Biliary dyskinesia

Nona Yeghoyan
Dyskinesia of bile ducts in children

 Disorders of gallbladder motility and sphincter

apparatus of the biliary system, clinically
manifested by pain syndrome, a complex of
functional disorders lasting more than 3 months,
accompanied by abdominal pain localized in the
right upper quadrant. This is the most common and
early pathology of the biliary system in children.
Epidemiology

 Statistical data, based on the principles of evidence-based

medicine, has not been collected to date. The data on the
incidence of dysfunction in the biliary system in children
are based on the account of clinical dysfunctions that
cause frequent visits to the pediatrician and occupy the
second place among gastrointestinal diseases. The
incidence of hypomotor dyskinesia of the gallbladder in
children varies from 40 to 99%.
The sphincter apparatus of the biliary
tract includes

 Lutkens sphincter located at the site of the confluence of

the bladder duct into the neck of the gallbladder;
 sphincter Mirizzi, located at the junction of the vesicle
and common bile ducts;
 Sphincter One, located at the end of the common bile
duct in place of its confluence with the duodenum.
The provoking factors of biliary dyskinesia are

 food errors (especially abuse of fried and fatty foods);

 intestinal parasitosis (especially giardiasis);
 a number of infections (acute hepatitis, salmonellosis,
dysentery);
 food allergy;
 duodenitis, peptic ulcer, liver disease, intestines, dysbiosis;
 inadequate level of physical and psychoemotional loads.
Symptoms of biliary dyskinesia in children

 The group of general symptoms of dyskinesia bile ducts

include
 fatigue
 irritability
 decreased performance in schoolchildren
 tearfulness in preschool children.
 Some children experience motor disinhibition, others have
hypodynamia, sweating, palpitations and other symptoms
are possible.
Symptoms of biliary dyskinesia in children
 With dysfunctions of the bile excretory system due to
gastrointestinal diseases, the child is troubled by a feeling of
 heaviness in the epigastric region
 nausea
 Vomiting
 Belching
 bitterness in the mouth.
 Changes in the frequency of stool and other disorders, the
occurrence of which is associated with the late release of bile into
the duodenum, a violation of the digestion of fats, duodenogastric
and gastroesophageal reflux, etc.
Hyperkinetic form

 With hyperfunction of the gallbladder (hyperkinetic form),

there are
 pains of paroxysmal nature
 Stitching
 cutting
 Compressing ,accompanied by nausea, eructation, vomiting
!!!!!!! In the interval between attacks, children do not
complain.
Hypotonic form

 With hypofunction of the gallbladder (hypotonic form), the pains acquire a

constant pressing character, periodically amplified. Characterized by a
feeling of bursting or heaviness in the right hypochondrium
 Children complain of bitterness in the mouth, nausea, and sometimes
vomiting occurs.
Diagnosis of biliary dyskinesia

 When collecting anamnesis, specify the nature,

frequency and localization of pain
Laboratory research
 By the results of biochemical analysis of blood serum, the activity of enzymes
- cholestasis markers (alkaline phosphatase, y-glutamyltranspeptidase) can be
increased.
 The diameter of the bile duct can be measured with ultrasound. An increase
in the diameter of the common bile duct after fatty food or the introduction
of cholecystokinin reflects a violation of the outflow of bile, which may
indicate a dysfunction of the biliary tract.
Diagnosis of biliary dyskinesia

 The most acceptable for practical use in children is considered hepatobiliary

scintigraphy, if necessary supplemented by pharmacological tests
(neostigmine morphine, the introduction of the relaxant nitroglycerin).