Biliary Dyskinesia (bd)

Biliary dyskinesia (BD) is a disorder of the sphincters’ tonus and kinetics of the gall-bladder and the bile ducts. There are two basic forms of BD: hypotonic-hypokinetic and hypertonic-hyperkinetic. Usually BD is a concomitant disease: for example "Chronic cholecystitis. Biliary Dyskinesia of hypertonic-hyperkinetic type". BD as an independent diagnosis is used rarely.

Criteria of diagnosis

/. Clinical

In hypertonic forms of BD pain occurs 30-40 minutes after meal, it is localized in the right hypochondrium or round umbilicus, it is paroxysmal and cutting or shooting, and it lasts: for 5-15 minutes. On palpation there is painfulness in the right hypochondrium. Signs of Ortner, Merphy, Boas, frenicus-symptom are positive. There are common manifestations of vegetative dysfunction, neurotic symptoms.

In hypotonic dyskinesia pain occurs 1-1,5 hours after meal (especially fatty) or after physical exertion, it is localized in the right hypochondrium. It is dull or pressing, and it lasts 1-2 hours, sometimes accompanied by nausea. On palpation painfulness is revealed in the right hypochondrium. Bladder signs are distinctly positive. Enlargement and tenderness of the liver are common.

//. Instrumental

The most informative test for verification of diagnosis is USE with use of cholekynetics (egg yolk, sorbit) for functional investigations. Changing of size of gall bladder helps to evaluate its tonus and the rate of contraction and in an indirect way to conclude about the state of the sphincters.

The less informative one is fractional duodenal tubing. The signs of hypertonic-hyperkinetic type BD are prolongation of period of closed Oddi’s sphincter (more than 6 min), diminished volume and speeded up excretion of B and C bile portions (more than 1,5 ml/min). Shortening of period of closed Oddi’s sphincter (less than 2 min), increase of bladder portion of bile (more than 50 ml) and slowing down of its excretion (less than 1,1 ml/min) are the signs of hypotonic-hypokinetic disturbances.