BILIARY DYSKINESIA

In the occurrence of biliary dyskinesia important role played by the functional state of the
stomach and duodenum. Violation of the sphincters, duodenostasis, swelling and spasms of the
large duodenal papilla lead to hypertension in the biliary system and the bile secretion. There are
various mechanisms that lead to a breach of the passage of bile. Two possible variants of such
mechanisms are shown in Fig. 15-2.

Duodenostasis

Raising intraduodenal pressure

II

Duodenitis, papillitis large duodenal papilla

Spasm of sphincter of Oddi

Throw the contents of the duodenum to the common duct

Expansion of common bile duct

The slowdown in the outflow of bile from the gallbladder

Expansion and increase

gall bladder, its aseptic inflammation

Slowing down the passage of bile from the gallbladder

Destabilization of the bile, precipitation of bile acids, cholesterol, bilirubin, calcium, with the
possible formation of concretions

Increasing the size of the gall bladder

Fig. 15-2. Mechanisms violations passage of bile.

CLINICAL PICTURE AND DIAGNOSIS

Excrete hypotonic (hypokinetic) and hypertensive (hyperkinetic) types of dyskinesia. It is also
possible mixed form.

Dyskinesia hypotonic type

The main signs of hypotonic dyskinesia type: lowering muscle tone of the gall bladder, a weak
its decline, an increase of the gall bladder. Clinically, this option is accompanied by aching pain
in the right hypochondrium or around the navel, general weakness, fatigue. Sometimes you can
palpated a large atonic gallbladder. When ultrasound reveal a larger, sometimes elongated gall
bladder with normal or delayed emptying. When you receive a stimulus (egg yolk), the
transverse size of the gall bladder usually decreases less than 40% (normally 50%). When
fractional duodenal sounding reveal an increase in the portion of normal or high-velocity outflow
cystic bile, if the tone of the bladder is preserved, the reduction of tone accompanied by a
reduction of this portion.

Dyskinesia hypertensive type

The main signs of dyskinesia hypertensive type - reducing the size of the gall bladder, the
acceleration of its discharge. Clinically, this variant is characterized by brief, but more intense
bouts of pain with localization in the right hypochondrium or around the navel, sometimes
indigestion. When ultrasound determine the decrease in the transverse dimension of the
gallbladder after choleretic breakfast for more than 50%. When fractional duodenal sounding
reveal a decrease in the portion of an increase in velocity outflow of bile.

TREATMENT

Treatment can be conducted in hospital and at home. In the appointment of treatment should take
into account the type of dyskinesia.

Medical nutrition:

-- Table number 5 with high-grade protein, fats and carbohydrates;

-- fasting days, such as fruit and sugar and kefir, cottage cheese (for detoxification);

-- fruit and vegetable juices, vegetable oil, eggs (for the natural increase outflow of bile).

Bile means. Bile therapy is necessary to conduct long-term, intermittent use.

-- Choleretic (stimulates the formation of bile) - allohol, bile + powder from pancreas and
mucosa of the small intestine (holenzim), hydroxy-metilnikotinamid (nikodin) osalmid
(oksafenamid) tsiklovalon (CEC-Valon) holosas, plants (mint, nettle, chamomile, St. John's wort,
etc.).
-- Holekinetiki (enabling the provision of bile) - increases the tone of gallbladder (eg, drugs
barberry usual, sorbitol, xylitol, egg yolk) that reduce the tone of biliary tract (eg, papaverine
hydrochloride, platifillin, an extract of belladonna).

-The elimination of cholestasis recommend tyubazh on GS Demyanov with mineral water or

sorbite. In the morning the patient give a drink on an empty stomach a glass of mineral water
(warm, no gas), and then for 20-40 minutes the patient lies on his right side on a warm hot water
bottles without a pillow. Tyubazh spend 1-2 times a week for 3-6 months. Alternatively
tyubazha: after taking a glass of mineral water makes the patient 15 deep breaths with the
diaphragm (the vertical position of the body). The procedure is carried out daily during