Hyper motor dyskinesia of biliary tract

Description:

This frustration of system of a zhelchevydeleniye, characterized by change of a tone of a gall bladder, bilious channels and their sphincters, shown disturbance of outflow of bile in a duodenum, followed by emergence of pains in right hypochondrium.

Symptoms of Hyper motor dyskinesia of biliary tract:

Hypertensive - the hyperkinetic form of dyskinesia of bilious ways is observed more often at persons with a vagotonia and the hypochondrium with irradiation in a right shoulder-blade, a shoulder (reminds hepatic colic) or, on the contrary, in the left half of a thorax, area of heart is characterized by the megalgia which is periodically arising acute kolikoobrazny, sometimes very in right (reminds a stenocardia attack). Cardial manifestations at diseases of a gall bladder were described by S. P. Botkin as a vesical and cardial reflex (Botkin's symptom). Pain, as a rule, arises suddenly, repeats several times in days, has short-term character, is not followed by fervescence, increase SOE and a leukocytosis. Sometimes attacks are followed by nausea, vomiting, dysfunction of intestines. Emergence at such patients of vasculomotor and neurovegetative syndromes is possible: perspiration, tachycardia, hypotonia, feeling of weakness, headache.

In right hypochondrium patients connect emergence of attacks of pain not so much with errors in food how many with a psychoemotional overstrain. The pain syndrome at a hyperkinetic form of dyskinesia of bilious ways is a consequence of sudden increase in pressure in a gall bladder which is reduced at sharply arisen hypertension of sphincters of Lyutkens or Oddi.

Most of patients note an acrimony, fatigue, differences of mood, a sleep disorder, emergence of pain in heart, heartbeat attacks.

At survey of patients skin is not changed; the hypodermic fatty layer is expressed normally, quite often is even increased. Palpatorno is sometimes marked out morbidity (a positive symptom of Zakharyin) in the field of a projection of a gall bladder - Shoffar's zone (in the place of crossing of bottom edge of a liver with the outer edge of the right direct muscle of an abdominal wall). There can sometimes be positive Vasilenko, Kerr, Murphy, Myussi-Georgiyevsky's symptoms on the right, the right frenikus-symptom. Zones of a skin hyperesthesia of Zakharyin-Geda in most cases are absent.

Out of the aggravation period at a palpation of a stomach insignificant morbidity in the field of a projection of a gall bladder and an anticardium is noted. The painful points characteristic of chronic cholecystitis are expressed unsharply or are absent. Functional changes of other digestive organs (a pylorospasm, a stomach hypokinesia, дуоденостаз, hypo - and a hyperkinesia of a large intestine), cardiovascular and endocrine systems are possible. During the mezhpristupny period the feeling of weight in right hypochondrium sometimes remains. Pains usually amplify after psychoemotional overloads, in the period of periods, after exercise stresses, the use of hot and cold dishes.

Hypotonic - a hyperkinetic form of dyskinesia of biliary tract

It is known that very often biliary dyskinesia, especially secondary, proceed with a dilatirovanny congestive gall bladder against the background of a spasm of a sphincter of Oddi. Most often it meets at the raised tone of parasympathetic department of the autonomic nervous system and a high kislotoobrazovaniye in a stomach. These are patients:

  1.konstitutsionalnye vagotonik;
  2.neyazvennoy dyspepsia;
  3.gastritom type B - chronic primary gastroduodenit (a predjyazvenny state);
  4.pepticheskoy ulcer;
  5.khronicheskim recurrent pancreatitis;
  6.cherepno-brain injury.

At all these diseases, especially at a round ulcer, the spasm of a sphincter of Oddi as the peptic ulcer is the bright representative of a disease of sphincters (a pyloric press and Oddi's sphincter) takes place. It is known also that the increased acidulation of a duodenum promotes a spasm of a sphincter of Oddi, and antacid drugs (antacids, H2-gistaminoblokatory, H+/K inhibitors +-Atfazy) indirectly promote a spasmolysis of a sphincter of Oddi.

In the presence of a spasm of a sphincter of Oddi there is a stagnation of bile in a gall bladder, and through certain time - its dilatation. Appointment and long reception of myogenetic spasmolysants (a papaverine, Nospanum) and non-selective M-cholinolytics (atropine, Platyphyllinum, Methacinum) aggravate hypomotor dyskinesia of a gall bladder. Especially it concerns a round ulcer as still until recently sick with a peptic ulcer received the courses of treatment consisting of myogenetic spasmolysants and non-selective M-cholinolytics. Even more aggravates dilatation of a gall bladder and stagnation of bile in it purpose of N-cholinolytics - ganglioblokator (petrolhexonium, Pyrilenum, Gangleronum) which are practically not applied now. This factor needs to be carried as very positive moment in treatment of patients with a round ulcer.

Patients in the presence of a congestive gall bladder with a spasm of a sphincter of Oddi, have the features of a pathogeny, clinic, diagnosis and treatment in comparison with earlier described dyskinesia forms. They usually complain of weight and nagging pains in right hypochondrium, dryness in a mouth, locks (the sheep chair is more often), instability of mood, irritability, fatigue. The last complaints are especially expressed in the presence of them and at a basic disease.

At survey scalloped language (prints of teeth) is defined that testifies to stagnation of bile in a gall bladder. At a palpation, as usual, sensitivity in Shoffar's zone (a positive symptom of Zakharyin) takes place, sometimes it is possible to propalpirovat the increased gall bladder. By all means there is a positive symptom of Myussi-Georgiyevsky and френикус - on the right. At a palpation spazmirovanny, moderately painful pieces of a large intestine, and hard filling with the fecal mass of a sigmoid gut are defined.

Reasons of Hyper motor dyskinesia of biliary tract:

Hyper motor dyskinesia as local display of the general neurosis, occurs at men and women, is frequent at young age up to 30 — 35 years, very excitable, they quite often show also hyperfunction of a thyroid gland, choleric temperament. Dyskinesia can arise at patients with duodenum pathology (a peptic ulcer, a duodenitis) as process secondary.

Treatment of Hyper motor dyskinesia of biliary tract:

    * At hypertensive type of dyskinesia the patient the condition of psychoemotional comfort, rest is very important. After elimination of a pain syndrome, aggravation signs regime of the patient extends.
    * The dietotherapy has essential value. The general principles of a diet are a diet with frequent receptions of small amounts of food (56 one-time food) with the last meal just before a dream that promotes regular emptying of bilious ways, elimination of stagnation of bile.

At hypertensive type restriction of the products stimulating reductions of a bubble - animal fats, beef-infusion, fish, mushroom broths, eggs is shown.

At this form of functional frustration the drugs relating to group of holespazmolitik give good effect.

The following drugs concern to group of holespazmolitikovkholinolitik:

    * Atropini sulfas, 0,1% solution appoint inside till 5-10 a cap. on reception.
    * Bellalgin (analginum of 0,25 g; anaesthesin of 0,25 g; extract of a belladonna of 0,015 g; Natrii hydrocarbonas of 0,1 g) accept 0,51 table 2-3 of time a day.
    * Besalolum (extract of a belladonna of 0,01 g, salol of 0,3 g) is appointed according to 1 tab. by 2 times a day.
    * Methacinum is applied according to 1 tab. 2-3 of time a day. At gripes the drug is administered subcutaneously or in a muscle on 1 ml of 0,1% of solution.
    * Platyphyllinum is appointed according to 1 tab. (0,005 g) by 2-3 times a day to food within 100 days. At gripes the drug is administered subcutaneously on 1 ml of 2% of solution 1-3 times a day.
    * Euphyllinum (theophylline of 80%; ethylene diamine 20%) according to 1 tab. (0,15 g) of 1 time a day.
    * At hypertensive dysfunction of ZhVP holespazmolitik of a synthetic origin are more often applied.
    * Noshpa (Drotaverinum a hydrochloride) is appointed in tablets on 0,04 g 1-3 times a day within 14 days and more or in ampoules on 2 ml of 2% of solution intramusculary or intravenously 1-2 times a day.
    * The papaverine (a papaverine a hydrochloride) is appointed inside in tablets on 0,04 or 0,01 g 3 times a day or intramusculary (intravenously) on 2 ml of 2% of solution.

Treat the combined holespazmolitika Nicospanum (niacin of 22%; Drotaverinum a hydrochloride of 78%) on 20 mg 1-2 times a day and Papazolum (Dibazolum of 0,03 g; a papaverine a hydrochloride of 0,03 g) according to 1 tab. 2-3 of time a day the Lack of drugs of this group is not selectivity, i.e. they affect all smooth muska to a latur, including urinary tract and blood vessels, and also there is a possibility of development of hypomotor dyskinesia and hypotonia of the sphincteric device GIT.