of illness associated with - bad habits, environmental conditions, difficult working conditions or previous illnesses, identified tumors.

Using palpation, the specialist determines the severity of pain during inspiration. By tapping, the size of the spleen and liver is measured.

If necessary, the patient is additionally examined by a therapist. Based on the tests performed and the results obtained, effective and prompt treatment is prescribed.

Treatment methods

Therapy is based not only on the results obtained from the study, but also on the identified cause that caused the disease. Primary treatment is based on removal of the underlying disease.

A fairly common cause of this problem is psychological stress and frustration. Therefore, the patient is recommended to visit a psychotherapist. If the leading symptoms are a depressive, depressed state, then the disease can only be eliminated with sedative medications.

If the symptoms do not relate to psychosomatic signs, then the form of dyskinesia (hypo- or hyperkinetic) is determined and, based on the results, treatment is recommended.

Healing requires an integrated approach, including several stages of therapy:

• Treatment with medications
• The use of traditional medicine using infusions, herbs and decoctions - recommended by a gastroenterologist
• Diet therapy
• Other cures

The main goal and main task of curing biliary dyskinesia is to normalize the functioning of the gallbladder, as well as to improve the motility of the excretory canals. In addition, treatment allows you to normalize the functioning of the outflow of bile.

Diet therapy

Diet for diseases of the biliary tract is the main component in normalizing the entire condition of the body. If you do not deviate from the established boundaries in nutrition and adhere to the work and rest regime prescribed by the doctor, you can avoid complications caused by the disease.

The diet for patients with this disease is No. 5. It has both general postulates for patients and differs depending on the form of the disease derived from the analysis (hypo- and hyperkinetic).

Food should be taken in small portions, 4-5 times a day. You need to eat food so that the introduced products are immediately broken down, and the gallbladder is quickly emptied. This is necessary to eliminate pain that occurs during prolonged digestion of food.

Eating should be done every 3-4 hours, this interval should not be increased or decreased. It is recommended to take the last meal before going to bed 2-3 hours in advance; however, you should not eat meat products, they are difficult for digestion.

Medical professionals recommend to improve motor skills gastrointestinal tract in the morning and after dinner, drink one glass of low-fat kefir (1%). At any stage of the disease, you should not heat or cook food with lard, margarine or similar trans fats.

You need to completely avoid the following products:

• spicy, fried, fatty, smoked
• sausages and meat products, fish (fatty varieties), lard
• fast food, chips, nuts, ice cream, chewing gum, chocolate
• alcohol and cold carbonated drinks
• canned food, baked goods, mushrooms

Select foods from the general diet that will need to be removed at the time of exacerbation of the disease:

• mustard, pepper
• salty ingredients and hot spices
• onion, radish, horseradish, radish
• Rye bread

For consumption during any period of illness, it is advisable to eat the recommended set of nutritional ingredients:

• low-fat soups and borscht
• switch to a vegetarian diet
• biscuits
• poached eggs, boiled
• porridge with water – buckwheat or rice
• steamed fish or meat (low-fat)
• vegetables in any form except raw
• cooking with sunflower or olive oil, cream should only be consumed
• in the morning as a sandwich
• bread - only yesterday's
• weak tea, preferably green, fresh juices, mostly freshly squeezed

If a hypokinetic form of the disease is detected, you should definitely include black bread, sour cream, cream, eggs (daily), vegetables and fruits in your diet. They are necessary to stimulate the motility of the ducts and pathways of the biliary system.

In a hyperkinetic state, it is necessary to strictly follow a diet and categorically refuse fermented milk products with high fat content; gray and black bread, fresh vegetables, sparkling water and animal fats. The use of mineral waters in any form is recommended.

Drug therapy

Due to the fact that most problems with the biliary tract occur against the background of mental disorders, treatment should begin with a psychotherapist. If the cause is confirmed and the basis for stagnation of bile and the lack of motility is the result of a depressive mood, antidepressants and sedatives are prescribed.

If the factors influencing the formation of the disease are provoked by neuroses, then antipsychotics and tranquilizers are recommended for use.

Do not forget about other reasons that led to the appearance of dyskinesia and carry out therapy to eliminate them: anthelmintic medications, removal of hypovitaminosis, combating allergic reactions, treatment of dysbacteriosis.

With the hypokinetic form of dyskinesia, choleretic medications are needed that can affect the growth of the tone of the gallbladder: xylitol, magnesium sulfate. The use of drugs that stimulate motor skills is also required bile ducts(Pankreosimin, Cholecystokinin).

If a hyperkinetic form is diagnosed, medications are required to increase the formation of internal fluid for the breakdown of products. These drugs include Oxafenamide, Nicodin, Flamin, Cyclalone.

If the sphincters are tense, then it is recommended to use antispasmodics (Buscopan, No-shpa). You definitely need to take medications that strive to normalize the balance of the sympathetic and parasympathetic systems. For these purposes, potassium bromide or tinctures of motherwort and valerian should be used.

Treatment with traditional methods

Traditional methods and medicinal herbs are an excellent addition to the main treatment. For therapy, decoctions are brewed and used separately for each form of the disease.

For the hypokinetic form of the disease, it is possible to use an infusion of chamomile flowers, corn silk, rose hips, nettle leaves, St. John's wort, oregano and immortelle flowers.

Separately, decoctions are prepared for the hyperkinetic stage - valerian or licorice root, dill, mint or motherwort.

You should not give up drinking mineral water. For active muscle contractions of the bile ducts, water is used:

While for decreased tone of the gallbladder, Essentuki No. 17 or Arzni is used to stimulate it.

Thus, herbal treatment and mineral water leads to positive results. But therapy should be carried out in combination with medications and diet.

Additional measures

In addition to therapy with medications, diet and folk remedies, it is also effective to use additional methods of treatment:

1. Physiotherapy is the effect of medical devices, namely the use of electric current on an area in the area of ​​the right forearm, as well as the effect of electrophoresis.
2. Acupuncture - when needles are inserted into specific points, the necessary internal organs are affected.
3. Exposure to leeches (hirudotherapy) - the latter are applied to nerve endings belonging to certain organs (pancreas, liver, gall bladder).
4. Balneology in sanatorium-resort recreation areas - treatment with mineral waters is advisable to carry out once every 12 months.
5. Acupressure – pressing and massaging non-specific points that affect the bile ducts are determined.

Thus, the methods of influencing the disease are so diverse that they can be selected individually for each patient. The main goal of therapy is to remove discomfort and completely eliminate the problem.

Complications of JVP

In the absence of therapy, the disease progresses and leads to a deterioration not only in a person’s general well-being, but also in the development of serious consequences. Complications are more difficult to treat than the original problem.

The following deteriorations may occur:

• inflammatory process of the bile ducts (chronic cholecystitis)
• gastritis
• atopic dermatitis
• cholelithiasis
• pancreatitis – chronic stage of development
• duodenitis
• sharp decrease in weight category (dystrophy)
• cholangitis

To protect yourself from emerging complications, you need to contact a medical specialist competent in this matter at the first symptoms.

You should also follow a number of rules to help prevent deterioration of the condition. You should not go to bed later than 11 pm, get enough sleep (8 hours a day), normalize the hours of intensive work and productive rest, and spend more time in the fresh air.

The main thing is to exclude a nervous condition or change your place of work if it involves constant stressful situations.

Dyskinesia in children

A similar disease occurs in children in the event of abnormal development in utero. Most often, a bend in the bladder or the presence of a septum in the central part is recorded, but there is also an incorrect location in the peritoneal cavity, and the formation of a secondary organ is also possible.

In children of preschool or primary school age, the causes are frequent stress, emotional stress, family quarrels, overexertion or frequent moving.

It is worth paying attention to the symptoms that appear in a child when an illness occurs:

• After eating a fatty or acute meal, complaints of pain in the right hypochondrium
• Frequent constipation or, conversely, intestinal upset
• Sudden onset itching of the skin

Diagnosis is identical to that for adult patients. During diagnosis, the appropriate form of the disease is determined and appropriate treatment is prescribed.

For hyperkinetic dyskinesia, medications are used:

1. Medicinal herbs: decoction of dandelion, mint, rose hips, corn silk.
2. To stimulate the formation of internal fluid (Allohol, Holagol).
3. Increasing the tone of bile ducts (Sorbitol).
4. Mineralka Essentuki No. 17.

When fixing the hypokinetic form, the following medications are required:

• Lightly carbonated mineral water– Slavyanskaya or Smirnovskaya
• Antispasmodics – Riabal, Eufillin
• Traditional medicine - decoctions of chamomile, nettle, St. John's wort

It is mandatory to use a diet - the products are completely identical for both adult patients and small patients. If there are no painful attacks, a slight deviation from the strict limits of product introduction is possible.

Children susceptible to biliary tract diseases are subject to constant monitoring by doctors - gastroenterologist, psychotherapist, pediatrician. They are prescribed a scheduled ultrasound examination once every 6 months.

So, the ongoing disease in children is more dangerous illness than in adult patients. The treatment of young patients is strictly controlled by medical professionals.

Thus, dyskinesia is a disease that has no boundaries in the age category. Anyone can purchase it; the main thing is that you should not neglect or refuse treatment.

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Biliary dyskinesia - causes, symptoms, forms and treatment methods

Biliary dyskinesia is a difficult flow of bile from the liver into the bladder and through the ducts. A distinctive feature of the disease is the absence of pathological changes in the structure of the liver and gallbladder with ducts. During examination, doctors identify two types of gallbladder dysfunction in patients - either its contraction is too slow or its contraction is too fast/frequent. According to statistics, men suffer from biliary dyskinesia more often than women (about 10 times).

Classification

The definition of the form of dyskinesia depends on how the gallbladder contracts:

• hypermotor - in this case, the contraction of the organ is very frequent and rapid. A similar form of the disease in question is characteristic of young people;
• hypomotor - contraction occurs slowly, the activity of this function of the gallbladder is significantly reduced. According to statistics, hypomotor biliary dyskinesia is often diagnosed in patients over 40 years of age and in patients with persistent neuroses/psychoses.

Depending on the cause of the development of the pathology in question, doctors can divide it into two types:

• primary dyskinesia - it is usually associated with congenital anomalies in the structure of the biliary tract;
• secondary - the disease is acquired during life and is a consequence of pathologies in other organs of the gastrointestinal tract (for example, secondary biliary dyskinesia often “accompanies” pancreatitis - an inflammatory process in the pancreas).

Causes of development of biliary dyskinesia

If we are talking about the primary type of the disease in question, then its causes are:

• narrowing of the gallbladder;
• doubling (bifurcation) of the bile ducts and bladder;
• constrictions and septa located directly in the cavity of the gallbladder.

All these causes are congenital anomalies and are detected in early childhood during examination.

A secondary type of dyskinesia of the gallbladder and ducts can develop against the background of the presence of the following factors:

• gastritis - an inflammatory process on the mucous membrane of the inner walls of the stomach;
• formation of ulcers on the mucous membrane of the stomach and/or duodenum – peptic ulcer;
• cholecystitis - inflammation of the gallbladder;
• pancreatitis - an inflammatory process in the pancreas;
• duodenitis – pathological process inflammatory nature on the duodenal mucosa;
• hepatitis of viral etiology is a systemic disease in which the liver is affected by viruses;
• hypothyroidism – decreased functionality of the thyroid gland.

In addition, the reasons that can lead to the development of dyskinesia of the gallbladder and ducts include neuroses - mental disorders, which are not only well understood by the patient himself, but are also subject to treatment, until complete recovery.

There are documented cases of diagnosing biliary dyskinesia against the background of a sedentary lifestyle, excess weight (stage 2-3 obesity), excessive physical activity (especially if heavy lifting is constantly occurring) and after psycho-emotional breakdowns.

Symptoms of biliary dyskinesia

The clinical picture of the described pathology is quite pronounced, so diagnosis does not present any difficulties for specialists. The main symptoms of biliary dyskinesia are:

1. Pain in the right hypochondrium , gallbladder and bile ducts - in the right hypochondrium. It can have a different character:

• with increased contractile activity of the gallbladder - acute, paroxysmal, with irradiation to the scapula and right shoulder. Occurs either after intense physical activity or eating fatty foods in large quantities;
• if the contractile activity of the bladder is reduced, then the pain will be of a completely different nature - dull, aching, constant (episodes of absence of pain are very rare), patients feel a feeling of fullness in the right hypochondrium;
• biliary colic - always occurs acutely, suddenly, differs in intensity, and is accompanied by increased heart rate. Increased blood pressure (not in all cases). Since the pain is too severe, the patient experiences a feeling of anxiety and fear of death.

1. Cholestatic syndrome (manifestations of pathology in the liver and biliary tract):

• jaundice - yellow different shades skin, sclera are stained eyeballs, oral mucosa and saliva;
• enlarged liver - in some cases the patient himself can feel it;
• change in the color of stool - it becomes noticeably light;
• change in urine color – it becomes distinctly dark;
• itching of the skin without a specific localization.

1. Digestive system disorders:

• bloating;
• loss of appetite;
• nausea and vomiting;
• bad breath from the mouth;
• bitter taste in the mouth;
• dry mouth.

1. Neurosis is a mental disorder that can be cured (reversible):

• irritability and insomnia;
• increased sweating (hyperhidrosis);
• chronic fatigue syndrome;
• headaches - they are not constant, they are periodic.

The above symptoms cannot appear at the same time. For example, cholestatic syndrome is diagnosed in only half of patients with biliary dyskinesia, and bitterness and dryness in the oral cavity are more characteristic of hyperdyskinesia (contractile activity of the gallbladder is increased).

Diagnostic methods

Based solely on the pronounced symptoms of biliary dyskinesia, no specialist can make a diagnosis. To make a final verdict, doctors carry out the following activities:

1. Questioning the patient and analyzing the description of the disease - how long ago the first attacks of pain or other symptoms appeared, what they may be associated with (according to the patient).
2. Collecting an anamnesis of the patient’s life - have there been any cases of diagnosing the disease in question in his relatives, are there any diagnosed chronic diseases of the gastrointestinal tract, have he taken any medications for a long time, have he been diagnosed with benign/malignant tumors, in what conditions does the patient work? (meaning the presence/absence of toxic substances at work).
3. Physical examination - the doctor determines what color the patient’s skin, sclera and mucous membranes are (whether there is jaundice or not), whether obesity is present, palpation (feeling) will help identify liver enlargement.
4. Laboratory testing – general and biochemical tests blood, general urine test, lipid profile (detects the level of fat in the blood), markers of hepatitis of viral etiology, examination of stool for worm eggs.

After this examination, the doctor can diagnose biliary dyskinesia, but to confirm it, the patient will also be prescribed an instrumental examination of the body:

• ultrasound examination of all abdominal organs;
• ultrasound examination of the gallbladder “with a test breakfast” - first an ultrasound scan is performed on an empty stomach, then the patient eats a fairly fatty breakfast and after 40 minutes a repeat ultrasound scan of the gallbladder is performed. This procedure makes it possible to find out in what form the disease in question occurs;
• duodenal intubation - using a special intestinal probe, the duodenum is examined and bile samples are taken for laboratory testing;
• FEGDS (fibroesogastroduodenoscopy) – examines the mucous membranes of the stomach, duodenum, and esophagus;
• oral cholecystography - the patient drinks a contrast agent and after half an hour the gallbladder can be examined for the presence of developmental anomalies;
• ERCP (endoscopic retrograde cholangiopancreatigraphy - one study combines both x-ray and endoscopic methods. This allows you to directly examine the bile ducts;
• hepatobiliary scintigraphy is a radioisotope method in which the patient is injected with a radioactive drug (intravenously), which accumulates in the liver and biliary tract, which makes it possible to study their complete and accurate image.

Treatment methods for biliary dyskinesia

The goal of treatment procedures is to ensure a complete outflow of bile from the liver. It will not be possible to do this solely with medications; an integrated approach is needed.

Therapy for biliary dyskinesia includes:

1. Creating and following a daily routine:

• a competent combination of work and rest - for example, night sleep should not be less than 8 hours;
• Take regular walks in the fresh air;
• When performing sedentary work, do gymnastics every 2 hours - we are talking about the simplest bending, squats, and twisting the body.

1. Strict diet:

• Spicy/fatty/smoked foods and canned food (homemade and industrial) are excluded from the menu;
• salt intake is reduced - it is permissible to take no more than 3 grams of salt per day;
• regularly drink mineral water - it can be different, which is suitable for a particular patient is determined by the attending physician or nutritionist;
• Food should be taken in small portions, but the frequency of meals should be large - up to 6-7 per day.

1. Medications:

• choleretic drugs - choleretics;
• enzyme preparations;
• Cholespasmolytics.

1. Additional medical procedures:

• tubing of the gallbladder (cleansing) - taking choleretic drugs in a lying position on the right side with a heating pad in the area anatomical location liver and biliary tract;
• regular duodenal intubation - cleansing the duodenum after the release of bile;
• electrophoresis;
• acupuncture;
• diadynamic therapy;
• acupressure;
• hirudotherapy (treatment with leeches).

Surgical intervention is absolutely inadvisable, therefore surgical treatment Biliary dyskinesia is never prescribed. On the recommendation of a gastroenterologist or therapist, the patient can be referred to a psychotherapist (if he has neuroses).

Treatment of biliary dyskinesia with folk remedies

Treatment of biliary dyskinesia with herbal preparations is also approved by official medicine - doctors recommend taking a course of using decoctions/tinctures of medicinal herbs twice a year. Here are two of the most effective and safe recipes:

1. Prepare the following herbs:

• elecampane root – 10 g;
• marshmallow root – 10 g;
• calendula (flowers) – 15 g;
• chamomile (flowers) – 10 g.

Mix the indicated plants and take only 2 tablespoons of the resulting mixture. They should be poured with half a liter of water, boiled and simmered over low heat for at least 7 minutes. Then the broth is infused (40-60 minutes), filtered and the resulting amount is drunk in small sips half an hour before meals three times a day. Duration of treatment – ​​3 weeks.

1. Mix plantain leaves (30 g), calendula flowers and sage leaves (10 g each), mint/rosehip/cumin (15 g each), cinquefoil (herb) and raspberry leaves (20 g each). And the preparation and administration scheme is the same as for the previous decoction.

Among the traditional methods, the following recipes can be distinguished:

• if the contraction of the gallbladder is reduced, a cold compress should be applied under the right hypochondrium at the time of an attack of pain, and in case of increased contractile activity, a hot compress should be applied.
• for a month, in the morning on an empty stomach, drink a glass of milk mixed with carrot juice in a 1:1 ratio;
• in case of pain syndrome against the background of diagnosed hypertensive dyskinesia, you should do an enema with corn oil - one tablespoon of oil per liter of warm water.

There are also methods of treatment with sand and clay, essential oils and vegetable juices, but there is no confirmation from official medicine regarding the advisability of such procedures. Any treatment with folk remedies should be carried out only after consultation with the attending physician and with regular monitoring of the dynamics of the disease.

Possible complications

As a rule, with biliary dyskinesia, patients seek help from doctors almost immediately after the first attack of pain. But many of them, having removed unpleasant symptoms, stop the prescribed treatment, thereby provoking the development of complications:

• chronic cholecystitis – inflammation of the gallbladder that lasts more than 6 months in a row;
• the formation of stones in the gallbladder and its ducts – cholelithiasis;
• chronic pancreatitis – inflammation of the pancreas for 6 months;
• atopic dermatitis is a skin disease that is a consequence of a decrease in the level of immunity;
• duodenitis is an inflammatory process on the lining of the duodenum.

Biliary dyskinesia has a fairly favorable prognosis and does not shorten the patient’s life expectancy. But in the absence of proper treatment and non-compliance with the nutritionist’s recommendations, the development of the above complications is inevitable. And even these diseases are not life-threatening, but the patient’s condition will worsen significantly and eventually lead to disability.

You will receive useful advice for patients diagnosed with VSD by watching this video:

Tsygankova Yana Aleksandrovna, medical observer, therapist of the highest qualification category.

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The information is provided for informational purposes only. Do not self-medicate. At the first sign of disease, consult a doctor. There are contraindications, a doctor's consultation is required. The site may contain content prohibited for viewing by persons under 18 years of age.

Biliary dyskinesia: symptoms, treatment

Dyskinesia is not at all an inflection, not a curvature of the pathways or the bile bladder itself, as most people believe. This term, translated from Greek, stands for “movement” and “violation”. Thus, we can conclude that biliary dyskinesia is a pathological condition of the body in which the motility or tone of the system that carries bile to twelve is impaired. duodenum from the liver. This condition leads to pain in the right iliac region, problems with stool, and in some cases bitterness in the mouth, but during the examination no damage to these organs is detected.

In most cases, dyskinesia develops in people who have abnormalities in the development of the biliary organs and also adhere to an unbalanced diet. Dyskinesia can also appear in people who are exposed to severe stressful and traumatic situations. In addition, there are other reasons for the development of this condition. Women are particularly susceptible to this disease. Treatment of dyskinesia consists of eliminating the manifestations, and also, if the biliary tract has poor contractility and slow speed of movement, ensuring the prevention of stone formation.

A little about physiology and anatomy

Bile is a brownish-yellow liquid that is needed by the body during digestion. The main function of bile is to separate dietary fats into small fractions, thereby increasing their surface area. In this state, fats are better processed by the lipase enzyme and, after decomposition, the components of fats are absorbed into the blood - fatty acid. In addition, bile is involved in the absorption of carbohydrates and proteins. Three-quarters of bile is produced by the liver and one-fourth by the hepatic ducts, and thanks to it, the small intestine can function normally: it carries out the processes of absorption of nutrients, division and death of its own cells.

To ensure the normal functioning of all the described processes, bile must be in normal concentration. The normalization process is carried out by the gallbladder, which releases excess water to the vessels. If bile enters the intestines in a diluted form (is not retained in the bladder), then irritation of the intestinal walls occurs, which leads to diarrhea. Also, when bile remains in the gallbladder for a long time, its concentration increases; this state of affairs also has its consequences.

Bile is formed in the liver, after which it reaches the gallbladder through special ducts, and from there it enters the duodenum. The movement of secretions is ensured by pressure changes in the biliary tract, which is pumped using sphincters - special circular muscles.

Thus, when the sphincter that allows bile into the gallbladder is closed, it drains from the liver. After its opening, the secretion penetrates into the bladder, which was in an almost empty state, and accordingly, the pressure in it was significantly lower than in the duct itself. When does it enter the duodenum from the stomach? fatty food, the gallbladder contracts due to muscles, and the sphincter opens, bile passes through the duct to the circular muscle, which closes the entrance to the duodenum. After the first sphincter closes, the second one (leading to the intestine) opens, and bile enters the intestine. The sympathetic nervous system, as well as some substances produced by the pancreas and stomach, are responsible for the reduction of the biliary tract.

Dyskinesia and its types

Having an idea of ​​the anatomy of the biliary system, the basic principles of pathology can be explained in detail. Thus, dyskinesia is a condition in which:

one or more sphincters located in the bile ducts do not relax in a timely manner;

or, conversely, regardless of food intake, they refuse to relax;

a very strong contraction of the gallbladder may occur;

the rate of bile outflow decreases due to sluggish contractions of the bile duct and bladder.

Depending on the nature of the tone disturbance and motor function, dyskinesia can be:

hyperkinetic: active outflow of bile, accompanied by sudden releases of bile;

hypokinetic: bile is released slowly, and movement in the biliary tract slows down;

hypotonic: sphincter tone is significantly reduced;

hypertensive: the tone of the circular muscles, on the contrary, is increased.

In most cases, the hypertensive state is combined with increased motor skills, and a spastic, or hypertonic-hyperkinetic type of dyskinesia is formed. In the case of the opposite situation, almost the same thing happens: the tone of the pathways is weakened and an atonic or hypotonic-hypokinetic type appears. A mixed type may also be present.

Spastic dyskinesia is most typical in the case of increased tone of the parasympathetic department. The atonic type of pathology develops in the case of predominance of the sympathetic department of the autonomic part of the central nervous system.

Causes of the disease

The following reasons lead to disruption of the movement or tone of the biliary tract:

Congenital malformations of the gallbladder and biliary tract:

abnormally located gallbladder;

accessory gallbladder;

valves in the gastric duct;

the presence of a dividing septum in the gallbladder;

inflection of the gallbladder;

intrahepatic gallbladder;

congenital weakness of the gallbladder wall;

duplication of the bile ducts.

Such pathologies lead to the development of so-called primary dyskinesia.

previous intestinal infections;

the period of menopause, in which dysregulation of bile duct contractility occurs;

giardiasis, in which the gallbladder is colonized by protozoan flagellated organisms;

previous viral hepatitis;

diseases endocrine system: thyrotoxicosis, diabetes, obesity;

foci of infection that are constantly present in the body (chronic tonsillitis, caries);

neurocircular dystonia, in which there is a violation of the normal sequence during contraction of the muscles of the biliary tract;

traumatic situations or constant stress;

eating habits: eating a significant amount of spicy, smoked, fatty foods, avoiding or focusing on vegetable fats, long periods of fasting.

Signs of the disease

Symptoms of biliary dyskinesia may differ depending on the type of pathology, that is, it is hypokinetic or hyperkinetic.

The main difference between the main types of dyskinesia is the nature of the pain.

In the iliac region on the right.

In the right hypochondrium.

Aching, dull, low-intensity pain. May be described as a feeling of pulling under the rib or heaviness.

It is felt only under the rib.

It radiates to the right shoulder and shoulder blade.

Errors in diet, strong emotions.

After fatty foods, stress, physical activity.

Symptoms associated with pain

Feeling of bloating, diarrhea, constipation, belching of air, loss of appetite, nausea, bitterness in the mouth.

Diarrhea, constipation, increased urine output, vomiting, nausea.

During an attack, the following may appear: headache, drop in blood pressure, sweating, irritability.

It goes away on its own.

Taking the drugs "Buscopan", "No-spa".

During the period between attacks

The disease gradually changes a person’s personality (reversibly): mood swings, fatigue, irritability, and tearfulness appear. Outside of an attack, there is nothing to worry about.

There is nothing to worry about; short-term pain may periodically appear in the right side of the abdomen near the navel, in the pit of the stomach, in the hypochondrium.

With both types of dyskinesia, the following symptoms may appear:

menstrual irregularities – in some women;

decreased libido levels in men;

the appearance of a yellow coating on the tongue;

bad smell from mouth;

recurrent headaches;

An extreme manifestation of the hyperkinetic variant of the disease is the formation of biliary colic. Its manifestation occurs suddenly, in the form of severe pain in the right region of the body, under the rib, which is accompanied by numbness of the limbs, panic attacks, and rapid heartbeat.

The maximum degree of manifestation of hypokinetic dyskinesia is a pathological condition called choleostasis - that is, stagnation of bile in the bile ducts. The following symptoms indicate it:

the stool becomes grayish or most often light yellow in color;

yellowing of the whites of the eyes and skin;

severe itching all over the skin.

Diagnosis of the disease

Symptoms alone are not enough to make a diagnosis, since similar signs can also appear with more severe liver pathologies. In addition, it is necessary to establish the exact cause (for example, a malformation of the biliary tract) that led to the disease in order to subsequently eliminate it.

Biliary dyskinesia is a condition in which the structure of these organs is not disturbed. Therefore, the diagnosis is made in the presence of contractility disorders or imbalances in tone along the path of bile from the liver to the duodenum. How can this be diagnosed?

Performing an ultrasound examination of the gallbladder after a choleretic breakfast. Initially, a three-day diet is followed, which ends with a “clean” ultrasound of the abdominal cavity. With the help of the study, the size of the volume of deformation is assessed, and an examination is carried out for the presence of gallstones and biliary tract abnormalities. After this, the person begins to take foods that promote the release of bile into the duodenum (the menu could be: a couple of bananas, chocolate, full-fat yogurt, 10 grams of fat sour cream or cream), after which the doctor can observe in what sequence and how the promotion of bile works along the paths.

By assessing portions of duodenal contents. To do this, a study is performed called duodenal intubation: a person swallows a thin probe, which, upon reaching the duodenum, collects its contents.

The study should be carried out on an empty stomach. First, through a probe, a portion of the intestinal contents is obtained, which is the standard intestinal environment, consisting of the juice of the duodenum itself, pancreatic juice and bile. After this, magnesium sulfate is injected into the intestine, which causes the gallbladder to contract, and bile enters the intestine from the bladder itself. It is taken for research, after which the bile, which has drained during this time, and the intrahepatic bile ducts are taken for analysis. To establish the diagnosis of dyskinesia, the time during which the process of obtaining the second analysis occurs, after the administration of the drug, and after the third analysis, is important. An important informative component is also the content of lipids, which are presented in the last two portions.

Cholangiography (examination of intrahepatic ducts) and cholecystography (examination of intrahepatic bile ducts) are methods contrast radiography. In cholecystography, the patient must take the contrast agent orally, after which the path of the contrast agent is traced using X-rays before it reaches the gallbladder and after it is removed. The work and sequence of contraction of the gallbladder sphincters and ducts are analyzed. When performing the second method, a radiopaque substance is injected directly into the duct itself, after which the doctor uses an X-ray machine to observe the progress of the substance along the biliary tract.

Endoscopic retrograde cholangiopancreatography, or ERCP, is an instrumental method in which a probe equipped with an optical fiber is inserted into the duodenum. Through it, a contrast agent is injected into the bile ducts, the opposite of the normal flow (retrograde), the progress of which is observed on x-rays.

Cholescintigraphy is a radiological study during which a radioisotope drug is injected into the body. Thanks to special radiation, it becomes possible to visualize the process of its passage into the liver, its release into bile ducts, the path to the gallbladder and reaching the duodenum.

At difficult cases disease, it is necessary to perform the method of magnetic resonance cholangiography, which is a non-invasive study in which a contrast agent is introduced into the body, and the path of its progress is visible on a magnetic resonance imaging scanner. To undergo such a diagnosis, the patient must remain in the tomograph chamber for about minutes, keeping still.

A blood test for bilirubin with fractions and lipids, a coprogram and a stool test for helminth eggs and dysbacteriosis are methods that allow you to determine the degree of preservation of the functions of the biliary tract, as well as studies that allow you to determine the presence in the body of the cause of the possible occurrence of the disease - worms. It is impossible to make a final diagnosis based on these tests alone.

Treatment of biliary dyskinesia consists of:

drug therapy: prescribed in courses to ensure the relief of an attack and prevent its further occurrences, as well as to prevent complications;

taking infusions and decoctions of various herbs: prescribed by a gastroenterologist depending on the type of disease and is an integral part of treatment;

diet therapy: is different for hyperkinetic and hypokinetic forms of pathology.

The basis of treatment for dyskinesia is nutrition. Only through strict adherence to the rules can the occurrence of attacks be avoided and prevention carried out surgical complications such as cholelithiasis and acute cholecystitis.

A diet for dyskinesia involves following general nutritional rules, however, there are points that differ significantly depending on the type of disease (hyperkinetic and hypokinetic).

It is necessary to eat food in such a way that the gallbladder is completely emptied, so as not to cause a painful attack. For this:

do not heat food in trans or animal fats: lamb, goose, pork, margarine;

avoid eating too hot or cold foods;

Eat low-fat fermented milk products in the morning and evening;

have dinner 2-3 hours before bedtime, but do not overeat meat;

maintain intervals of 3-4 hours between meals;

eat food in small portions;

eat little by little, 4-5 times a day.

Avoid during periods of exacerbation

cold carbonated drinks;

lard from any bird or animal;

fatty fish and meats;

freshly squeezed juices and diluted with water;

sweets: jam, pastille, caramel, marshmallows, marmalade, honey;

ripe and sweet berries and fruits;

a small amount of butter, while a certain part of it should be taken on an empty stomach as a sandwich;

olive and sunflower oil;

steam omelettes and boiled eggs;

low-fat fermented milk products;

boiled, stewed and baked vegetables;

porridge with milk or water, rice and buckwheat;

boiled, steamed and baked low-fat fish, poultry and meat;

milk soups with cereals;

Features of nutrition for hypomotor dyskinesia

The diet should consist of foods that stimulate biliary motility:

vegetable and butter;

vegetables (boiled, stewed, baked);

Features of nutrition for hypermotor dyskinesia

If this form of pathology is present, it is imperative to exclude daily diet products that stimulate bile secretion and bile formation: soda, broths, fresh vegetables, fatty fermented milk and dairy products, black bread, animal fats.

It has general purpose and is based on the type of dyskinesia present.

Since dyskinesia is a disease caused by a violation nervous regulation, directly depends on the mental state, then before starting treatment for disorders motor activity in the biliary tract when using choleretic drugs, it is necessary to restore mental background patient. If the pathology appeared against the background depressive state, it is necessary to prescribe a course of mild antidepressants. If the disruption of the bile secretion process was caused by severe anxiety, neuroses, then it is advisable to start with antipsychotics and tranquilizers.

Such drugs can be prescribed by a psychiatrist or psychotherapist.

In addition, the cause of dyskinesia is treated: correction of dysbiosis, elimination of hypovitaminosis, treatment of allergies, anthelmintic therapy.

In this case, choleretic drugs are needed, which:

improve motility of the biliary tract: for example, pancreozymin, cholecystokinin;

increase the tone of the gallbladder: xylitol, magnesium sulfate.

In addition to choleretic drugs, tonics are also required: lemongrass tincture, Eleutherococcus extract, ginseng adjustment.

In this case, drugs are needed that stimulate an increase in the formation of bile: with a larger volume of bile, the ducts work longer and do not contract quickly, causing a painful attack. These are medications: “Nicodin”, “Flamin”, “Okafenamide”.

Also, if the sphincters are overstrained, it is necessary to relax them. This effect is achieved by taking antispasmodics: Buscopan, No-shpy.

In addition, drugs are needed that normalize the balance of sympathetic and parasympathetic systems: motherwort tincture, potassium bromide, valerian tincture.

Treatment with traditional methods

Biliary dyskinesia is one of those pathologies for which treatment with folk remedies is an excellent addition to the main treatment with medications, and in some cases is the only method (in the treatment of dyskinesia in children).

High degree of mineralization:

Low degree of mineralization, which must be consumed warm:

Herbs used to make a decoction

chamomile flowers

If the test results confirm the presence of bile stagnation, but there is no damage to the liver tissue (AST and ALT levels are not increased in the analysis of “liver samples”), then blind zoning is necessary. To do this, on an empty stomach you should drink a solution of magnesium sulfate, highly mineralized mineral water or a sorbitol solution. After this, you should lie on your right side, before placing it under it warm heating pad. You should lie in this position for about minutes.

Additional therapies

For the treatment of biliary dyskinesia the following is used:

treatment in gastroenterological sanatoriums, which provide therapy with mineral waters;

treatment with leeches (hirudotherapy);

physiotherapy: microwave, electrophoresis, diadynamic currents.

Complications of biliary dyskinesia

Such a functional disorder can cause the following consequences:

metabolic disorders and weight loss, which occurs as a result of impaired absorption of necessary substances without their proper bile treatment;

allergization of the body, which manifests itself in the form of a skin rash;

gastritis and gastroduodenitis - inflammation of the stomach or duodenum. This is due to the fact that in the presence of this disease, unconcentrated bile is often thrown into the duodenum and stomach, which leads to subsequent inflammation;

inflammation of the pancreas;

cholangitis - inflammation of the intrahepatic bile ducts;

the formation of chronic cholecystitis (inflammation of the gallbladder wall).

Disease prevention and prognosis

To prevent the development of pathology, certain rules must be followed:

exclude traumatic situations;

eat well: eat more plant fiber, boiled animal products, cereals, less fried fish or meat;

walk in the fresh air;

alternate physical and mental work;

go to bed no later than 11 pm;

sleep at least 8 hours a night.

If pathology already exists, then you should follow all the recommendations of the gastroenterologist, and also pay attention to the psycho-emotional background.

Biliary dyskinesia cannot reduce life expectancy, but can affect its quality.

The cause of biliary dyskinesia, which develops in children younger age, is the anomalous structure of these very pathways. In most cases, this is a bend in the gallbladder or the presence of additional partitions in it; an abnormal location or duplication of the biliary tract may also be present.

In older children, the cause of the development of pathology is emotional stress. This is a large workload, a team at school or kindergarten, family relocation, parental quarrels and other factors.

Other causes of biliary dyskinesia are:

helminthic infestations: roundworms, giardiasis;

past salmonellosis, dysentery, hepatitis A;

chronic tonsillitis, frequent sinusitis;

asphyxia or hypoxia during childbirth;

Childhood dyskinesia is a more dangerous disease: without normal emulsification of fats, the absorption of sufficient amounts of substances and fatty acids necessary for the body does not occur, as well as fat-soluble vitamins– K, E, D, A, each of which is very important for a growing organism.

If parents begin to notice that the child begins to cry at the slightest provocation, gets tired quickly, becomes irritable, withdrawn, then it is necessary to contact a gastroenterologist to rule out the presence of biliary dyskinesia. If on this moment it will not be identified, this is not a reason to think that the danger has passed. This result indicates that there is a predisposition to the disease, but the pathology has not yet appeared. In this case, it is necessary to pay attention to the child’s daily routine and diet in order to prevent the formation of the disease.

The following symptoms may indicate the development of pathology:

itching of the skin, the cause of which is unknown, not as a result of taking a new medication or food, not after a bite, not after an injection;

periodic - especially if fried or fatty foods were consumed, manifestations of pain in the right hypochondrium;

alternating diarrhea and constipation.

Diagnosis of the disease is carried out through ultrasound examination with a choleretic breakfast. X-ray contrast, and even more so, radioisotope techniques can be performed in children only if there are strict indications, and since the advent of magnetic resonance cholangiography, they have practically ceased to be performed.

Treatment of pathology in children

For the treatment of diseases in children, special preference is given to drugs plant origin. Their selection is carried out depending on the type of pathology.

Thus, in the presence of hypomotor dyskinesia, the following is prescribed:

mineral waters "Essentuki 17";

blind probing with xylitol or sorbitol;

herbal therapy: decoctions of mint, corn silk, rose hips, dandelion;

medications that increase the tone of the biliary tract: xylitol, sorbitol or magnesium sulfate;

drugs that stimulate the process of bile formation: “Liobil”, “Allohol”, “Holosas”, “Holagol”.

For hypermotor dyskinesia, therapy is as follows:

electrophoresis with novocaine in the area of ​​the gallbladder;

mineral waters: “Smirnovskaya”, “Slavyanovskaya”;

herbal therapy: decoctions of stinging nettle, chamomile, St. John's wort;

antispasmodic drugs: “Riabal”, “Eufillin”.

After stopping the attack, the child should be rehabilitated in a sanatorium that offers mineral water therapy and other physiotherapy:

to improve the motor activity of the biliary tract: electrophoresis of magnesium sulfate, SMT therapy;

for sedative purposes: bromelectroson, pine baths;

to eliminate spasm of the biliary tract: electrophoresis of antispasmodics (papaverine, no-spa) in the area of ​​the biliary tract, magnetic therapy;

galvanic collar according to Shcherbak;

The diet described above can be fully applied to children. A strict diet must be followed for a year, after which an examination is carried out for the presence of attacks of biliary colic; if the symptom is not confirmed, the diet can be gradually expanded.

Children with biliary dyskinesia are registered with children's pediatrician, neurologist, gastroenterologist. They must undergo routine ultrasound scans twice a year. Also, courses of choleretic therapy should be carried out every 6 months. Once or twice a year, the child should receive a referral for therapy in sanitary resort complexes.

Lecture No. 27

Clinic of biliary tract diseases

Before discussing diseases of the biliary tract, it should be remembered that there are intrahepatic bile ducts, hepatic bile ducts, common bile duct, or common bile duct, and gallbladder.

All diseases of the biliary tract are divided into:

functional diseases (hypertensive - hyperkinetic and hypotensive - hypokinetic biliary dyskinesia);

inflammatory diseases of the gallbladder (acute and chronic cholecystitis);

inflammation of the common bile duct (acute and chronic cholangitis);

inflammation of small bile ducts (angiocholitis);

diseases associated with lipid and pigment metabolism disorders (cholelithiasis);

tumor diseases (cholangiogenic cancer and cancer of the papilla of Vater);

In today's lecture we will look at the main diseases of the gallbladder.

The gallbladder is a hollow organ of the digestive system in which bile accumulates, its concentration increases, and from which periodically, when additional bile discharge is necessary, bile flows into the common duct, then into the duodenum. With the help of feedback through sympathetic and parasympathetic nerve fibers, the gallbladder maintains an optimal level of bile pressure in the bile ducts. The vagus nerve (PS ANS) is the motor nerve of the gallbladder, causing its tonic contractions with simultaneous relaxation of the finkter of Oddi, and the secretory nerve of the liver. The sympathetic nerve relaxes the wall of the gallbladder and contracts the sphincter of Oddi.

The shape of the gallbladder is pear-shaped, length - about 6 - 10 cm, width - 2.5 cm, capacity 30 - 70 ml. But the wall of the bladder is easily extensible, and it can sometimes hold up to 200 ml of bile. The thickness of the wall, consisting of 3 membranes: mucous, muscular and connective, usually does not exceed 1.5 - 2 mm.

There are 3 types of bladder movement: 1) rhythmic - 3 - 6 times per minute - in a hungry state; 2) peristaltic waves of different lengths and strengths - during the digestion of food; 3) tonic contractions, causing a prolonged increase in intravesical pressure.

After eating, the gallbladder begins to contract in the area of ​​the bottom and neck, while the neck expands, and then the entire bladder contracts, the pressure in it increases, and a portion of bile is released into the common bile duct. The valve located in the duodenum, which regulates the release of pancreatic juices (sphincter of Oddi), must work synchronously with it. During the period of emptying of the gallbladder, the sphincter of Oddi relaxes. The regulation of motility is influenced by the following hormones: 1) acetylcholine and thyroxine accelerate the emptying of the gallbladder; 2) serotonin and adrenaline, on the contrary, delay contractions.

When food mass enters the outlet sections of the stomach, duodenum and small intestine, another mechanism is activated - the release of cholecystokinin (duodenal hormone), which regulates the contraction of the gallbladder. Its release is stimulated by hydrochloric acid and fatty acids. Secretin, also released in the duodenum, helps cholecystokinin.

Functional diseases or biliary dyskinesias

Their development is associated with disturbances in the regulation of bile secretion. Dyskinesias are formed when there is a violation of the coordination of contraction and relaxation of the gallbladder and sphincters - Oddi, located in the papilla of Vater, and Lutkens, located in the neck of the gallbladder. It is clear that the dyssynergism of the function of these structures can be of any kind. Domestic researchers have made a great contribution to the study of functional disorders and suggest, for the convenience of treatment and understanding the mechanism of drug action, the identification of 4 dysfunctions of the gallbladder: 1) hypotonic dyskinesia (the bladder is large, stretched, does not contract well, 2) hypokinetic dyskinesia (there is no necessary peristalsis and correct contraction) , 3) hypertensive dyskinesia (the bladder is small, contracted), 4) hyperkinetic dyskinesia (frequent peristalsis, the bladder is prone to strong contractions), 5) the question of dysfunction of the sphincter of Oddi is raised separately.

In addition, they talk about primary dysfunctions - disorders with a disorder of neurohumoral (neurohormonal) regulation or a decrease in the response of sphincter receptors, and secondary dyskinesias - in various diseases of the abdominal organs. Sometimes dyskinesias occur with long-term use of medications - nitrates, m-anticholinergics (methacin, atropine), calcium ion antagonists (isoptin).

In practice, combined forms of dyskinesias are more common: hypotonic - hypokinetic dyskinesia of the gallbladder (often called hypomotor dyskinesia) and hypertonic - hyperkinetic dyskinesia (often called hypermotor dyskinesia).

Hypomotor dyskinesia is usually observed when the tone and contractility of the gallbladder are sharply reduced, and the tone of the sphincters is quite high. Hypermotor dyskinesia is characterized by high excitability and contractility of the gallbladder with low sphincter tone.

It is more convenient to present the clinical symptoms of these forms of dyskinesia in tabular form.

Hypermotor dyskinesia	Hypomotor dyskinesia
Pain stabbing, piercing, short-term	The pain is dull, aching, nagging, prolonged
Pain intensifies after taking choleretic drugs, duodenal intubation	The pain intensifies after taking the antispasmodic
During duodenal intubation, the time of the bladder reflex is short, often bile is released without an irritant, simply upon insertion of the probe into the intestine.	During duodenal intubation, the time of the vesical reflex is increased; repeated introduction of the stimulus may be required.
During duodenal intubation, light liquid bile is quickly released in a small volume	During duodenal probing, dark, thick, almost black bile is released for a long time and slowly
Pain is relieved by administration of an antispasmodic	Pain is relieved by administration of a cholekinetic agent
A hot heating pad increases pain, while a warm heating pad relieves pain.	A hot heating pad relieves pain, and a warm heating pad makes it worse.
X-ray and ultrasound examination reveals a small pear-shaped gallbladder	X-ray and ultrasound examination shows a large and round gallbladder

Bile, produced in the liver, is a solution of organic and inorganic substances:

A) Bile acids (cholic, deoxycholic) promote the absorption of lipids, activation of the motor function of the gastrointestinal tract, the release of cholecystokinin, secretin, and stimulation of mucus secretion. They have a bactericidal effect against a number of pathogenic bacteria.

B) Organic components (glutamine, plant steroids, bilirubin, cholesterol) are partially removed from the body, and partially used to build its own hormones.

C) Phospholipids help in the absorption of cholesterol and the protection of liver cells.

D) Immunoglobulins - the body’s defense against foreign agents.

D) Mucus prevents pathogenic bacteria from sticking to the walls of the bladder.

The first link in the formation of bile is the hepatocellular stage. Bile acids and organic anions, incl. sterols. The formation of bile begins with the capture of bile acids by hepatocytes and their simultaneous synthesis from cholesterol. Bile acids then form water-soluble complexes that are non-toxic to hepatocytes and ductal epithelium. All components of the formed bile are transported to the opposite biliary pole of hepatocytes. After hepatitis or an overdose of drugs (especially those with a sedative effect), blockade of transport agents may occur, leading to cholestasis.

Choleretic drugs will not help in this case; substances that thin the bile or improve its rheological properties are needed.

After formation, primary bile is transported into the tubules, where water and bicarbonates are supplied to it using osmotic pumps. As a result, 2 fractions of bile are formed, dependent and independent of bile acids. The first fraction, approximately 225 ml in volume, depends on the amount of bile acids, and the second fraction, also approximately 225 ml, is mainly organic anions. This fraction may increased with the use of choleretic drugs, which is very important in improving the rheological properties of the bile itself. The final formation of hepatic bile occurs as a result of the secretion of water and bicarbonates by the epithelium of the bile ducts under the action of secretin. There is a continuous flow of bile into the gallbladder, and the formation of gallbladder bile with its further concentration.

Thus, dyskinesias may be associated with impaired bile concentration, impaired contraction of the gallbladder with a deficiency of bile acids and organic bile anions, with dysfunction of the bladder sphincters, ducts, and sphincter of Oddi.

The most important stage is the formation of hepatic bile. It is there that sometimes lithogenic bile (thick) is formed, which leads to sedimentation and the formation of stones. The leading factor here is the ratio of cholesterol to cholesterol esters. The more cholesterol in bile and the less cholesterol esters, the greater the likelihood of stone formation.

G. Panchev, Br. Bratanov, A. Angelov

CONGENAL ANOMALIES

Cystic expansion ductus choledochus Characteristic is a local expansion of the canal in the upper or middle third; as a rule, the gallbladder is not affected. This anomaly is based on a congenital defect in the canal wall (lack of elastic fibers or intramural ganglia, infections in the canal wall, etc.)

Clinic It is characterized by three main signs of pain and tumor formation in the abdomen and intermittent jaundice. Children have predominantly jaundice, acholic bowel movements and dark urine

The sizes of tumor-like formations vary. In cases of effusion of bile into the intestines or during duodenal probing, they decrease. This disease is characterized by a chronically relapsing course - light intervals that alternate with one or more of the mentioned signs

Venous cholangiography does not always give a positive result; additionally, echography, endoscopy, retrograde cholangiography, trial laparotomy with transvesical cholangiography are used

Treatment - excision of the area with cystic expansion

Forecast. In the absence of surgical intervention, biliary cirrhosis develops

BILIAL TRACT DYSKINESIA

Dyskinesias are functional disorders tone and evacuation function of the gallbladder walls and biliary tract. There are two forms of such disorders: hypertensive and hypotonic

Hypertensive dyskinesia occurs as a result of spasm of the sphincter of Oddi and increased tone of the gallbladder; hypotonic dyskinesia is a consequence of decreased tone of the biliary tract. This form is more common

In the hypertensive form, the main symptom is abdominal pain, which has a paroxysmal nature. Attacks are accompanied by nausea, vomiting, and a feeling of heaviness.

In the hypotonic form, the pain is dull, constant, localized in the right hypochondrium. With severe atony and enlargement of the gallbladder, it can be palpated

In the hypertensive form, duodenal intubation is often unsuccessful (negative bladder reflex) or bile begins to be released after 2-3 hours; antispasmodics (atropine or belladonna) should be prescribed 2-3 days before the study. The resulting bile is a small amount of dark, concentrated ( spastic cholestasis) fluid

In the hypotonic form, the bladder reflex occurs quickly - after 510 -ten minutes. A large amount of concentrated dark bile is released (atonic cholestasis).

The clinic of dyskinesia is difficult to distinguish from the clinic of inflammatory diseases of the biliary tract, since they often arise precisely because of the latter. The diagnosis is clarified based on the following signs characteristic of dyskinesia: absence of fever, sensitivity abdominal wall, changes in the blood picture, inflammatory elements in the resulting bile and cholecystography data (a small gallbladder in the hypertensive form and a large relaxed one in the hypotonic form).

Diagnosis of dyskinesia It is placed only when all diseases that cause abdominal pain are excluded. Treatment involves the use of sedatives.

INFLAMMATORY DISEASES OF THE BILITAL TRACT

They occur in 8-10% of children over 8 years of age with gastrointestinal diseases. At the same time, girls get sick 3-5 times more often than boys. Gallstone disease is extremely rare. The inflammatory process rarely affects only the gallbladder or the remaining bile ducts in isolation. Chronic inflammatory processes predominate.

Etiology. The most common pathogens are staphylococci and E. coli ; Streptococci, enterococci, salmonella and shigella are less commonly isolated. A large number of infectious diseases (shigellosis, salmonellosis, viral hepatitis, typhoid fever, scarlet fever, enterocolitis, appendicitis, etc.) lead to secondary diseases of the biliary tract. Often acute or chronic focal infections (sore throats, pharyngitis, adenoids, inflammation paranasal sinuses, carious teeth, etc.) cause or accompany inflammatory processes in the bile ducts.

The infection reaches upward path from the duodenum through the bile duct, through the lymphatic route - from neighboring organs, and through the hematogenous route v. portae or a. hepatica.

Consequently, the pathogenesis of cholepathies can be represented in this way: under the influence of various factors, dyskinesia of the biliary tract occurs, which leads to stagnation, thickening and changes in the composition of bile; stagnation and slow outflow of bile favor the entry and proliferation of pathogenic microorganisms and the occurrence of inflammatory changes.

ACUTE CHOLECYSTITIS

This disease is rare in childhood. Catarrhal forms predominate; Cases of purulent, phlegmonous and gangrenous cholecystitis in childhood are rare.

Clinic. The disease occurs in the form of an acute abdomen: severe pain localized in the right hypochondrium, less often in the epigastrium or near the navel, and sometimes is diffuse. The pain radiates to the right shoulder, right shoulder blade or right pubic area. They are accompanied by a feeling of heaviness, nausea, and vomiting. The temperature rises to 39-40°C. The child's general condition is serious; he constantly changes position to relieve pain; When lying on the right side, the pain intensifies, but calms down when the child pulls his knees towards his stomach. The oral mucosa and tongue are dry, and there is an unpleasant odor from the mouth. The abdomen is swollen, weakly or does not participate in breathing at all. Palpation reveals tension in the abdominal wall and severe pain in the depths of the abdomen. The liver is enlarged and painful. The gallbladder is rarely palpable. There is retention of stool and gases.

The blood picture reveals leukocytosis and polynucleosis with a shift to the left. ESR accelerated. Protein and an increase in urobilinogen content are established in the urine.

Diagnosis. Murphy's symptom has diagnostic value: fingers placed directly to the right costal arch in the area of ​​the gall bladder, when the child takes a deep breath, they feel the liver and gall bladder descending downwards, while the child receives severe pain, which stops breathing for a moment; Boas symptom - pain when pressing on the right to the VIII-X thoracic vertebra; Ortner's symptom - pain when tapping on the right costal arch.

Differential diagnosis. The possibility of acute appendicitis, peritonitis, intussusception, suppurating bile duct cyst, etc. is taken into account.

Treatment. Strict bed rest. At catarrhal forms- broad-spectrum antibiotics, and for purulent and gangrenous infections - surgery(cholecystectomy).

Forecast and development. Acute catarrhal cholecystitis has a benign course. Pain and other symptoms gradually weaken and disappear after 7-10 days. Very rarely, against this background, gangrenous cholecystitis develops with perforation and the subsequent development of purulent bilious peritonitis. Very often (about 60%) acute catarrhal cholecystitis is the beginning of chronically recurrent cholecystitis.

Chronically recurrent cholecystitis

It occurs more often than acute, usually is a consequence of acute catarrhal cholecystitis, but can also occur independently.

Clinic. The disease proceeds latently for a long time, without any particular symptoms. Later (after 2-3 years), the phenomena of asthenia and intoxication begin to develop: low-grade fever, lethargy, irritability, fatigue, bad mood, restless sleep, headache, lack of appetite. These are signs of the so-called. latent chronic cholecystitis, which is characteristic of early childhood. The disease is expressed only in the appearance of abdominal pain, which is localized in the right hypochondrium or is diffuse in nature. They can be constant, dull or moderately intense, paroxysmal (lasting minutes or hours), and can be repeated for weeks. They may be preceded or accompanied by a feeling of heaviness and fullness in the epigastrium. The patient refuses to eat. he experiences vomiting, constipation or unstable stools, excessive gas formation. During severe attacks, the temperature rises, but, as a rule, a low-grade or even normal temperature is observed. Objectively, icteric staining of the sclera and skin is established extremely rarely; an enlarged liver with mild pain is noted. The abdomen is distended, there is mild pain on palpation in the right hypochondrium, but the child still allows deep palpation. During a painful attack, the child’s face is pale, and during elevated temperature- red. A number of neurovegetative manifestations are noted: severe headache, sweating, red dermographism, dilation or constriction of the pupils, arrhythmia, low blood pressure.

The blood picture reflects slight leukocytosis or normocytosis with mild polynucleosis and elevated ESR. There is protein (traces) in the urine and a slight increase in urobilinogen content.

The diagnosis is initially associated with certain difficulties. Dyskinesias are excluded based on data from duodenal intubation - cloudy bile with abundant mucus, leukocytes, and bacteria.

Treatment. The most appropriate diet is table 5 (according to Pevzner). Fatty and irritating foods (egg yolk, fish, chocolate, spicy seasonings, etc.) should be avoided. Proteins, vegetable fats, carbohydrates, vegetables and fruits are given in sufficient quantities. Fat- and water-soluble vitamins are used, and in case of exacerbation, antibiotics are used. In the non-attack period - balneotherapy, physiotherapy, physical therapy (children’s games should not be limited).

The prognosis is favorable. With a longer duration of the disease, destructive processes develop in the walls of the gallbladder, which lead to sclerosis and deformation, as well as the development of adhesions with adjacent tissues (pericholecystitis).

CHOLANGITIS

The concept of cholangitis includes the inflammatory process in the intrahepatic and extrahepatic bile ducts. They are combined with cholecystitis (cholecystocholangitis) or develop independently when the infection penetrates along the ascending path.

Acute cholangitis

Clinic. Characterized by sudden deterioration general condition, a rapid increase in temperature to high levels, accompanied by fever, trembling, sweating; there is a feeling of heaviness, sometimes vomiting, an unpleasant feeling of pressure, dull or colicky pain in the right hypochondrium. Such attacks are repeated several times a day. The liver enlarges in the first days and can be felt 2-4 cm from under the costal arch; it is dense and painless. Jaundice may appear, which indicates involvement of the liver parenchyma in the process.

There is moderate leukocytosis with polynucleosis and a shift to the left, the ESR is accelerated. The level of urobilinogen in the urine is increased, and with jaundice the presence of bilirubin is also detected. Duodenal intubation is an important study to prove acute cholangitis and differentiate it from acute cholecystitis: the presence of inflammatory elements in portions A and C and the absence of such in the gallbladder bile (portion B).

The level of excretory enzymes (alkaline phosphatase) sharply increases in the serum.

Treatment is aimed at eliminating the infection (tetracycline, ampicillin) and improving the outflow of bile (choleretic drugs).

Forecast and course. Catarrhal cholangitis usually ends in recovery and only in some cases becomes chronic. Purulent forms often lead to changes in the extrahepatic bile ducts (stenoses, curvatures, kinks), which slow down recovery.

CHRONIC CHOLECYSTOCHOLANGITIS

The disease is a chronically recurrent inflammation of the gallbladder and bile ducts. Caused, as a rule, by opportunistic flora: E. coli . streptococci, staphylococci, less often enterococci, V. Proteus etc. The etiological role of Giardia has not yet been proven.

Clinic. It is very diverse and is characterized by a long course with intermittent exacerbations. In most children, the disease can be latent. After a certain time, intoxication syndrome and neurovegetative reactions are observed: headache, lethargy or irritability, bad mood, weakness, insomnia, dizziness, loss of appetite, heaviness in the epigastric region, nausea, less often vomiting, constipation. The temperature rises. With such a clinical picture, a diagnosis of tuberculous or tonsillogenic intoxication, anemia and neurasthenia, etc. is often made. Only the appearance of pain in the right hypochondrium directs the doctor’s attention to a disease of the biliary tract. An exacerbation occurs and the pain takes on a different character, sometimes in the form of colic, and they vary in duration - 1-3 days. Usually the pain is dull and unclear.

The liver can be felt 2-3 cm from under the costal arch, slightly painful, smooth. There are distinct symptoms of Murphy, Ortner, etc. The appearance of jaundice is a rare symptom. Splenomegaly is most often not diagnosed.

In infancy and toddlerhood clinical picture manifested by low-grade fever, loss of appetite, frequent vomiting, anxiety, poor physical development (latent form).

During an exacerbation, slight leukocytosis with moderate polynucleosis and moderately accelerated ESR is noted. An increase in urobilinogen is often detected in the urine.

Biochemical blood tests, as a rule, do not show deviations from the norm, with the exception of mild cholestatic syndrome, characterized by elevated levels of bilirubin, cholesterol, lipids, alkaline phosphatase, etc., and mesenchymal inflammation - an extended Veltman strip, a positive thymol test and changes in the proteinogram.

Diagnosis. To make a final diagnosis, the results of duodenal intubation are important - pathological changes in portions B and C. Cholecystography and cholangiography help to establish dyskinetic manifestations or anatomical abnormalities, which are a predisposing factor for the occurrence of chronic cholecystocholangitis.

differential diagnosis. Gastroduodenitis, peptic ulcer, chronic pancreatitis, etc. are taken into account.

Treatment. During an exacerbation, the child must remain in bed. Dietary food is complete with a limitation of smoked meats, fried foods, canned foods, egg yolk, chocolate, cocoa, citrus fruits, strawberries, etc. The diet includes vegetable oils. Vegetables and fruits are recommended. Multivitamins are prescribed. When data indicate biliary dyskinesia, choleretic drugs are used. In case of exacerbation, antibiotics are indicated, which are eliminated primarily through the bile ducts. They should be compared with an antibiogram of the gallbladder (gentamicin, chlornitromycin, tetracycline, ampicillin, etc.); It is appropriate to alternate them with chemotherapy drugs (nitrofurans).

When acute processes subside, physiotherapeutic procedures (paraffin, ultratherm) are prescribed for the liver area, mineral waters, physical therapy, and later an active regimen (games, walks, moderate sports).

Forecast. With timely comprehensive treatment, the prognosis is favorable.

Prevention consists of proper diet, protection from infectious and especially acute intestinal diseases, sufficient physical activity, in the rehabilitation of focal infections (tonsillitis, paranasal cavities, damaged teeth).

CHOLELITHIASIS

In childhood, this disease is very rare. Localized mainly in the gallbladder.

Pathogenesis. Dyskinesia, congenital anomalies, some constitutional features (obesity, exudative diathesis, etc.) are predisposing factors to the formation of stones. This is facilitated by three conditions: stagnation of bile, cholesterolemia and inflammation in the bile ducts.

Depending on the composition, three types of stones are distinguished: I) cholesterol - with a small content of calcium and bilirubin; 2) bilirubin with a low content of calcium and cholesterol (for chronic hemolytic anemia) and 3) mixed - containing cholesterol and bilirubin.

Clinic. In childhood, the disease has a very varied course. In some cases it is latent: capricious appetite, vague weak complaints in the upper abdomen, a feeling of heaviness, belching, bitter taste in the mouth, unstable stool. The diagnosis is made by excluding other diseases and based on cholecystography data. In other cases, cholelithiasis manifests itself in typical crises. Sudden onset of acute severe pain in the right hypochondrium or in the epigastrium, which then spread throughout the abdomen or radiate to the right shoulder, right shoulder blade or right side of the neck. The pain can last from several minutes to several hours. They are accompanied by nausea and vomiting. During attacks, the temperature rises, breathing quickens and the pulse slows down (vagus phenomenon), the abdomen is swollen, tension in the abdominal wall is established in the right hypochondrium with localization of pain in the same area. Sometimes a distended gallbladder can be felt.

In a third of cases, children complain of intermittent abdominal pain with different localization, but still more often in the epigastric region and right hypochondrium. There is a mild syndrome of upper dyspeptic disorders (feeling of heaviness, belching, dry mouth, rarely vomiting). Appetite is usually preserved. As a rule, pain occurs soon after eating (from 5 to 30 minutes) without connection with the consumption of fatty foods and fried foods.

During duodenal intubation, cholesterol crystals, sometimes gall sand or small gallstones, are detected in the bile from the gallbladder.

When a bile duct is blocked by a stone, cholestatic jaundice develops with colorless stools and dark urine. The content of direct bilirubin, lipids, cholesterol and alkaline phosphatase increases in the blood. There is bilirubin in the urine, but no urobilinogen. Duodenal sounding fails. The diagnosis is clarified by cholecystography.

Differential diagnosis. Gallstone disease is difficult to differentiate from acute cholecystitis and biliary dyskinesia. Differential diagnosis includes peptic ulcer, acute appendicitis, right-sided renal colic, etc.

Treatment. In the presence of a gallstone crisis, antispasmodic drugs, water-salt resuscitation, etc. are indicated. If the bile ducts are blocked, surgical intervention is required.

The prognosis depends on the severity of inflammatory changes in the bile ducts - they support the formation of stones. A small stone can spontaneously pass through the bile ducts, and it is detected after 1-2 days in the stool. Sometimes, after prolonged standing of a stone in the duct, fistulas form between the gallbladder and the duodenum, transverse colon, pancreatic duct of the pancreas, etc. Perforation followed by biliary peritonitis is rare.

The basic principles of prevention of cholelithiasis coincide with those for biliary dyskinesia and cholecystocholangitis.

Clinical Pediatrics Edited by prof. Br. Bratanova