What is Biliary Dyskinesia?

Biliary dyskinesia is a functional disease described as abnormal motion of the bile ducts or the inability of the gallbladder to contract and release bile. The disorder involves the sphincter of Oddi associated with biliary colic. It is a common disease of the gallbladder and normally occurs without the growth and development of gallstones. It is characterized by abdominal pain located in the right upper quadrant. Increased pressure build up is attributed to its typical gallbladder symptoms. The disorder is much more common in women than in men.

Gallbladder functions by storing the bile released by the liver. The bile passes through the common bile duct to reach the small intestine. Biliary dyskinesia happens when the gallbladder cannot flow through the common bile duct and thus returning to the gallbladder.

Bile is vital to digestive process where it act to emulsify the fats and provides normal absorption of fat soluble vitamins. Bile is described as bitter tasting fluid with dark green to yellowish color. It is produced by the liver in most of the vertebrates and aids in proper digestion. Bile contains cholesterol, bile acid and bilirubin.

Biliary dyskinesia can be classified as acute, which suddenly occur and often as one time occurrence only and often happen as secondary complication of other illness. Another classification of biliary dyskinesia is chronic in which arises from dysfunctional muscle resulting to inability of the gallbladder to contract and release bile.

There are two types of biliary dyskinesia defined as hyperkinetic or spastic characterized by intense spasm or sometimes with jaundice and itchiness. The second type is hypokinetic or atonic defines spasm as seldom in occurrence with pain in the right hypochondrium associated with feeling of arching after eating or exercise.

Picture : Biliary system showing – Gall bladder, Common bile duct, duodenum, Cystic duct, Pancreatic duct and Common Hepatic duct

Image  source : trialx.com

Biliary Dyskinesia Symptoms

Increased pressure build up results to typical gallbladder symptoms. The abdominal pain is localized in the upper right quadrant which may radiate to the upper back or shoulder blades. Biliary dyskinesia however, is more of a symptom than a disease itself.

Other symptoms include:

• Abdominal discomfort after eating fried food and fat rich food
• Belching due to fats inappropriately digested
• Nausea
• Vomiting of bile
• Bloating
• Indigestion
• Loose stool
• Pain in the right hypochondrium accompanied by a feeling of heaviness in the liver
• Flatulence
• Diarrhea or constipation

Biliary Dyskinesia Causes

There are multiple causes of Biliary Dyskinesia and these may include:

1. Excessive consumption of fat rich food and fried food
2. Stress which can contribute to gallbladder function impairment
3. Chronic inflammation of the gallbladder
4. Overweight women of older age are more prone to biliary dyskinesia
5. Decreased released of cholecystokinin
6. Systemic disorder such as diabetes mellitus, celiac disease and cystic fibrosis
7. Increased level in the resistance of sphincter of Oddi
8. Excessive consumption of refined foods
9. Excessive consumption of antacids and anti-depressant medicines
10. Chronic inflammatory bowel disease
11. Hormonal imbalance
12. Aging process
13. Alcohol abuse
14. Obesity
15. Thyroid disease
16. Low level of stomach acid

Biliary Dyskinesia Diagnosis

Diagnosing biliary dyskinesia is carefully done to rule out gallstones, pancreatitis and cancer. After ruling out certain conditions that have common symptoms with biliary dyskinesia doctors may require the following diagnostic procedure to confirm presence of biliary dyskinesia and these are:

CCK-HIDA or Cholecystokinin Dimethyl Iminodiacetic Acid Scan

Low strength radioactive substances is mixed with the blood sample of the patient which is then infuse back to the patient to facilitate clear image of functionality of the gallbladder where a camera captures the images of gallbladder activity emptying into the duodenum.

Abdominal Ultrasound

Routine abdominal ultrasound is done to rule out gallstones and other stomach disorder that have exact symptoms with biliary dyskinesia.

Endoscopic Ultrasound

Suspected bile duct stones cannot be seen with a regular ultrasound that endoscopic ultrasound may be requested especially when there is a suspicion of bile duct stones development.

Computed Tomography Scan or CT Scan

Doctors may request additional imaging technique when there is a suspicion of complications such as perforation and other problems such as cancer in the pancreas or gallbladder.

Laboratory Test

Laboratory test is done to determine elevation in levels of bilirubin and enzyme alkaline phosphatase.

Biliary Dyskinesia Diet

Patient suffering from biliary dyskinesia is usually given a low fat diet to help limit gallbladder contraction and alleviate pain. Diet may include:

1. Skim milk is recommended instead of dairy products which are rich in protein and fat. Non-fat yogurt and cheese of less than 3grams per serving are also recommended.
2. Lean meat such as skinless poultry, fish, egg whites and tofu are best for low-fat diet and should consider an intake of 6 ounces a day.
3. Grains are naturally low in fat and are good source of carbohydrate. Four or more servings a day is recommended for patient with biliray dyskinesia.
4. Fruits and vegetables should be considered in the diet with at least five servings a day.

Biliary Dyskinesia Treatment

Treatment of biliary dyskinesia needs careful evaluation to rule out other complications. The condition of the gallbladder should be toned first by regulating bile secretion of the hepatic tissue.

A surgical procedure called Laparoscopic cholecystectomy is the usual treatment for biliary dyskinesia. The procedure involves complete removal of the gallbladder. It has been the recommended treatment for biliary dyskinesia although the symptoms may still persists after cholecystectomy. Medical follow ups with the doctor is required to properly guide and prescribed patient of medical regimen to completely recover from biliary dyskinesia.

Also Read:

• Steatorrhea
• Excessive Belching (Burping) and Bloating

by Dr. Chinchu on 14. Feb, 2012 in Diseases and Conditions