Biliary dyskinesia
| Biliary dyskinesia | |
|---|---|
| Classification and external resources | |
| Specialty | gastroenterology |
| ICD-10 | K82.8 |
| ICD-9-CM | 575.8 |
| DiseasesDB | 12297 |
| eMedicine | med/347 |
| MeSH | D001657 |
Biliary dyskinesia is a disorder of some component of biliary part of the digestive system in which bile physically can not move normally in the proper direction through the tubular biliary tract. It most commonly involves abnormal biliary tract peristalsis muscular coordination within the gallbladder in response to dietary stimulation of that organ to squirt the liquid bile through the common bile duct into the duodenum. Ineffective peristaltic contraction of that structure produces postprandial (after meals) right upper abdominal pain (cholecystodynia) and almost no other problem. When the dyskinesia is localized at the biliary outlet into the duodenum just as increased tonus of that outlet sphincter of Oddi, the backed-up bile can cause pancreatic injury with abdominal pain more toward the upper left side. In general, biliary dyskinesia is the disturbance in the coordination of peristaltic contraction of the biliary ducts, and/or reduction in the speed of emptying of the biliary tree into the duodenum.
Normally, the downstream gallbladder stores and concentrates the bile which originates in liver hepatocyte cells and is released into the microscopic component of the biliary system by the liver. Through aggregating tubules of increasing diameter, the bile leaves the liver and reaches the upstream (proximal) component of the common bile duct. Apparently, the common bile duct beyond (distal to) the gallbladder tends to normally have a greater tone so that the bile backs up into the gallbladder. When bile enters the duodenum (the first part of the small intestine), it aids in digesting the fat within food leaving the stomach. When the bile can not be properly propelled from the not-mechanically-obstructed gallbladder or can not flow out of the end of the common bile duct properly, there is a state of biliary dyskinesia.
So, biliary dyskinesia is a dynamically (functional...not fixed mechanical) obstructive, pain-producing disorder. Obstruction by a stone or tumor is a static, mechanical obstruction and tends to produce a more intense pain known as biliary colic.
Failure of the biliary sphincter of Oddi can be distinguished from failure of the pancreatic sphincter.[1]
Treatment
Laparoscopic cholecystectomy has been used to treat the condition when due to dyskinesia of the gallbladder.[2]
Symptoms may persist after cholecystectomy,[3] and have been linked to the use of proton pump inhibitors.[4]
See also
References
- ↑ Toouli J (August 2002). "Biliary Dyskinesia". Curr Treat Options Gastroenterol 5 (4): 285–291. doi:10.1007/s11938-002-0051-9. PMID 12095476.
- ↑ Haricharan RN, Proklova LV, Aprahamian CJ, et al. (June 2008). "Laparoscopic cholecystectomy for biliary dyskinesia in children provides durable symptom relief". J. Pediatr. Surg. 43 (6): 1060–1064. doi:10.1016/j.jpedsurg.2008.02.032. PMID 18558183.
- ↑ Geiger TM (May 2008). "Prognostic indicators of quality of life after cholecystectomy for biliary dyskinesia". Am Surg 74 (5): 1364–1367. PMID 18481495.
- ↑ Cahan MA (Sep 2006). "Proton pump inhibitors reduce gallbladder function". Surg. Endosc. 20 (9): 1364–1367. doi:10.1007/s00464-005-0247-x. PMID 16858534.