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Dyskinesia of bilious ways is a disturbance motor evakuatornoy functions of a gall bladder and bilious ways, without anatomic and inflammatory changes in them, arising under the influence of functional factors.
In foreign literature for designation of this disturbance the term "dysfunction of a gall bladder" is used.
Evacuation of bile happens in the course of reduction of a gall bladder at simultaneous harmonious sphincteri incontinence of Oddi located in the mouth of the general bilious channel, in a duodenum wall. Cholecystokinin (pancreozymin) produced by duodenum I-cells causes reduction of a gall bladder with simultaneous sphincteri incontinence of Oddi. Somatostatin causes relaxation of a bubble and a spasm of a sphincter of Oddi.
Types of dyskinesia of bilious ways
Hypertensive type of dyskinesia
Consists in increase of a tone of a sphincter of Oddi with bent to his spasm asynchronously with reduction of a gall bladder. Can be the cause of this dyskinesia:
• viscerovisceral reflexes at diseases of a digestive tract, kidneys, genitalias (in particular, at a peptic ulcer, colitis, an urolithiasis, an appendicism and an adnexitis);
• neurosises, nervous stresses;
• hormonal frustration at a climax, a thyrotoxicosis.
Hypotonic type of dyskinesia
It is shown by sluggish reduction of a gall bladder at normal function of a sphincter of Oddi.
Asthenic states, neurosises, hormonal frustration, for example, a hypothyroidism can be the cause of this dyskinesia; pregnancy.
Clinical displays of dyskinesia of bilious ways
The main symptom of hypertensive dyskinesia are pains in right hypochondrium and epigastric area of various character (skhvatkoobrazny) and intensity (are more often up to kolikoobrazny attacks).
At hypotonic dyskinesia long pains in right hypochondrium less intensive (holding apart, aching), gripes are absent; but there can be a nausea connected with meal and other displays of dyspepsia.
Inspections necessary for confirmation of the diagnosis of dyskinesia of bilious ways
Ultrasonography — for ascertaining of lack of stones in a gall bladder.
Cholecystography. At the same time bad reduction of a gall bladder, the stretched gall bladder, etc. can be revealed.
Duodenal sounding. At the same time lack of signs of an inflammation in bile, disturbance of a reflex on sulfate magnesia with absence or overdue emergence of bile "B" comes to light.
Laparoscopy (at differential and diagnostic difficulties). She allows to find an atonic gall bladder or to reveal expansion of bilious ways at a spasm of a sphincter of Oddi.