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What you need for good contraction of the gallbladder. On ultrasound, the gallbladder is contracted

When it hurts on the left, a person involuntarily understands that it is rather disturbing the heart, above the navel - problems with the stomach, lower abdomen - disturbing the genitourinary system. The most common pathology of the right side is problems with the liver or biliary system. Almost every fifth person sees a diagnosis with the words - the gallbladder is contracted. But not everyone understands what this means. The purpose of the article is to provide the reader with complete, and most importantly understandable, information on this issue.

Almost every fifth person sees a diagnosis with the words – the gallbladder is contracted

Bile is a secretion of the liver. It is formed in the gallbladder. If you imagine this organ as a slightly inflated balloon, then when you press it, the tail relaxes and air comes out through the hole. Our organ works in a similar way: when it contracts, the sphincter of Oddi opens and the yellow solution entering the duodenum begins to activate the processes of processing the food we take. The hypermotor form of dyskinesia is a pathology in which the hollow organ with bile is contracted, that is, the ball is constantly in a deflated state, which means that the procedure for supplying the yellow substance becomes uncontrollable.

In an adult, this part of the liver is in the form of an elongated pear, 5-14 cm long and 3-5 cm wide. The shape can vary due to deformation, the most unusual being kinks in the form of an hourglass and a boomerang. The size of the organ depends on the amount of yellow secretion inside. If normal functioning keeps its volume within 30-80 ml, then with bile retention it changes. The mucous membrane is covered with grooves and folds, which form the Lutkens-Martynov sphincter at the neck of the bile storage reservoir. As a fuse, it is responsible for the timely supply of bitter liquid.

Hormones and neuropeptides trigger the synthesis of yellow-green fluid for the functioning of important processes in the gallbladder:

  • opening the intestines, disinfecting its mucous membrane;
  • activation of fat decomposition: glycerin and acids;
  • assimilation of necessary elements;
  • conducting a safe digestion system.

Biliary dysfunction provokes other process disorders. When the gallbladder is contracted, problems with digestion of food, like a domino principle, overlap each other.

Causes and symptoms of pathology

Most people are accustomed to enduring pain, believing that it will soon go away without a trace. But something provokes these unpleasant sensations. There is a list of symptoms with which the body tries to convey to a person the seriousness of the situation, which makes a trip to a medical institution urgent.

Among them are the following signs:

Diarrhea indicates problems with the gallbladder.

  1. Belching. Due to the disorder, the patient takes more sips to eat, so the excess air needs somewhere to go.
  2. Unpleasant taste in the mouth. Malfunction of the ducts that bring excess secretion to the throat and mouth.
  3. Yellowness of the skin.
  4. Urine is dark in color, feces become light in color.
  5. Flatulence is provoked by a deficiency of the yellow-green solution. In simple words, for an ideal chemical reaction there are not enough necessary elements, the result is more gas is released.
  6. Diarrhea. This secretion helps absorb vital elements. Its deficiency irritates the walls of the mucous membrane, so digested food moves quickly without having time to be absorbed.
  7. Plaque on the tongue occurs due to improper transportation of undigested nutrients into the oral cavity.
  8. Gag reflex. A malfunction of the gastrointestinal tract causes disruption of the diaphragm.

There are only two reasons why the gallbladder is contracted. The primary hypermotor form of dyskinesia of the gallbladder and biliary tract is considered to be congenital abnormalities; the secondary form is the presence of a disease that is directly related to digestion.

So the sources of the first group include:

  • allergy,
  • narrow or blocked ducts
  • the presence of partitions,
  • doubling of the pyriform sac,
  • stress,
  • wrong lifestyle
  • lack of body weight.

The most common sources of secondary forms of dyskinesia:

Diabetes mellitus may be a source of secondary dyskinesia

  1. Disorders of the thyroid gland, causing the production of insufficient amounts of the hormone.
  2. Inflammation of the duodenum.
  3. The presence of cholecystitis of the gallbladder reduces the tone of the ducts, which is also an explanation for why the piriform sac is reduced.
  4. Gastritis, ulcers.
  5. Kidney stones.
  6. Myotonia.
  7. Dystrophy.
  8. Viral hepatitis.
  9. Infection with worms.

It doesn’t matter whether a deficiency or an excess of bitter solution provokes the disease. After all, delayed secretion can provoke cholelithiasis. The formation of stones is promoted by fasting, obesity, and high cholesterol. To prevent gallstone disease, you need to drink beetroot juice diluted with water on an empty stomach. All these pathologies cause thickening of the walls of the gallbladder.

Recognition of the disease and ultrasound results

It is important to follow the doctor’s recommendations: do an ultrasound, take tests strictly on an empty stomach. After all, if you take medicine in the evening or have a hearty dinner, the body will still process food and the pear-shaped sac will automatically contract to supply yellow-green liquid. Such carelessness may affect the reliability of the research result.

Since inflammation is always accompanied by an increase in the level of red blood cells and leukocytes, a general blood test is indispensable when diagnosing biliary disease. At the conclusion of the biochemical analysis, the level of bilirubin will be visible. An increase in concentration indicates retention of the yellow substance.

An obligatory and final step in making a diagnosis is an ultrasound examination. In this case, the doctor will make sure that the correct treatment is chosen. You need to understand that thickening of the walls of the gallbladder occurs as a result of some kind of disease.

Causes and signs of illness in children

Most often, newborns and women suffer from this pathology. In children, it is associated with dysregulation of motor skills. In addition to these primary sources, there may be the following factors:

Diagnosis of dyskinesia in children is problematic

  • congenital abnormalities of the gallbladder;
  • worms;
  • sedentary lifestyle;
  • poor nutrition;
  • pancreatitis;
  • hepatitis.

Diagnosis of dyskinesia in newborns and preschool children is problematic. In them, the pathology externally manifests itself only in the form of abdominal pain and heaviness under the right rib. Which greatly complicates the doctor’s task.

Therapy methods

When the doctor has determined the causes of biliary dysfunction, treatment of the patient begins. To normalize the action of secretion, it is necessary to increase the activity of the reduced part of the liver and reduce the tone of the ducts. For this purpose, cholekinetics are taken:

  • Oxafenamide (1-2 capsules before meals, course is two weeks).
  • Gepabene (1 tablet with meals, three times a day, for at least 3 weeks).

Treatment of the disease is closely related to pain reduction and relaxation of sphincter tone. Therefore, antispasmodics are used for a short course:

  • Hymecromone.
  • Papaverine, Drotaverine, No-shpa.

In this case, drinking water of low mineralization is additionally prescribed. This is Essentuki 2, 4 and rest in a sanatorium. There they will take care of the pear-shaped bile sac and intestines, they know everything about medications and there are doctors of a narrow specialty - hepatologists.

Prevention and diet

The goal of the diet is to reduce the load on the liver. It is recommended to eat steamed food often, in small portions. When the pain intensifies, it is advisable to eat food in liquid form.

When the biliary system is reduced, the following are excluded from the diet:

When the biliary system is reduced, sweets are excluded from the diet

  1. Absolutely all sausages.
  2. Beef, pork.
  3. Eggs.
  4. Fresh vegetables, fruits and berries.

The following products have a beneficial effect on the body:

  • low-fat kefir, yogurt,
  • bird, fish,
  • oil,
  • vegetable soup,
  • tea, coffee with milk.

Interesting fact: drinking coffee in the morning helps you forget about gallstones.

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Gallbladder.

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Contraction of the gallbladder allows this organ to push bile produced by the liver into the digestive organs when food enters there. Bile is responsible for the breakdown of difficult-to-digest fats and contributes to the normal digestive process. That is why good contractility of this important organ of the digestive system is the main indicator of its normal functioning.

Alas, gastroenterologists are often faced with such a pathology as impaired motility of this organ and bile ducts, in which the contractile function of the gallbladder deviates from the norm.

This disease is called dyskinesia, which is a very common disease of this organ. According to medical statistics, women suffer from gallbladder dyskinesia ten times more often than men.

The gallbladder and the liver form the so-called biliary system. It is located directly under it and is a small oval, bag-shaped cavity (reservoir) with a volume of up to 70 cubic centimeters. The length of this organ in adults can reach up to 14 centimeters.

Main functions of the gallbladder:

  • accumulation of bile produced by the liver around the clock;
  • bringing it to the required consistency;
  • delivery of this liver secretion to the duodenum when food enters the gastrointestinal tract.

Bile is a biological fluid that is involved in the breakdown of heavy animal fats and the release of necessary nutrients from foods entering the body.

The liver is responsible for the production of this fluid, from where it then enters the gallbladder through the common bile duct. There it accumulates, acquires the necessary consistency and, if necessary, is released into the digestive tract. This release occurs a short time after food enters the gastrointestinal tract.

Gallbladder dyskinesia is a disease (usually non-infectious) in which the motor (in other words, evacuation) function of this internal organ is impaired. This interferes with the normal filling of the bladder with bile, and also disrupts its contractile function.

Women are much more likely to get this disease, and this is due to the specifics of their hormonal levels and the general structure of the female body. Often, gallbladder dyskinesia develops during pregnancy.

If we talk about the share of dyskinesia in the total number of diseases of the biliary system, then it is about 12 percent. This pathology is a functional disorder and does not cause morphological changes in this internal organ.

Such disorders of gallbladder motility are primary and secondary.

In addition, experts distinguish the following types of this pathology:

  • hypotonic;
  • hypertensive;
  • hypokinetic;
  • hyperkinetic dyskinesia.

Hypotension is a decrease in the level of contractility of the gallbladder. This type of pathology is characterized by difficult bile excretion and difficulties with the accumulation of bile.

On the contrary, hypertension is characterized by a sharp increase in muscle tone. This increased contractility also disrupts normal bile secretion, since the resulting spasms of the muscles of the walls of this organ lead to chaotic functioning of the sphincters.

The reasons for the appearance of such pathologies

There are many reasons that cause this functional disruption of the normal functioning of the gallbladder. Dyskinesia in its primary form, as a rule, occurs as a consequence of congenital features of the development of this internal organ. The secondary form of this pathology is mainly provoked by various kinds of concomitant diseases.

The main factors provoking primary dyskinesia of the gallbladder:

The process of bile secretion is monitored by the nervous and endocrine systems of the human body. Increased activity of the vagus nerve leads to increased contractility of the gallbladder. This pathology occurs due to a malfunction in the autonomic nervous system. Also, such dyskinesia can be provoked by disturbances in the production of hormones such as gastrin, secretin, cholecystokinin, and so on.

Hypotonic dyskinesia, in which contractility, on the contrary, decreases, usually occurs as a result of the effect of neuropeptides on this internal organ.

Both hypotension and hypertension of the gallbladder can be caused by improper and irrational nutrition. If food intake does not occur regularly, at different times, if a person practices dry meals and snacks on the go, as well as in the case of constant consumption of fatty, fried, spicy or simply low-quality foods, this is a sure way to the appearance of such disorders of gallbladder motility. Such disorders can also be provoked by various diets for the purpose of losing weight and starvation, in which there are long breaks between meals.

Dyskinesia can also develop as a result of a constant state of stress, as a consequence of various types of allergic diseases (for example, asthma) and as a consequence of a sedentary lifestyle. People with an asthenic physique are more susceptible to this pathology.

In children, as a rule, dyskinesia is either a consequence of congenital weakness of the muscular system (primary form), or this disease occurs against the background of concomitant diseases (secondary form). In both children and adult patients, impaired motility of the gallbladder can be caused by pancreatitis, cholelithiasis, dysentery, salmonellosis, peptic ulcer, gastritis, enterocolitis and various atrophies of the mucous membrane of the digestive organs.

The main risk factors for the occurrence of this disease in female patients are various pathological changes in the pelvic organs (for example, salpingitis or adnexitis).

Hypomotor course of dyskinesia

The clinical picture of this gallbladder disease depends on the type of pathology that manifests itself.

Impaired motor skills of this hypomotor internal organ are accompanied by the following symptoms:

  • constant dull pain in the right hypochondrium;
  • flatulence;
  • constant belching;
  • bad breath after belching;
  • a feeling of bitterness in the mouth;
  • nausea;
  • periodic vomiting;
  • bloating;
  • loss of appetite;
  • stool disorders (alternating constipation and diarrhea);
  • decreased heart rate (bradycardia);
  • decreased blood pressure;
  • weight gain (typical of the chronic form of gallbladder hypotension);
  • increased sweating;
  • hypersalivation.

The majority of patients with dyskinesia of this type complain of constant dull pain. Pain of varying intensity is present almost constantly, its character can be dull, squeezing or pressing, the intensity of pain increases during movement and decreases at rest. All this is associated with an increase in pressure in the abdominal cavity and disruption of normal bile outflow. Such pain, as a rule, does not have a clear localization and belongs to the “spread” category. Basically, food intake does not affect the intensity or appearance of pain in these cases.

For dyskinesia, a very characteristic symptom is belching of air, which is provoked by impaired function of the nervous system, forcing more swallowing movements.

With the hypokinetic course of this pathology, patients often experience nausea caused by irritation of the receptors of the digestive organs and stimulation of the nerve center responsible for vomiting. As a rule, the patient begins to feel sick after eating too fatty foods, as well as after overeating or in cases of eating food too quickly.

Another characteristic symptom of deterioration in the muscle tone of the gallbladder is a feeling of bitterness in the mouth (especially in the morning and immediately after eating). The reason for this phenomenon is the entry of bile into the stomach, which is then thrown into the esophagus (which never happens during normal functioning of the gallbladder).

Since hypokinetic dyskinesia of the gallbladder provokes the development of fermentation and putrefaction processes in the digestive system, caused by a deficiency of bile that breaks down food, this course of the disease is often accompanied by bloating.

Enzymes such as bile acids are responsible for good appetite in the human body. If the bile outflow process is disrupted, a deficiency of these substances occurs, and appetite sharply worsens.

Constipation and diarrhea with hypokinetic dyskinesia are quite rare. Their manifestation is caused by decreased intestinal motility, as well as disturbances in the normal course of the digestive process associated with the normal processing of fats, proteins and carbohydrates.

When bile stagnates in the gallbladder, the so-called cholestatic syndrome occurs. It is characterized by:

  • itching of the skin;
  • change in their color (yellowness);
  • yellowing of the eye sclera;
  • darkening of urine;
  • lighter (yellow-green) color of stool.

Symptoms

Hypermotor (or hyperkinetic) dyskinesia of the gallbladder has some characteristic features.

This form of the disease is characterized by the following clinical picture:

  1. the occurrence of intense pain syndrome similar to hepatic colic;
  2. significant deterioration in the patient’s general well-being;
  3. weight loss;
  4. decreased appetite;
  5. loose stools;
  6. nausea;
  7. vomit;
  8. rapid heartbeat;
  9. yellowing of the skin;
  10. high blood pressure;
  11. general weakness;
  12. constant malaise;
  13. the appearance of plaque on the tongue.

The most common and unpleasant symptom of hypertensive dyskinesia of this internal organ is pain, which is characterized by the following symptoms:

  • duration – up to 30 minutes;
  • sharp character;
  • occurs in the form of attacks;
  • localized in the area of ​​the right hypochondrium;
  • provoked by physical overexertion or stress;
  • radiates to the right arm and right shoulder blade.

The patient quickly loses his appetite, begins to eat poorly, which causes a sharp decrease in body weight. In addition, weight loss is also affected by insufficient breakdown of nutrients contained in food, caused by bile deficiency. The subcutaneous fat layer in such patients becomes thinner.

Also, with dyskinesia of this type, the functioning of the autonomic nervous system is disrupted, which is manifested by mood swings, irritability and sleep disorders.

The appearance of a yellowish or greenish coating on the tongue can occur with both forms of dyskinesia. In some cases, patients complained of changes in taste sensitivity. In addition, stagnant processes in the gallbladder also negatively affect the patient’s sexual function, and in women with this pathology, in some cases the menstrual cycle was disrupted.

Diagnosis of this pathology

Despite the rather characteristic clinical picture, external symptoms alone are not enough to accurately diagnose gallbladder dyskinesia.

To determine the reasons that provoked impaired motility of this organ, laboratory and instrumental studies of the gallbladder itself, its ducts and other organs of the digestive system are prescribed.

Such examinations include:

  1. ultrasound examination of the gallbladder, as well as the pancreas and liver;
  2. general blood test;
  3. blood test for biochemistry;
  4. urine test;
  5. coprogram (analysis of feces);
  6. laboratory examination of feces for the presence of helminth eggs in it;
  7. cholangiography;
  8. cholecystography;
  9. bile examination (microscopic);
  10. duodenal intubation, after which gastric juice is analyzed.

Laboratory tests when diagnosing gallbladder dyskinesia make it possible to identify the following negative changes:

  • increased erythrocyte sedimentation rate (ESR);
  • increased levels of leukocytes;
  • increased bilirubin levels;
  • increased levels of cholesterol, C-reactive protein and bile acids;
  • increased amylase levels (typical for cases of concomitant inflammation of the pancreas).

Liver tests are also required to make this diagnosis.

Also, to clarify this diagnosis, instrumental diagnostic techniques such as cholangiography and cholecystography are used.

Retrograde cholangiopancreatography is also mandatory. To exclude stenosis of the sphincter of Oddi, a manometry procedure is performed.

In order to exclude possible pathologies of the duodenum and stomach, a special examination called fibroesophagogastroduodenoscopy is performed.

Treatment method for this disease

As a rule, treatment of this pathology is carried out using conservative methods - with the help of medications. The choice of drug is based on the type of organ motility disorder. For hypotension of the gallbladder, the following are used:

  • drugs that normalize the level of contractility (prokinetics) (for example, Cerucal or Domperidone);
  • To improve bile flow, medications called choleretics (Cholenzim or Allochol) are used;
  • To increase the tone of this organ while simultaneously decreasing the tone of the bile ducts, cholekinetic drugs are used.

In addition, to normalize the functioning of the autonomic nervous system, the doctor may prescribe sorbitol, magnesium sulfate or Eleutherococcus extract. In the hyperkinetic course of this pathology, cholekinetics and antispasmodics are usually used.

Antispasmodics relieve pain. The most famous drugs in this group are No-shpa, Duspatalin, Odeston, Papaverine and Drotaverine. In especially severe cases, it is possible to prescribe narcotic painkillers.

Physiotherapy methods are often used to treat patients with this pathology.

Increased tone of the gallbladder helps to normalize electrophoresis with drugs such as Platiphylline and Papaverine. If the tone is reduced, then electrophoresis with Pilocarpine is used.

For any pathologies of the biliary system, patients must follow a diet called “Therapeutic Table No. 5.”

Articles written

Source: puzyrzhelchnyj.ru

Ilchenko A.A.

GBUZ Central Research Institute of Gastroenterology, Moscow Healthcare Department

Based on an analysis of the literature and our own experience, the role of the contractile function of the gallbladder (CFG) in the digestive processes is shown. The changes in SFTP in various diseases and the reasons for its violation are shown.

Key words: gallbladder, contractile function of the gallbladder, cholecystokinin, gallbladder diseases

Introduction

Among the various functions of the gallbladder, the central place is occupied by the contractile function, which, together with the biliary sphincter apparatus, ensures the timely and adequate flow of concentrated bile into the intestine. The parasympathetic and sympathetic parts of the autonomic nervous systems, as well as the endocrine system, take part in the regulation of the motor activity of the biliary tract, as well as the endocrine system, which ensures synchronized the sequence of contraction and relaxation of the gallbladder and sphincter apparatus of the biliary tract.

The experiment showed that moderate irritation of the vagus nerve causes coordinated activity of the gallbladder and sphincters, and severe irritation causes spastic contraction with delayed bile evacuation. Stimulation of the sympathetic nerve helps relax the gallbladder.

Currently, the leading role in the regulation of the functions of the biliary system, including the motor-evacuation system, belongs to gastrointestinal hormones (cholecystokinin-pancreozymin, gastrin, secretin, motilin, glucagon, etc.).

Under normal physiological conditions, the gallbladder contracts repeatedly throughout the day. During the interdigestive period, the gallbladder deposits hepatic bile, and during meals, depending on the degree of neurohormonal stimulation, it releases the required amount of bile into the ductal system.

Normal contractile function of the gallbladder

It is provided by the fibromuscular membrane, which is represented by smooth muscle bundles mixed with collagen and elastic fibers (Fig. 1). The smooth muscle cells of the bottom and body of the bladder are located in two thin layers at an angle to each other, and in the neck area they are circular, therefore, when the bladder contracts, simultaneously with the evacuation of bile, its mixing occurs. Transverse sections of the gallbladder wall show that from 30 to 50% of the area occupied by smooth muscle fibers is represented by loose connective tissue. This structure is functionally justified, since when the bladder is filled with bile, the connective tissue layers with a large number of elastic fibers are stretched, which protects the muscle fibers and mucous membrane from overstretching and damage (Fig. 2), since when the bladder is filled with bile, it stretches in all planes. At the same time, its volume increases almost 2 times, and its planar dimensions (length and, especially, width) increase by 30-40%.

Rice. 1. The structure of the wall of the human gallbladder.

1- mucous membrane; 2 - fibromuscular membrane; 3 – subserous membrane. Hematoxylin-eosin. Uv. x200.

Rice. 2. Changes in the gallbladder wall during computer simulation of stretching during bile filling. Explanations in the text.

Facilitate the evacuation of bile from the bladder and glands located in its cervical region, which secrete mucins (Fig. 3). Mucins are designed to facilitate the flow of bile in the narrowed space of the cervix and cystic duct, as they are easily washed off from the surface of the mucous membrane of the cervix and, depending on the direction of the bile flow, enter the lumen of the bladder or cystic duct. The volume of mucin secretion does not exceed 20 ml per day. With their excessive secretion, for example, with cervical cholecystitis, mucus plugs can form in this place, making it difficult to empty the bladder. In addition, mucins, in combination with altered bile chemistry, may be the nucleus (matrix) for the formation of gallstones.

Rice. 3. Alveolar tubular glands under the mucous membrane of the cervical region of the gallbladder. Hematoxylin-eosin. Uv. x 200

Complete evacuation of bile from the gallbladder is ensured by the synchronous operation of the sphincter apparatus of the biliary tract, mainly the sphincter of Oddi. A feature of the smooth muscles of the sphincter of Oddi is that its myocytes, compared to the muscle cells of the gallbladder, contain more g-actin than a-actin. Moreover, the actin of the sphincter of Oddi muscles is more similar to the actin of the longitudinal muscular layer of the intestine than, for example, to the actin of the muscles of the lower esophageal sphincter. This fact has important physiological significance, since the synchronous motility of the sphincter of Oddi and the duodenum ensures adequate bile outflow and creates the most optimal conditions for digestion.

Regulation of gallbladder contractions is carried out by the nervous and hormonal systems. Despite the contradictory information regarding the interaction between the secretion of cholecystokinin and the autonomic nervous system, data have been obtained that the nature of the motor-evacuation function of the gallbladder is also determined by the sensitivity of the neuromuscular apparatus of the biliary tract to an increase in the concentration of cholecystokinin under the influence of various choleretic stimuli, and not only by the level of basal and stimulated secretion of cholecystokinin. The sensitivity of smooth muscles to cholecystokinin in patients with biliary dyskinesias can be influenced by the functional state of the autonomic nervous system, as well as the inflammatory process in the wall of the gallbladder. The ability to influence the mechanisms that change the sensitivity of the gallbladder to increased concentrations of cholecystokinin will improve the treatment of motor dysfunctions of the biliary tract and gallbladder, in particular.

Cholecystokinin (CCK) is the main hormonal stimulus regulating postprandial contraction of the gallbladder. CCK is produced mainly by I-cells of the small intestine. It has now been established that CCK has a broader biological effect, because It is also found in other organs, including the nervous system. "Intestinal" CCK was isolated and isolated by Mutt and Jorpes in 1968. In the gastrointestinal tract, CCK regulates motility, the secretion of pancreatic enzymes, the acid-forming function of the stomach and its emptying, and through hormones of eating behavior it affects the process of obesity. In the nervous system, CCK is involved in angiogenesis, saturation processes, nociception (nociceptors - pain receptors), affects memory and learning processes. In addition, CCK interacts with other neurotransmitters in some areas of the central nervous system. Recent studies have identified a whole family of CCKs. Gallbladder contractile function (GBF) is associated with CCK-8. CCK exerts its biological effects through receptor-mediated mechanisms. There are two subtypes of CCK receptors that differ in the structure of the G protein – CCK-1 and CCK-2. In the literature, the CCK-1 receptor is also referred to as CCKA. The main interaction of CCK occurs through the subtype A receptor located on the smooth muscle cell of the gallbladder, the sensitivity of which to CCK is 1000 times greater than to gastrin and does not depend on a person’s age, gender and weight. CCK antagonists, the pharmacological and therapeutic potential of which have been intensively studied recently, play a role in the regulation of the motor function of the gallbladder, intestines, exocrine function of the pancreas, as well as in the development of pathological reflux in GERD. The possibility of selective blockade of CCK antagonists can significantly improve FVSP.

Despite the fact that the study of SFLP has a long history, there is still no consensus on the norm and methods for its determination.

For a long time, oral cholecystography was considered the classic method for determining FVST. A reduction in the size of the gallbladder on the cholecystogram by 1/3 after taking two chicken egg yolks was considered normal. The method had a number of disadvantages - X-ray irradiation, the need to use iodine-containing drugs on the eve of the study, which often had a laxative effect, which was the reason for insufficient contrasting of the gallbladder. In addition, in patients with a “disabled” gallbladder, it was not contrasted. Insufficient visualization of the bladder during oral cholecystography was also observed with concomitant liver diseases.

Currently, two methods are mainly used to study FFVS for scientific and practical purposes - dynamic cholescintigraphy and dynamic ultrasonography.

These methods make it possible to provide a reliable assessment of the FFB and show that normally, after each meal, the gallbladder is quickly emptied and then refilled with bile.

The main method for assessing FFV is transabdominal ultrasonography (TUS). Modern ultrasound devices equipped with computer programs make it possible to obtain objective criteria characterizing the motor-evacuation function of the biliary tract.

To assess the state of motor function of the gallbladder, the following indicators are taken into account:

Fasting (initial) volume of the gallbladder (Vn, ml);

Latent period - the time from the moment of taking a choleretic breakfast to the beginning of gallbladder contraction (min);

The presence and severity of the primary reaction (PR) phase to a choleretic breakfast (increase in the volume of the gallbladder due to additional intake of bile (PR, in% relative to the initial volume of the gallbladder);

Duration of the period of emptying the gallbladder until the minimum volume is reached (DO, min);

Minimum volume of the gallbladder during its emptying (Vm, ml);

Emptying fraction (ejection fraction) – the difference between the initial and minimum volume of the gallbladder (FO, ml);

Gallbladder emptying rate (GC, %):

KO = (Vn – Vm)/Vn100%;

Volumetric rate of gallbladder emptying (CO, ml/min):

CO = (Vn – Vm)/DO;

Relative rate of gallbladder emptying (SD, %/min):

CO = KO/DO.

For the clinic, according to TUS, the most important indicators that allow judging the efficiency of emptying the gallbladder are the following: emptying fraction, volumetric and relative emptying rate, emptying coefficient. The difficulty of determining the norm is explained by the great variability of both the size of the gallbladder and the degree of its contraction.

According to numerous literary sources, according to ultrasound data, it is considered normal for SFVP if the volume of the bladder by 30-40 minutes decreases by 1/3-1/2 from the original, and the emptying coefficient is 30-70%. Based on our own experience, we recommend that you consider SFVP normal if the volume of the bladder by 30-40 minutes has decreased by 1/2 of the original, and the emptying coefficient is in the range of 50-75%. Thus, if the CR is less than 50%, the SFVP should be considered reduced, and if the CR is more than 75%, it should be considered increased. Based on these indicators, corrective therapy should be prescribed.

Dynamic cholescintigraphy is used to assess the condition of the SFJ. However, its accuracy is lower compared to ultrasound. In this regard, interesting studies conducted by J. Donald et al. 2009. Volunteers simultaneously underwent cholescintigraphy and TUS. Data were analyzed every 5 minutes for 1 hour, and FFPT was assessed using the cholecystokinin test. CR with ultrasound was 66.3% ± 20%, with scintigraphy - 49% ± 29%. At the same time, the scintigraphy scintigraphy scattered values ​​were wider compared to sonography, which required continuation of the study for another 30 minutes. In addition, in 5% of participants, it was not possible to assess the BFV due to the lack of visualization of the bladder after the administration of radiopharmaceuticals. The authors also showed that TUS is less labor-intensive and less expensive compared to scintigraphy. Therefore, when assessing FVST performed using TUS or scintigraphy, it is necessary to remember the results of this comparative study.

To assess the motor function of the gallbladder, various cholecystokinetic tests (choleretic breakfasts) are performed. As a choleretic breakfast, use 20.0 g of sorbitol with 100 ml of water or intravenous administration of cholecystokinin at a dose of 20 mg/kg body weight. Studies show that the cholecystokinetic effect after the use of sorbitol or cholecystokinin is not statistically significantly different.

In practice, a sandwich with bread and 10 g of butter or 200 ml of 10% cream, two egg yolks or 50 ml of vegetable oil is also used to assess the FFPS. It should be noted that in different patients the reaction to the same choleretic breakfast can differ significantly, and the emptying time can last from 60-80 to 150-225 minutes with multiple repeated phases of contractile activity of the smooth muscles of the gallbladder. Therefore, when comparing FFPT, for the assessment of which various stimuli were used, this factor should also be taken into account, especially in studies conducted for scientific purposes. For this, a necessary condition in the study protocol is an indication of the choleretic breakfast used.

In practice, sorbitol is often used as a hocecystokinetic test, the duration of the emptying period of which is 15 - 55 minutes. Our experience shows that to solve both scientific and practical problems in which the assessment of FFLP is necessary, 10% cream (200 ml). The use of standardized cholecystokinetic tests in population studies is especially important.

Contractile function of the gallbladder in pathology

The contractile function of the gallbladder is impaired in both functional and organic pathologies of the biliary tract, as well as diseases of other digestive organs and systems.

Biliary dysfunctions and hypokinesia, in particular, can be primary or secondary.

The causes of primary dysfunction of the gallbladder of the hypokinetic type are: decreased sensitivity of the smooth muscles of the gallbladder to neurohumoral stimulation, increased resistance from the cystic duct as a result of impaired patency or motor incoordination between the gallbladder and the Lütkens sphincter, anatomical features of the structure of the outlet section and neck of the gallbladder ( enlarged Hartmann's pouch, elongated and tortuous neck of the gallbladder, pronounced spiral valve of Heister), impeding bile outflow from it, congenital pathology of smooth muscle cells of the gallbladder, irregular diet and sedentary lifestyle.

The causes of secondary gallbladder dysfunction of the hypokinetic type are: inflammatory diseases of the gallbladder (acute and chronic cholecystitis), cholecystosis (cholecystosteatosis, steatocholecystitis, lymphoplasmacytic cholecystitis, xanthogranulomatous cholecystitis, neurofibromatosis, etc.), polyposis of the gallbladder, liver diseases (fatty liver, hepatitis, cirrhosis of the liver), stomach and duodenum (chronic gastritis with reduced secretory function, chronic duodenitis, peptic ulcer localized in the duodenum), pancreas (chronic pancreatitis with impaired endocrine function), diseases accompanied by impaired cholesterol metabolism (cholesterol cholecystolithiasis, cholesterosis of the gallbladder), intestinal diseases (celiac disease, Crohn's disease), surgical interventions (vagotomy, resection of the stomach and duodenum, extensive resection of the small intestine), long-term adherence to a strict diet, irregular meals at long intervals, endocrine diseases (hypothyroidism, diabetes mellitus ), high levels of estrogen in the blood (pregnancy, taking contraceptive drugs, the second phase of the menstrual cycle), long-term therapy with myotropic antispasmodics and somatostatin, systemic diseases (systemic lupus erythematosus, scleroderma) and other reasons.

These reasons explain the widespread occurrence of gallbladder hypokinesia and justify the need for its correction. The criterion for prescribing conservative therapy is a decrease in the gallbladder emptying rate below 50%.

Functional disorders of the biliary tract occur after emotional stress, overwork and other reasons. The influence of psychogenic factors on the function of the biliary tract is realized through the interaction of cortical and subcortical formations with the nerve centers of the medulla oblongata, hypothalamus, complex nervous and local hormonal relationships between the central nervous system and the digestive system.

The classification of functional disorders of the gallbladder, based on x-ray examination and proposed by L.D. Lindenbraten back in 1980, retains its significance to this day. According to this classification, there are hyperkinetic and hypokinetic forms of gallbladder dyskinesia. To diagnose SFTP in functional diseases of the biliary tract, previously described methods with sequential stimulation with cholecystokinin, xylitol or a balanced food load are used. The assessment of SFVP cannot be carried out in isolation from studying the state of sphincter of Oddi tone. It should be remembered that hypokinesia of the gallbladder in some cases can be secondary in nature and is caused by hypertonicity of the sphincter of Oddi. In these cases, it is necessary to have information about its functional state. Dysfunction of the sphincter of Oddi can be determined using radioisotope studies, staged chromatic duodenal sounding or direct manometry. Relief of dysfunction of the sphincter of Oddis with the help of selective antispasmodics in these cases leads to the restoration of reduced SFVP.

Organic pathology of the gallbladder in the vast majority of cases is accompanied by a decrease in FFP. Let us consider the state of the SFJ in the most common biliary pathology.

In acute and chronic cholecystitis, thickening of the gallbladder wall is noted, which is clearly detected by ultrasound. Despite the fact that the level of CCK does not decrease, the muscular layer involved in the inflammatory process does not ensure adequate evacuation of bile from the bladder. There is a direct correlation between the subsidence of the inflammatory process in the wall of the gallbladder and the restoration of its contractile function. However, a long-term inflammatory process is accompanied by the secretion of inflammatory mediators, primarily proinflammatory cytokines, which negatively affect the contraction of myocytes.

In gallstone disease (GSD), the state of the contractile function of the gallbladder has been studied in sufficient detail, because Reduced SFVP is one of the factors contributing to the formation of gallstones. As a rule, patients with cholesterol gallstones have an increased bladder volume on an empty stomach and a low emptying rate after a food load. Moreover, these indicators do not depend on whether patients have small or large stones or only lithogenic bile.

It should be noted that, despite the presence of stones in the gall bladder and impaired motor function, inflammation in the wall of the gallbladder in cholelithiasis, even at stage II of the disease (according to the classification of cholelithiasis developed by the TsNIIG) is usually absent or mild and therefore cannot be considered the main cause decreased contractile function. Studies conducted in the clinic have shown that hypokinesia of the gallbladder develops already at the initial stage of the formation of cholesterol gallstones, although it is not yet accompanied by an increase in the volume of the gallbladder on an empty stomach.

It has been established that the degree of reduction in gallbladder emptying is directly dependent on the concentration of cholesterol in the bile of the gallbladder. Moreover, this dependence persists in healthy individuals in the absence of gallstones. These study results suggest that excess cholesterol molecules in bile act as a myotoxic agent on the gallbladder wall.

In vitro studies comparing gallbladder contractility in patients with cholesterol gallstones and controls have revealed abnormalities in the binding of agonists, such as cholecystokinin, to plasma membrane CCK-1 receptors, decreased contraction of isolated smooth muscle cells or isolated smooth muscle bands of the gallbladder.

As is known, CCK modulates contractions of the gallbladder and sphincter of Oddi. This effect is realized through the activation of smooth muscles as a result of interaction with CCK-1 receptors (CCK-1Rs). In an experiment on mice lacking CCK-1Rs (line 129/SvEv), which were fed a standard or lithogenic diet (containing 1% cholesterol, 0.5% bile acids and 15% milk fat) for 12 weeks, it was found that regardless of the diet received Animals lacking CCK-1Rs had a larger gallbladder volume, predisposing to bile stagnation, as well as a significant slowdown in the transit of small intestinal contents, leading to increased cholesterol absorption and increased cholesterol secretion into bile. Increased cholesterol levels in bile along with gallbladder hypokinesia promoted the nucleation, growth and agglomeration of cholesterol monohydrate crystals, which in turn led to more frequent detection of cholesterol gallstones in mice lacking CCK-1Rs. . This gave reason to believe that the receptor-mediated mechanism is the leading one in reducing the contractile function of the gallbladder. Indeed, subsequent studies did not reveal any disturbances in the intracellular mechanisms of smooth muscle contraction of the human gallbladder in the presence of cholesterol gallstones.

Violation of SFG, caused by excess cholesterol in bile and its effect on the membranes of smooth muscle cells, is detected at an early stage of the formation of gallstones. In this regard, it becomes clear why emptying of the gallbladder is reduced even before the formation of gallstones, when the bile is just oversaturated with cholesterol.

These studies provided strong evidence to support the hypothesis that increased cholesterol concentrations in bile and increased absorption from the gallbladder cavity lead to smooth muscle dysfunction. In addition, it was found that the absorption of cholesterol by the wall of the gallbladder is accompanied by an increase in the stiffness of the sarcolemmal membrane of the cell. Therefore, when CCK binds to a receptor on a smooth muscle cell, its G proteins are not activated and gallbladder contractility is reduced.

At the early stage of gallstone formation, impaired contractility of the gallbladder is still reversible. However, if this background is accompanied by acute or exacerbation of chronic inflammation in the wall of the gallbladder, one cannot count on restoration of the SFG.

In contrast to the above, there is an opinion that hypokinesia of the gallbladder may precede cholecystolithiasis. Congestion caused by hypofunction of the gallbladder provides the necessary time for crystal nucleation and growth of gallstones in the mucin gel. In addition, the viscous mucin gel that forms in the cavity of the gallbladder can contribute to the development of hypokinesia, because difficult to push through the cystic duct. In the presence of mucin and biliary sludge containing calcium, pigments and glycoproteins, conditions are quickly created for the nucleation of cholesterol or the precipitation of calcium bilirubinate.

This opinion is confirmed by the high incidence of cholelithiasis in patients receiving total parenteral nutrition and emphasizes the importance of hypokinesia and bile stagnation in the gallbladder for the formation of gallstones. For example, in Crohn's disease, the frequency of detection of gallstones reaches 27%, and in patients on total parenteral nutrition - 49%. This is due to the fact that during parenteral nutrition the gallbladder does not empty, since the food irritant for the release of CCK is excluded. Stagnation of bile contributes to the formation of biliary sludge, and subsequently gallstones. On the contrary, daily intravenous administration of CCK can completely prevent gallbladder dysmotility and eliminate the inevitable risk of biliary sludge and gallstone formation. In addition, delayed emptying and increased volume of the gallbladder, which occur, for example, during pregnancy or when taking oral contraceptives, also predispose to the formation of gallstones.

However, it should be noted that a decrease in FFP, even with multiple gallstones, is not always a mandatory attribute. We observed patients with multiple stones in the gallbladder, in whom the SFG was not affected (Fig. 4).

Rice. 4. TUS. Cholecystolithiasis (multiple stones in the gallbladder with an acoustic shadow). Study of the contractile function of the gallbladder after a standard choleretic breakfast (cream 10% - 200ml):

a – before stimulation;

b – after 40 minutes CO 57%;

c – after 1 hour CO 60%

Conclusion: normal FFV

With cholesterosis of the gallbladder (CG), as with cholelithiasis, there is a supersaturation of bile with cholesterol. This allows us to explain not only the deposition of cholesterol into the wall of the gallbladder, but also the frequent combination of CGD with cholecystolithiasis. A decrease in SFG is a factor contributing to the progression of gallbladder cholesterosis and the formation of gallstones. According to Yu.N. Orlova, with CVD, 40.2% of patients have a decrease in SFVP, regardless of its form. The gallbladder ejection fraction was significantly lower in CGD in combination with biliary sludge and cholecystolithiasis. During ursotherapy, there is an increase in the ejection fraction of the gallbladder in 95.2% of patients in the absence of cholecystolithiasis (by an average of 21.2%) and in 83.3% when combined with cholecystolithiasis (by an average of 12.9%).

FGLP in non-alcoholic fatty gallbladder disease. Obesity, which has become an epidemic, has ensured a steady upward trend in the number of patients with cholesterol gallstones. However, in recent years, information has appeared that cholecystectomy has increasingly begun to be performed for chronic cholecystitis, in the absence of gallstones, and the frequency of such operations has more than doubled in recent years. According to J. Majeski, the number of patients operated on for chronic acalculous cholecystitis increased to 20-25%. No convincing explanations for this phenomenon have been found. Due to the fact that the disease is more common among women, part of the reason was explained by the influence of estrogen and progesterone, which reduce FFA. Studying the problem of obesity and, in particular, non-alcoholic fatty gallbladder disease (NAFLGD), has made it possible to answer many questions. The term NAFLD was proposed based on studies showing that, like non-alcoholic fatty liver disease, NAFLD has similar stages: gallbladder steatosis, steatocholecystitis, and gallbladder cancer.

The first experimental studies on leptin-deficient and leptin-resistant obese mice showed that they have an increased gallbladder volume that does not respond to the administration of cholecystokinetic neurostimulants. Subsequent studies found that in mice with congenital obesity and in mice fed a high-fat diet, the amount of lipids in the gallbladder wall increases. A study of the gallbladder's FGLP revealed a relationship: it was lowest in mice with a high content of lipids in its wall. The results of experimental studies on animals made it possible to draw a fundamental conclusion: leptin-deficient obesity and/or a high-fat diet causes non-alcoholic fatty gallbladder disease, which is manifested by a decrease in SFTP.

As mentioned above, an increase in cholesterol in cell membranes and an increase in the cholesterol/phospholipid ratio in them affect smooth muscle cells, changing the fluidity of the membranes. Back in 1996, P.Yu et al. reported that animals fed a cholesterol diet increased the cholesterol content of the gallbladder wall and decreased the phospholipid content, which was accompanied by an increase in the cholesterol/phospholipid ratio.

Later, Q. Chen et al. showed that smooth muscle cells from human gallbladders with cholesterol stones have increased cholesterol content and an increased cholesterol/phospholipid ratio compared to the gallbladders of patients with pigment stones. They also demonstrated a decrease in membrane fluidity in cholesterol cholecystolithiasis and a decrease in gallbladder muscle cell contraction with increasing cholesterol/phospholipid ratio.

Thus, we can conclude that the deposition of lipids in the wall of the gallbladder is accompanied by a decrease in its contractile function and in some patients may be the reason for cholecystectomy.

SFTP in adenomyomatosis. Most pathological processes in the gallbladder wall are accompanied by a decrease in FFA. An exception is adenomyomatosis (AMM) - an acquired, hyperplastic lesion of the gallbladder, characterized by excessive proliferation of the surface epithelium with invagination into the hyperplastic muscular layer and the formation of internal false diverticula - Rokitansky-Aschoff sinuses. AMM belongs to the group of hyperplastic cholecystosis - diseases, the development of which is based on degenerative and proliferative changes in the wall of the gallbladder of a non-inflammatory nature. AMM of the gallbladder is considered to be a rare disease. However, the incidence of AMM according to our data (11,000 ultrasounds and 2,300 cholecystectomies) is 16% and 33%, respectively.

It is important to note that an increase in FFA in AMM is one of the characteristic ultrasound criteria that substantiates the diagnosis. The reason for the increase in FFP in adenomyomatosis is explained by hypertrophy of the muscular layer. It should be noted that CR of more than 75% is observed only with a diffuse form of AMM and macroscopically visible thickening of the gallbladder wall. Focal and segmental forms of AMM do not have a significant effect on the FFSP. The initial manifestations of AMM, which are detected only by histological examination, also do not affect the state of the SFJ. FFP does not decrease even when AMM is combined with cholecystolithiasis. In these cases, SFG probably plays a minor role in the formation of gallstones.

Only in some cases with AMM can a decrease in FFLP be detected. This may be due to the presence of an extensive adenoma localized in the fundus, a cancerous or sclerotic process in the wall of the gallbladder. The FFLP also decreases in the diffuse form of AMM with a predominant lesion in the cervical region. In these cases, contraction of the gallbladder in the cervical area may also make it difficult to empty. The combination of AMM with other types of hyperplastic cholecystosis (lymphoplasmocytic and xanthogranulomatous cholecystitis, gallbladder steatosis and steatocholecystitis, etc.) also negatively affects the SFG.

Conclusion

SFZH, providing adequate outflow of concentrated bile, promotes complete digestion in the small intestine. The choice of the method for determining FFPT and the correct interpretation of the results obtained make it possible to justify the need for corrective therapy. Knowledge of the causes of FFV dysfunction gives the doctor the opportunity to select the most optimal treatment option and monitor its effectiveness.

Literature

1. Fedorov N.E., Nemtsov L.M., Solodkov A.P. and others. Indicators of cholecystokinin secretion, autonomic regulation of heart rate and level of anxiety in patients with motor dysfunction of the gallbladder. Experiment.iclin.gastroenterol. - 2003. - No. 1. - p.53-56.

2. Schjoldager BT. Role of CCK in gallbladder function. Ann N Y Acad Sci. 1994 Mar 23;713:207-18.

3. Herranz R. Cholecystokinin antagonists: Pharmacological and therapeutic potential. Med Res Rev. 2003 Sep;23(5):559-605.

4. Donald JJ, Fache JS, Buckley AR, Burhenne HJ. Gallbladder contractility: variation in normal subjects. AJR Am J Roentgenol. 1991 Oct;157(4):753-6.

5. Barr RG, Kido T, Grajo JR. Comparison of sonography and scintigraphy in the evaluation of gallbladder functional studies with cholecystokinin. J UltrasoundMed.2009 Sep;28(9):1143-7.

6. Ilchenko A.A., Maksimov V.A., Chernyshev A.L. and others. Staged chromatic duodenal sounding. Methodological recommendations. - Moscow. - 2004. - 26 p.

7. Ilchenko A.A. Diseases of the gallbladder and biliary tract. Guide for doctors. – 2nd ed., revised. and additional – M.: Publishing House “Medical Information Agency” LLC, 2011. – 880 p.

8. Ilchenko A.A. 10 years of classification of cholelithiasis (CNIG): main results of scientific and practical application. - Experimental and clinical gastroenterology. – 2012. - No. 4. – p.3-10.

9. Wang DQ, Schmitz F, Kopin AS, Carey MC. Targeted disruption of the murine cholecystokinin-1 receptor promotes intestinal cholesterol absorption and susceptibility to cholesterol cholelithiasis. J Clin Invest. 2004 Aug;114(4):521-8.

10. Ivanchenkova R.A., Izmailova T.F., Metelskaya V.A. and others. Cholesterosis of the gallbladder. Clinic, diagnosis, treatment. Klin.med. – 1997. - No. 5: 46-51.

11. Orlova Yu.N. Gallbladder cholesterosis. Clinical sonographic study. Author's abstract. ...candidate of medical sciences. – M.: 2003. – 30 p.

12. Joahanning JM, Gruenberg JC. The changing face of cholecystectomy. Am Surg 1998;64:643–647.

13. Patel NA, Lamb JJ, Hogle NJ, Fowler DL. Therapeutic efficacy of laparoscopic cholecystectomy in the treatment of biliary dyskinesia. Am J Surg 2004;187:209–212.

14. Majeski J. Gallbladder ejection fraction: an accurate evaluation of symptomatic acalculous gallbladder disease. Int Surg 2003; 88:95–99.

15. Yu P, Chen Q, Biancani P, Behar J. Membrane cholesterol alters gallbladder muscle contractility in prairie dogs. Am J Physiol1996;271:G56–G61.

16. Chen Q, Amaral J, Biancani P, Behar J. Excess membrane cholesterol alters human gallbladder muscle contractility and membrane fluidity. Gastroenterology 1999;116:678–685.

17. Ilchenko A.A., Orlova Yu.N., Bystrovskaya E.V. and others. Adenomyomatosis of the gallbladder. Analysis of 215 surgical cases. Experiment and wedge. gastroenterol. - 2013. - No. 4. - Accepted for publication.

Diseases biliary tract often occur in children and most of them are so-called functional disorders of contractions (motility) of the gallbladder and its ducts, as well as defects in the functioning of the sphincter of Oddi (from the Greek sphincter constrictor, a ring-shaped muscle, the contraction of which closes or narrows the opening), due to This causes problems with the excretion of bile. Motility disorders of the biliary system are often called dyskinesias , although in recent years this term has become much less used. Dyskinesia biliary tract occur in children of preschool and school age, somewhat more often in girls than in boys.

Bile formed in cells liver(Fig. 1) and performs a number of important functions for the body, the first of which is to ensure the normal course of the processes of digestion and absorption of food in the intestines. The components of bile, in particular bile acids, promote the digestion of fats, stimulate intestinal motility, and have a bactericidal effect. From the liver cells to the duodenum, bile passes through the system bile ducts, accumulating in gallbladder . At the same time, bile continues to form in the biliary system. If for various reasons its movement through the ducts slows down or accelerates, then the process of bile formation may be disrupted, and its composition will differ from that necessary for normal digestion. The normal secretion of bile is also important from the point of view of its entry into the intestines at the right time and in the right quantity, adequate to the volume of food in the intestines. duodenum. Regulation of contractions biliary tract carried out central nervous system, as well as the hormone - cholecystokinin, which is produced by the cells of the duodenum in response to the intake of food, primarily containing fats. Cholecystokinin stimulates contraction of the gallbladder and peristalsis (rhythmic contraction) of the ducts, facilitating the flow of bile into the intestines. Numerous factors play an important role in the regulation of this process. sphincters, also under the control of the central nervous system and gastrointestinal hormones. Bile ducts form common bile duct, which flows into the duodenum. In the intestinal lumen, the duct appears as a small elevation and is called Vater's nipple, in the thickness of which the last sphincter on the path of bile to the intestines is located - sphincter of Oddi, ( it not only regulates the flow of bile into the duodenum, but also protects the ducts from the backflow of intestinal contents into their lumen). When a person takes food from the central nervous system, and subsequently through hormonal mechanisms, at the level of the stomach and duodenum, signals are sent to the biliary system to relax the sphincters and increase contraction, and the amount of bile entering the intestine must correspond to the nature of the food taken. In the case of normal functioning of this mechanism, bile mixing with intestinal contents along with digestive enzymes (primarily the pancreas) ensures the successful digestion and absorption of food.

Manifestations of dyskinesia

Children have motor impairments biliary tract They usually manifest themselves as pain in the abdomen (typically in the area of ​​the right hypochondrium) of varying intensity, but small children do not localize the pain well and usually point to the navel. Nausea and a feeling of bitterness in the mouth appear. Disorders accompanied by increased motility and increased tone of the gallbladder sphincters are characterized by intense abdominal pain that occurs after physical or emotional stress. In the case of slow motor skills and decreased sphincter tone, dull pain associated with eating is more often noted. With severe dysfunction of the bile ducts and gallbladder, and a significant change in the composition of bile, liquefied, discolored stool appears, in some cases it becomes greasy, and vomiting and attacks of severe abdominal pain are also associated.

Classification

Functional motor disorders biliary tract classified as follows: 1) motor disorders ( dyskinesia ) gallbladder; 2) tone disturbances ( dystonia ) sphincter of Oddi. Dyskinesia can be hyper- and hypomotor (another name: hyper- and hypokinetic, i.e. contractions are enhanced or slowed down), and dystonia - hyper- and hypotonic (i.e. sphincter tone is increased or decreased).

Causes of dyskinesia

Diagnostics

An obligatory component of the correction of motor skills disorders biliary tract is diet therapy. So, with increased sphincter tone, a diet low in vegetable fat is prescribed, with the exception of fried, spicy and sour foods. With slow contraction of the gallbladder, motility-stimulating vegetables, fruits, berries and cereals (beets, dried apricots, strawberries, raspberries, oatmeal, dried rose hips, etc.) that stimulate motility and are rich in dietary fiber are introduced into the diet in order to correct motility and sphincter tone. biliary tract The gastroenterologist prescribes drug therapy, taking into account the individual characteristics of a particular patient. Antispasmodics and choleretic drugs are used. Antispasmodics(drugs that eliminate spasms) are indicated for increased sphincter tone and increased motility of the gallbladder. Representatives of this group of drugs are very numerous. The drug has been used for many years NO-SHPA, which has not lost its significance today and has an antispasmodic effect. The drug is prescribed for spasms through the mouth for children under 6 years old - 0.01 - 0.02 g 1 - 2 times a day, for children 6 - 12 years old - 0.02 g 1 - 2 times a day. Choleretic drugs(increase the flow of bile from the liver) are used for hypomotor dyskinesia biliary tract. Divided into cholekinetics(stimulate motor skills biliary tract) And choleretics(stimulate bile synthesis), although this division is very arbitrary and most drugs have a double effect. These include various choleretic herbs and preparations FLAMIN, CHOLAFLUX, BERBERINE, CHOLAGOGUM, which can be used to treat preschool children.

Prevention

In the prevention of dyskinesia biliary tract Providing a balanced diet for a child from the first days of life is of great importance. The nature of nutrition also plays an important role in older children. It is especially important to emphasize the need for a sufficient amount of plant-based products in the child’s diet, rich in fiber and other dietary fibers, as well as vegetable oils. The second most important factor that can reduce the risk of developing pathology biliary tract, especially of a functional nature (dyskinesia), is to ensure the psychological comfort of the child, first of all, in the family. A favorable attitude towards the child, as well as between all family members, is a necessary component of a healthy lifestyle. Finally, general strengthening measures, hardening, and prevention of diseases of other body systems also contribute to the prevention of diseases of the biliary system. Thus, diseases biliary tract are very diverse, and clinical manifestations can vary from minimal symptoms to severe attacks requiring emergency care. Modern medicine has a significant arsenal of means for therapeutic or surgical correction of these disorders, but the success of treatment is largely determined by the patient’s early access to a doctor.

If a person has pain above the navel, then most likely the problem lies in the stomach. If you have pain in the lower abdomen, you may suspect pathologies of the genitourinary system.

But discomfort in the right side of the abdomen indicates diseases of the liver or biliary tract.

Many people are diagnosed with hypermotor gallbladder dyskinesia. The gallbladder is contracted, what does this mean? It is worth considering this issue in more detail.

Causes of hypermotor dyskinesia

When making the diagnosis in question, doctors point out to the patient that their organ is not visible on ultrasound because it is not filled with bile.

This phenomenon does not always indicate any pathology. It is worth taking into account that the gallbladder is considered the place where bile, which is produced in the liver, accumulates.

When food enters the gastrointestinal tract, the bladder contracts and throws bile into the duodenum.

Therefore, we should not exclude the possibility that the ultrasound was performed precisely at such a moment.

Incorrect preparation for ultrasound examination

The gallbladder is contracted, what does this mean? A person may deliberately be poorly prepared for an ultrasound or simply not have such an opportunity if the procedure needs to be performed urgently.

Most often, patients eat enough before the procedure, which is not allowed. The gallbladder contracts and releases bile needed to digest food. This phenomenon is considered natural, but makes it impossible to study the organ.

In this case, the contraction is not caused by any pathology. But despite this, it cannot be studied, so the patient will have to undergo another ultrasound examination.

Taking choleretic medications

This is the second reason that the gallbladder may be contracted during ultrasound.

This phenomenon is also considered a variant of the norm and does not require any medical intervention. Here we are talking about a repeated examination of the body.

Organ pathology

Collapse of the gallbladder can be caused by pronounced sclerotic changes in its walls and the walls of the cystic ducts.

Such phenomena can be provoked by a long course of chronic cholecystitis and its exacerbations.

It is noteworthy that each stage of exacerbation leaves scars and adhesions on the organ, which cause deformation of the bladder, its complete overgrowth and replacement of its tissues with scar tissue.

Such pathological processes often accompany a chronic inflammatory process in the organ in question.

As a result, the gall bladder stops stretching and contracting, taking the form of a lump of scar tissue.

Here we are talking about a pathological condition when problems with the gallbladder are caused by its diseases.

In this case, the organ can no longer function normally and loses its functional characteristics.

What causes hypermotor dyskinesia?

In addition to the already indicated reasons for the development of the pathology in question, there are several other main factors that can provoke it. We should consider them in more detail:

If a person exhibits any of these factors, then he should regularly undergo a complete examination of the body.

Signs of a pathological process

The gallbladder is contracted, what does this mean? There are several main symptoms that may indicate the development of hypermotor dyskinesia of the gallbladder.

Due to the fact that there are quite a lot of them, each of them should be considered in more detail:

  1. Belching air. The fact is that with the pathology in question, the patient has to swallow more air while eating, this excess air is regularly released naturally.
  2. The presence of excess secretion in the throat and mouth, causing a peculiar unpleasant taste in the mouth.
  3. Yellowing of the skin.
  4. Severe darkening of urine and lightening of stool.
  5. Bloating, the formation of gases in the intestines, which leads to a lack of yellow-green solution. Simply put, insufficient extraction of elements that are necessary for full-fledged chemical reactions.
  6. Diarrhea. With increased secretion, absorption of important elements is observed. This phenomenon provokes stomach irritation and speeds up the process of digesting food, which interferes with its absorption.
  7. A kind of coating on the tongue, which is explained by the improper movement of nutrients into the mouth that have not had time to be absorbed.
  8. Vomiting caused by pathological processes in the gastrointestinal tract.

These symptoms may indicate not only that a person has an abnormal contraction of the gallbladder, but also many other diseases developing in the patient.

This suggests that you should not hesitate to visit a specialist, undergo a full examination of the body and receive timely treatment.

Treatment Options

If specialists have accurately identified the causes of the development of the pathology in question, then they can prescribe the patient a course of therapy aimed at getting rid of discomfort and dangerous consequences.

To normalize secretion, additional liver activity should be provoked and the tone in the ducts should be reduced.

For these purposes, it is customary to use the following medications:

  1. Oxafenamide – 2 tablets before the first meal for 14 days.
  2. Gepabene – 1 capsule with meals, 3 times a day for 21 days.

Don’t forget about taking antispasmodics, which will relieve pain and relax the sphincter:

  1. Papaverine.
  2. No-shpa.
  3. Hymecromone.

In addition, the doctor should prescribe weak mineral water. Essentuki water No. 2 and No. 4 are ideal for these purposes.

Prevention of hypermotor dyskinesia

To prevent gallbladder contraction, you should follow a special diet that will help reduce the load on the liver.

  1. Sweet products.
  2. All types of sausage.
  3. Beef.
  4. Pork.
  5. Eggs.
  6. Fresh vegetables and fruits.

But the following food products have a positive effect on the pathology in question:

  1. Kefir and yogurt with a minimum percentage of fat content.
  2. Lean fish and poultry.
  3. Oil.
  4. Vegetable soups.
  5. Weak tea.
  6. Coffee with added milk. It is worth considering the fact that a morning cup of coffee can prevent the formation of stones in the gall bladder.

If, during the diagnostic process, doctors have identified a shriveled reservoir that is no longer able to perform its functions, then the situation requires serious therapy.

Surgery cannot be ruled out.

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