Biliary Dyskinesia is due to irregularity in the contraction of the gallbladder or the adjoining sphincter whcih result in accumulation of bile in the gall bladder.
The common symptoms of biliary dyskinesia are:
Diagnosis of biliary dyskinesia is basically based on exclusion of other causes of biliary colic. Usually, after an episode of biliary pain, the physical examination is normal with slight upper abdominal tenderness due to the pain. Other than a mild tenderness, no other symptom is elicited on clinical examination.
Thus to come to a confirmatory diagnosis certain criteria should fulfilled known as Rome III criteria:
Before starting the treatment, it is vital to understand the exact mechanism of biliary dyskinesia, whether the problem is the contraction of the gallbladder or in the sphincter of Oddi. General advice regarding diet should be given, as patients with biliary dyskinesia should have at least 4-5 meals per day. Fatty food should be avoided and loads of fruits and berries should be included in the diet. Food should be boiled and steamed.
Medications in the form of antispasmodics can be given to reduce the spasm of the sphincter which prevents reflux of bile and allows free flow of bile through the biliary tract and ducts. Antispasmodics should not be given to individuals with gastroesophageal reflux disease as it can worsen the condition. Choleretics can be given to stimulate the secretion of bile and prevent its concentration and absorption back into the gall bladder.
Surgery is the mainstay of treatment, wherein laparoscopic cholecystectomy is done . This procedure is performed by making 3-4 incisions on the abdominal wall followed by removal of gallbladder with the help of a laparoscope. This is a minimal invasive procedure which provides relief to 90% of the cases. Another surgical option is sphincterotomy, wherein an incision is made on the sphincter of Oddi to help in the flow of bile. This also provides relief in the symptoms in about 80% of the cases . Cholecystectomy still remains the best and most effective form of treatment for biliary dyskinesia.
The prognosis of biliary dyskinesia is usually not associated with this symptom complex, but rather with the method of treatment or invasive diagnostic techniques. Biliary dyskinesia usually does not progress into any serious condition.
The earlier this condition is detected and treated the better is the prognosis, if treated with cholecystectomy. Symptomatic relief is achieved with cholecystectomy, but complete resolution of symptoms is not achieved with surgery.
The causative factors of this condition are not clear and biliary dyskinesia is a symptom complex rather than a disease itself. Often this motility disorderrequires cholecystectomy; hence it is also termed as post cholecystectomy syndrome. The symptom of biliary dyskinesia may also indicate other pathologies such as inflammation or gallstones, and even certain food stuffs can trigger this disorder. Chronic inflammation also can result in biliary dyskinesia. Recent studies indicate stress as a causative factor for biliary dyskinesia. Some dysfunction in dopamine receptors will result in gallbladder not receiving signals from the brain. Other risk factors include obesity, low roughage and fat diet, increased sugar intake, history of thyroid dysfunction, patients with irritable bowel syndrome, increased intake of alcohol and individuals with decreased gastric acid production. Differentiation should be made regarding failure of the biliary sphincter or the pancreatic sphincter .
The exact prevalence is not known. The occurrence of functional biliary pain in normal ultrasound is 8% in men and 21% in women. The best epidemiological screening test for this functional disorder is ultrasound. Biliary dyskinesia affects females more than males, usually between the age group of 40-60 years. Nowadays, with the increasing use of laparoscopic surgery, biliary dyskinesia tops the list for indication of laparoscopic cholecystectomy in cases of functional gallbladder disease, ranging about 10-20% in adults. Though the cases of biliary dyskinesia post cholecystectomy are present, no evident documentation exists.
The exact cause still remains unclear, but this condition arises due to an abnormality in the motility of the gall bladder. Biliary dyskinesia is regarded as a condition arising due to an abnormality in the movement of the bile. There are a number of factors responsible for the obstruction of the physiological transportation of bile from the gall bladder to the small intestine. If the sphincter of Oddi does not function optimally, it prevents the transportation of bile through the common bile duct to the duodenum. This results in stagnation of bile in the gall bladder leading to biliary dyskinesia. Any abnormality in production of bile or its traverse through the bile duct will result in biliary dyskinesia. Thus, these reasons cause a disruption in the normal physiological transport of bile to the small intestine resulting in changes in the metabolism of the body.
Certain steps can be taken to prevent biliary dyskinesia such as:
Repetitive pain in the right upper abdomen can be a challenging symptom to be diagnosed by physicians, although this type of pain is common and termed as biliary colic. Biliary dyskinesia is a frequent term for a medical disorder known as acalculous cholecystopathy. This condition is diagnosed in cases with persistent right sided upper abdominal pains with the absence of gallstones, typically similar to biliary colic. This is a functional condition wherein the motility of the gallbladder is reduced. The condition is purely symptomatic with no known cause, more or less similar to the other metabolic disorders affecting the motility of the gastrointestinal tract. Thus, biliary dyskinesia is a motility disorder which indicates either abnormal functioning of the gallbladder or the Sphincter of Oddi which is located at the end of the common bile duct.
The gallbladder's primary function is to store the bile released by the liver. This bile further reaches the small intestine to help in the process of digestion. Thus, any obstruction in this pathway either through common bile duct or in the functioning of the gallbladder itself, results in biliary dyskinesia. Due to this abnormal functioning and motility, it leads to stagnation of bile in the gallbladder. Thus, this disorder is a symptom which indicates some underlying pathology leading to dyskinesia rather than a disease itself. Diagnosis of biliary dyskinesia is made after other causes of abdominal pain have been excluded.
The common choice of treatment is laparoscopic cholecystectomy, though the success is not sure. The exact etiology of this medical condition is not clearly understood.
Biliary dyskinesia is a common condition of the gall bladder wherein an individual usually complains of a dull aching pain in the right upper abdominal pain. This pain may be accompanied by nausea or vomiting. This condition usually affects females more than males and is a primary motility disorder of the gallbladder and its sphincter muscles. There is no known cause for this condition and a diagnosis is usually formed on the principle of exclusion. Absence of gallstones and sludge and other structural abnormality in the gallbladder and biliary tract usually indicate this condition. This condition is due to irregularity in the contraction of the gallbladder or the adjoining sphincter whcih result in accumulation of bile in the gall bladder. A complete examination and workup assist the physician to come to a diagnosis. Certain blood tests and scans will be required to exclude other causes with similar pain in the abdomen. Surgical removal of gall bladder is the preferred choice of treatment which provides relief to most of the cases. Certain dietary restrictions and exercise can help you prevent and control biliary dyskinesia.