Biliary Dyskinesia: What It Is, Types, and Signs

Biliary dyskinesia (BD) is a motility disorder of the gallbladder and bile ducts in which bile enters the intestine in an uncoordinated manner. The terms "gallbladder dysfunction" and "biliary dyskinesia" are also used; this refers to a functional disorder, not to inflammation or stones. According to the definition by A. L. Grebenev and A. A. Sheptulin (1997), it is a disorder of the motor and tonic function of the biliary system.

What biliary dyskinesia is

BD is not an independent inflammation and not a diagnosis of "gallstones." It is a disorder of contraction and relaxation of the gallbladder and the sphincters (muscular valves) of the biliary tract. The causes are divided into functional ones, related to regulation by the nervous system, and organic ones, related to damage to the biliary tract itself. Motility disorders of the gallbladder are secondary in nature, so the doctor looks for the underlying gastrointestinal disease. This is how motility disorders of the biliary tract are referred to in conclusions.

How the gallbladder and bile ducts work

The gallbladder is a pear-shaped organ under the liver. It stores bile, which the liver produces to digest fats. During digestion, the gallbladder releases bile through the common bile duct, which connects the gallbladder and liver to the small intestine. Coordination is provided by the sphincters of Oddi, Lutkens, and Mirizzi: they contract and relax in sequence. In dyskinesia, this order is disrupted, and bile may flow out too weakly or too abruptly.

Types of dyskinesia: hypotonic and hypertonic

In the classification of BD, the hypokinetic (hypomotor) and hyperkinetic (hypermotor) variants are distinguished. In hypotonic dyskinesia, contractions are weakened; in hypertonic dyskinesia, they are excessive. Other formulations may also appear in conclusions, for example "gallbladder atony"; their meaning is clarified by the doctor. The type of dyskinesia affects the nature of the pain but does not replace examination.

Causes and risk factors of gallbladder dysfunction

In hypertonic dyskinesia, attacks are more often associated with emotional or physical strain and with eating fatty foods. Correction begins with identifying the cause and eliminating it — treating the underlying gastrointestinal disease.

Symptoms and how the diagnosis is made

The clinical signs of BD are pain in the right hypochondrium and epigastrium, nausea, vomiting, a bitter taste in the mouth, bad breath, signs of cholestasis (impaired bile outflow), liver enlargement, and tenderness on palpation. The doctor checks gallbladder symptoms and the Chauffard-Rivet area. In hypertonic dyskinesia, the pain is paroxysmal, acute, and short-lived; in hypotonic dyskinesia, it is dull, aching, with a feeling of fullness, decreased appetite, and belching.

• pain in the right hypochondrium or epigastrium after eating or exertion;
• radiation of pain upward and to the right shoulder;
• nausea, vomiting, bitter taste in the mouth;
• tenderness on palpation and gallbladder symptoms.

The diagnosis is based on history, examination, laboratory, and instrumental tests. To assess motility, duodenal intubation, EGD with examination of the major duodenal papilla, X-ray cholecystography, ultrasound, and hepatobiliary scintigraphy are used. Blood tests assess biochemical parameters and the lipid profile; laboratory signs are used when inflammation or infection of the biliary tract, gallbladder, pancreas, or liver is suspected.

Possible complications and when to see a doctor

If something blocks the outflow of bile, it is usually a stone; then sudden pain appears in the upper right part of the abdomen, and medical help is needed without delay. Gallstones can cause complications if there is no medical care. For pain in the right hypochondrium, nausea, vomiting, and other listed signs, a doctor's consultation is needed; the doctor decides which examinations are necessary.

Biliary dyskinesia by itself is not a reason to call an ambulance; 103/112 — for sudden pain in the upper right part of the abdomen, if it is caused by blockage of the bile ducts by a stone, and for other life-threatening conditions.

This material is for reference purposes and does not replace a doctor's consultation.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer