Biliary dyskinesia

A dyskinesia of a biliary tract called persistent violation of their motor function, leading to stagnation of bile.
Functional, dyskinetic disorders in the biliary tract is mainly formed by the function disorders of the gall bladder and closing of the lower end of the cystic duct. On the one hand, there are atopic, hypotensive and hypertensive gall bladders, and on the other hand,the States of the sphincter of Oddi, including its failure.
It is established that the sphincter of Oddi equipped with a wide network of nerve endings that is involved in a complicated the work of the digestive tract. Irritation of the vagus nerve, as shown by experiments D. E. Hodinova, entails the strengthening of the motor function of the gall bladder, and irritation of the sympathetic nerve causes the relaxation of the bladder walls that interferes with the normal emptying it. Last encouraged by weak stimulation of the vagus nerve upon the reduction of muscles of the bladder and the disclosure of the sphincter of Oddi. Reduction of the gall bladder and sphincter of Oddi are interrelated.
Disorders of the function of the sphincter of Oddi may be caused by: 1) the vegetative dystonia; 2) reflex influences from patients with abdominal organs, particularly stomach, duodenum, pancreas and the vermiform process; 3) anatomical and physiological changes in extrahepatic biliary tract; 4) the violation of the functions of the endocrine glands.
Symptoms of erectile function of the sphincter of Oddi little characteristic and reminds duodenitis or partly cholecystitis. Appeared suddenly without jaundice symptoms of inflammation allows us to Express the suspected spasm of the sphincter of Oddi. Similarly, jaundice, which emerged after cholecystectomy or operation of the stomach, causing an educated guess of spasm of the sphincter of Oddi. Still fairly common for clinically severe biliary dyskinesia should be considered biliary colic, which can one day be repeated several times, not accompanied by fever and jaundice. When x-rays of the gastrointestinal tract such patients can sometimes find spastic phenomena on the part of the stomach and colon.
Women biliary dyskinesia is sometimes associated with menstruation or during menopause.
In the differential diagnosis of biliary dyskinesia first of all it is necessary to consider the possibility of cholecystitis and cholelithiasis. When duodenal intubation in patients with a dyskinesia is not set signs of inflammation, and when cholecysto - and cholangiography is revealed dysmotility of the gallbladder and bile ducts in the absence of concrements.
In the treatment of biliary dyskinesia until recently there are two directions: conservative and surgical. As the biliary dyskinesia is a spasm of the sphincter of Oddi, the main focus of the doctor should be aimed at its elimination. To this end it is recommended that the appointment of neurotropic drugs: atropine, bellaid, holinolitikov (arpenal, Espinal, rubroman), tranquilizers (meprobamate, meprobamate, trioxazin), and antihistamines (pipolfen, suprastin, diphenhydramine), and perirenal and intradermal blockades of novocaine and dificila. Auxiliary role of physiotherapy: paraffin baths, diathermy and ultrasound.
Considering the usual reflex nature dyskinesia, it is necessary to strive for the elimination of pathological processes in the abdominal cavity, which is the reflexogenic zones of inflammation in the ileocecal region, in the pelvis and other
From the operative methods of treatment of biliary dyskinesia should indicate the operation subphrenic vagotomy (Crile, Miller, 1962), concomitant expansion of Vater nipple with drainage and deaf seam choledochus. The efficiency of the surgical intervention is still insufficient. Often relapses occur. Therefore, surgical treatment is indicated only by the failure of conservative therapy.