Summary about Disease
Biliary dyskinesia is a motility disorder of the gallbladder. It means the gallbladder doesn't squeeze (contract) properly to release bile, even when stimulated to do so by eating. This impaired gallbladder function can lead to abdominal pain and other digestive symptoms. The gallbladder itself is typically structurally normal.
Symptoms
The primary symptom is biliary-type pain, which is often described as:
Severe, steady pain in the upper right abdomen.
Pain that may radiate to the back or right shoulder.
Pain that can last for 30 minutes to several hours.
Nausea and vomiting may occur.
Bloating and indigestion.
Pain that occurs after eating, especially fatty foods.
Causes
The exact cause of biliary dyskinesia is not always clear. However, some potential contributing factors include:
Abnormal gallbladder motility: The muscles in the gallbladder wall may not contract effectively.
Sphincter of Oddi dysfunction: Problems with the valve that controls the flow of bile and pancreatic juices into the small intestine.
Hormonal influences: Hormones can affect gallbladder function.
Nerve problems: Issues with the nerves that control gallbladder contractions.
Inflammation: Chronic low-grade inflammation.
Medicine Used
Ursodeoxycholic acid (UDCA): In some cases, used to improve bile flow.
Antispasmodics: Medications like hyoscyamine or dicyclomine may be prescribed to reduce spasms and pain.
Pain relievers: Over-the-counter or prescription pain medications may be used to manage pain episodes.
Anti-nausea medications: To alleviate nausea and vomiting.
Surgical removal of the gallbladder (cholecystectomy): This is often the most effective treatment for biliary dyskinesia, especially if other treatments are unsuccessful.
Is Communicable
No, biliary dyskinesia is not a communicable disease. It is not caused by an infection and cannot be spread from person to person.
Precautions
Dietary modifications: Avoid high-fat foods, processed foods, and other foods that trigger symptoms.
Eat smaller, more frequent meals: This can reduce the workload on the gallbladder.
Stay hydrated: Drink plenty of water.
Manage stress: Stress can sometimes exacerbate digestive problems.
Follow your doctor's recommendations: Adhere to any prescribed medications or lifestyle changes.
How long does an outbreak last?
Outbreak" isn't the correct term since this is not an infectious disease. Episodes of pain can last from 30 minutes to several hours. The frequency and severity of episodes vary from person to person. Without treatment (typically cholecystectomy), symptoms can be chronic and recurrent.
How is it diagnosed?
Medical history and physical exam: The doctor will ask about your symptoms and perform a physical exam.
Blood tests: To rule out other conditions, such as liver or pancreatic problems.
Abdominal ultrasound: To visualize the gallbladder and rule out gallstones or other structural abnormalities.
Hepatobiliary Iminodiacetic Acid (HIDA) scan (Gallbladder Scan): This is the most important test. It measures the gallbladder's ejection fraction (EF). A low EF (typically below 35-40%) suggests biliary dyskinesia. The HIDA scan involves injecting a radioactive tracer and monitoring how the gallbladder fills and empties. Stimulation with sincalide (Kinevac) or a fatty meal is often used to assess gallbladder contraction.
Timeline of Symptoms
The onset and progression of symptoms can vary. A typical timeline might look like this:
Initial Phase: Intermittent episodes of upper right abdominal pain after eating, especially fatty foods. The pain may be mild at first.
Progression: The frequency and intensity of pain episodes increase. Nausea, vomiting, and indigestion may become more common.
Chronic Phase: Pain becomes more persistent and may be less clearly related to meals. Quality of life is significantly affected.
Important Considerations
Differential Diagnosis: It's important to rule out other conditions that can cause similar symptoms, such as gallstones, peptic ulcer disease, irritable bowel syndrome (IBS), and sphincter of Oddi dysfunction.
Ejection Fraction Cutoffs: The definition of a "normal" ejection fraction (EF) on HIDA scan varies slightly between institutions, and there is some debate about the optimal cutoff. Symptom correlation is essential. A low EF alone does not always mean surgery is necessary.
Psychological Factors: Chronic pain conditions can be associated with anxiety and depression. Addressing these factors can be an important part of management.
Second Opinions: Consider seeking a second opinion from a gastroenterologist or surgeon specializing in biliary disorders, especially if the diagnosis is uncertain or if surgery is being considered.