Biliary dyskinesia is a motility disorder that affects the gallbladder and sphincter of Oddi.

The motility
disorder of the gallbladder is called gallbladder dyskinesia. Patients with this condition present with
biliary-type pain, and investigations show no evidence of gallstones in the gallbladder

The diagnosis is made by performing a gallbladder ejection fraction, which is a radionuclide

investigation. An abnormal gallbladder ejection fraction has a value less than 40%.

Biliary dyskinesia is an enigmatic but important condition to consider in the evaluation of patients
with right upper quadrant pain. A thorough history, work-up and examination are needed, as this
diagnosis is primarily a diagnosis of exclusion. Proper selection of patients for cholecystectomy is
essential in order to avoid unnecessary operative intervention.

What is biliary dyskinesia?

Biliary dyskinesia is a symptomatic functional disorder of the gallbladder whose precise etiology is
unknown. It may be due to metabolic disorders that affect the motility of the GI tract, including the
gallbladder, or to a primary alteration in the motility of the gallbladder itself. Biliary dyskinesia
presents with a symptom complex that is similar to those with biliary colic.

What are the symptoms?

Biliary dyskinesia presents with a symptom complex that is similar to those with biliary colic.

Episodes of right upper quadrant pain

Severe pain that limits activities of daily living

Nausea associated with episodes of pain

How is it diagnosed?

In order to diagnose biliary dyskinesia, the patient should have right upper quadrant pains similar to
biliary colic but have a normal ultrasound examination of the gallbladder (no stones, sludge,
microlithiasis, gallbladder wall thickening or CBD dilation). For patients who are suspected to have
biliary dyskinesia, the Rome III diagnostic criteria for functional gallbladder disorders should be
considered.

These include:

Pain episodes that last longer than 30 minutes

Recurrent symptoms that occur at variable intervals

Pain that is severe enough to interrupt daily activity or lead to ER visits

Pain that builds up to a steady level

Pain that is not relieved by bowel movements, postural changes, or antacids

Exclusion of other structural diseases that could explain the symptoms

Other supportive criteria include: association of pain with nausea and vomiting, radiation of the pain
to the infrascapular region, and pain that wakes the patient in the middle of the night.

Normal liver enzymes, conjugated bilirubin, and amylase/lipase.

Acalculous Gallbladder Disease

Acalculous gallbladder disease (biliary dyskinesia) occurs without the presence of gallstones. It can be
chronic or acute and may result from the gallbladder muscles or valve not working properly.
Symptoms include abdominal pain on the right side of the body, radiating to the shoulder. Eating
high fat foods often triggers this. Related symptoms may include nausea, vomiting, bloating, and
loose stools.

Gallbladder dyskinesia presents with typical biliary pain in the absence of gallstones

right upper quadrant pain, pain after meals, and reproduction of the pain after CCK administration

Este o afectiune a veziculei biliare caracterizata de absenta calculilor biliari; de asemenea, mai poate
fi considerata o tulburare functionala sau de golire a veziculei biliare.

Cauze - inflamatia cronica, disfunctii ale musculaturii netede a veziculei biliare, ale canalului coledoc
sau ale musculaturii sfincterulului Oddi (formatiune musculara cu fibre longitudinale si circulare) care
ar putea fi prea ingust.

Simptome - durere in cadranul superior drept, cu absenta calculilor biliari. Totusi, diskinezia biliara
poate fi insotita si de alte simptome specifice veziculei biliare, ca rezultat al scaderii concentratiei
biliare in procesul digerarii grasimilor.

Potrivit studiilor, stresul creste riscul aparitiei acestei afectiuni; deseori dischinezia biliara fiind
rezultatul proiectiilor mentale.

Dischinezia biliara = evacuare anormala a veziculei biliare ( fierii) , care apare mai ales mai femeile cu
varsta de 40 ani.

In mod normal, vezicula biliara isi evacueaza minimum 40% din continut cand este stimulata (fractia
de ejectie). In caz de disfunctie, colecistul se poate goli mai mult sau mai putin.

Clasificarea dischineziei biliare

Dischinezia biliara poate fi hipertona (“fiere nervoasa”) sau hipotona (“fiere lenesa”)

Cel maI frecventi dischinezia biliara se intalneste in urmatoarele situatii:

predispozitia genetica – provenienta dintr-o familie cu pietre la fiere, reprezinta un risc de a le face-

sexul feminin -face mai frecvent boala

afectiuni hepatice

boli gastrointestinale, inclusiv parazitoze digestive

boli pancreatice

sensibilitate psiho-emotionala, stres, emotivitate, suprasolicitarile

tulburari hormonale de menopauza

http://www.mymed.ro/diskinezie-biliara-bila-lenesa.html

http://www.hepatite.ro/probleme-cu-fierea/2011/dischinezia-biliara-362/

http://www.romedic.ro/dischinezia-biliara

http://www.mymed.ro/diskinezie-biliara-bila-lenesa.html