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In the occurrence of biliary dyskinesia important role played by the functional state of the
stomach and duodenum. Violation of the sphincters, duodenostasis, swelling and spasms of the
large duodenal papilla lead to hypertension in the biliary system and the bile secretion. There are
various mechanisms that lead to a breach of the passage of bile. Two possible variants of such
mechanisms are shown in Fig. 15-2.
Duodenostasis
II
Destabilization of the bile, precipitation of bile acids, cholesterol, bilirubin, calcium, with the
possible formation of concretions
The main signs of hypotonic dyskinesia type: lowering muscle tone of the gall bladder, a weak
its decline, an increase of the gall bladder. Clinically, this option is accompanied by aching pain
in the right hypochondrium or around the navel, general weakness, fatigue. Sometimes you can
palpated a large atonic gallbladder. When ultrasound reveal a larger, sometimes elongated gall
bladder with normal or delayed emptying. When you receive a stimulus (egg yolk), the
transverse size of the gall bladder usually decreases less than 40% (normally 50%). When
fractional duodenal sounding reveal an increase in the portion of normal or high-velocity outflow
cystic bile, if the tone of the bladder is preserved, the reduction of tone accompanied by a
reduction of this portion.
The main signs of dyskinesia hypertensive type - reducing the size of the gall bladder, the
acceleration of its discharge. Clinically, this variant is characterized by brief, but more intense
bouts of pain with localization in the right hypochondrium or around the navel, sometimes
indigestion. When ultrasound determine the decrease in the transverse dimension of the
gallbladder after choleretic breakfast for more than 50%. When fractional duodenal sounding
reveal a decrease in the portion of an increase in velocity outflow of bile.
TREATMENT
Treatment can be conducted in hospital and at home. In the appointment of treatment should take
into account the type of dyskinesia.
Medical nutrition:
-- fasting days, such as fruit and sugar and kefir, cottage cheese (for detoxification);
-- fruit and vegetable juices, vegetable oil, eggs (for the natural increase outflow of bile).
-- Choleretic (stimulates the formation of bile) - allohol, bile + powder from pancreas and
mucosa of the small intestine (holenzim), hydroxy-metilnikotinamid (nikodin) osalmid
(oksafenamid) tsiklovalon (CEC-Valon) holosas, plants (mint, nettle, chamomile, St. John's wort,
etc.).
-- Holekinetiki (enabling the provision of bile) - increases the tone of gallbladder (eg, drugs
barberry usual, sorbitol, xylitol, egg yolk) that reduce the tone of biliary tract (eg, papaverine
hydrochloride, platifillin, an extract of belladonna).