How are bile duct dyskinesias treated?

Treatment of biliary dyskinesia in children has one goal - the restoration of functional disorders of the biliary tract.

[1], [2], [3], [4], [5], [6], [7], [8]

Non-drug treatment of biliary dyskinesia in children

With dysfunction with increased sphincter tone, a full-fledged diet with normal protein content is prescribed, the maximum restriction of fats (primarily refractory - lamb, goose, internal) and foods that enhance fermentation and putrefaction in the intestine (whole fresh milk, buttery dough, canned food, etc.). .). Foods with a high content of vitamins A, C, Group B, as well as vegetable fiber and liquid are needed, which contributes to the outflow of bile and the emptying of the intestine. Food should be taken in small portions 5-6 times a day.

Exclude meat, mushroom and fish broths, green cabbage soup, fatty meat and fish varieties, animal fats, fried foods, including pancakes and pancakes, freshly baked bread, dough and puff pastry, egg yolks. Canned food, sausages, smoked products, mustard, pepper, horseradish, acetic essence of any concentration, onion, garlic, sorrel, radish, peas, mushrooms, cocoa, chocolate, ice cream, sour fruits and berries.

Recommend gray, coarse, rye dried bread, not butter, sugar cookies. Soups should be prepared on a vegetable broth, any vegetables, cereals, pasta, fruit soups are allowed. Low-fat varieties of meat and poultry are desirable in boiled form, baked with pre-boiling, stewed with the removal of juice, low-fat varieties of fish (cod, pike perch, navaga, pike, etc.) in boiled or baked form. Protein omelets can be cooked 1 time per week from 1 egg. Showed sour cream in dishes, cottage cheese degreased in natural or baked form, cheeses up to 30% fat, sour-milk one-day low-fat products (kefir, curdled milk, etc.). Vegetables are allowed in raw, boiled, baked form; onion before adding to the dishes should be boiled. Fruits are permissible all. Except for sour. Of drinks recommended broth of dogrose, non-acidic juices. Diluted in half with water, tea with milk or lemon, coffee with milk. Compotes of dried fruits. You can not eat very cold and very hot food.

When hypomotor disorders in the diet of a child, vegetables and fruits rich in dietary fiber (dried apricots, strawberry, raspberries, oatmeal, dried rosehips, etc.), which reduce the content of cholesterol and triglycerides, and the bile lithogenicity are necessary. Showing wheat bran, rich in magnesium salts, as well as buckwheat, oatmeal and sea kale. The American Association of Dieticians recommends calculating the intake of dietary fiber by adding the number 5 to the age of the child. For example, a child aged 4 years should receive 9 g of dietary fiber, and at 17 years - 22 g.

Diet should be enriched with vegetable refined oils, added to ready meals after the end of cooking. Use corn, olive, linseed, soy, peanut butter. A good choleretic effect is provided by protein lipotropic products (cottage cheese, fish, egg whites, lean meat).

Food is served in boiled or baked form, grinding is not necessary. The temperature of ready meals is normal, the number of meals is 5-6 times a day.

Drug treatment of biliary dyskinesia in children

The main drugs for stopping and preventing attacks of acute pain in the abdomen with dysfunction of the biliary tract are considered antispasmodics. It is advisable to use drugs with a rapid achievement of the maximum concentration in the serum, for example, high-speed nitrates under the tongue, holinoblokatorov and inhibitors of phosphodiesterase I type for parenteral administration.

High-speed nitrates (nitroglycerin) are most effective for stopping severe bouts of pain. The drug is given under the tongue in a dose of 2.5-5 mg at the age of 7-12 years; 5-10 mg once a day for a child over 12 years old. Platifillin is administered orally or subcutaneously 1 mg at the age of 5 years; 2 mg at 10 years; 3-4 mg child over 12 years. Hyoscine butyl bromide is administered intramuscularly or intravenously for 10-20 mg for children over 12 years of age. Myotropic antispasmodics (drotaverin) appoint intramuscularly for 0.5 ml of a 2% solution 2-3 times a day at 5 years; 1 ml - the child is 10 years old; 1,5-2 ml - from 15 years. Spazmolitiki vegetable origin (a chololag of 5-20 drops on sugar or hofitol 1 tablet inside) are shown with an attack of hypertensive dyskinesia.

In severe, long-term non-redundant pains, the treatment of biliary dyskinesia is based on the use of narcotic analgesics, such as promedol, intramuscularly 0.25 ml of a 1% solution at the age of 5 years; 0,5 ml - in 10 years; 0,75-1,0 ml for the child 15 years 1-2 times a day. It is necessary to avoid the use of codeine and morphine-like drugs.

To prevent the development of seizures, one of the inhibitors of phosphodiesterase type IV, blockers of sodium and calcium channels is administered inside the courses for 1-2 months:

• drotaverin inside by 0.01 mg (child 5 years) 3-4 times a day; 0.02 mg (10 years) 3-4 times a day or 0.03-0.04 mg (15 years) 3-4 times a day;
• papaverine inside or rectally at 5 mg (child from 6 months to 2 years); 5-10 mg (3-4 years); 10 mg (5-6 years); 10-15 mg (7-9 years) 15-20 mg (10-14 years) 3-4 times a day;
• otilony bromide inside 1/2 tablet of 40 mg (child 5 years) or 1 tablet (10 years and older) 2-3 times a day;
• Mebeverin inside by 50 mg (from 6 years); 100 mg (9-10 years), 150 mg (over 10 years) for 20 minutes before meals 2 times a day;
• Gimecromone for children over 12 years old inside 200-400 mg 3 times a day.

The action of gimecromone resembles the biological effects of cholecystokinin.

The drug has an selective spasmolytic effect on the sphincter of Oddi and the sphincter of the gallbladder, provides an outflow of bile into the duodenum, lowers the pressure in the biliary system, practically does not affect the smooth myocytes of other localization. Drugs that eliminate hypertension of the gallbladder:

• platifillin inside by 0,001 g (5 years), 0,002 g (10 years), 0,003 g (15 years) 2-3 times a day before meals;
• gimecromone for 0.1 g - 1/2 tablet (5-10 years), 0.2 g - 1 tablet (15 years) 3 times a day for 30 minutes before meals for 2 weeks.

To stimulate bile formation, true choleretics are used, in particular, drugs containing bile or bile acids:

• holenchium inside 1/2 tablet (child 5-10 years) or 1 tablet (15 years) after eating 3 times a day for 2 weeks;
• Allochol - for children under 7 years of age, 1 tablet, over 7 years - 2 tablets 3 times a day for 3-4 weeks. Synthetic medicines:
• tsikvalon inside 1/2 tablet (child 5-10 years) or 1 tablet (15 years) after eating for 2 weeks;
• oxaphenamide inside 1/2 tablet (child 5-10 years) or 1 tablet (15 years) before meals 3 times a day for 2 weeks.

Cholagogue preparations of plant origin are widely used:

• flaminum inside 1/2 tablet (child 5-10 years) or 1 tablet (15 years) 30 minutes before meals for 2 weeks;
• gepabene inside 1 capsule 3 times a day during meals for 2 weeks;
• hofitol inside 1 tablet (child 5-10 years) or 2 tablets (15 years) 3 times a day before meals for 2 weeks;
• olimethine for 1-2 capsules 3 times a day before meals for 3 weeks.

To increase the secretion of bile and reduce its viscosity, as well as stimulation of blood and lymph circulation in the liver, mineral water of medium mineralization is prescribed ("Essentuki No. 4" inside 3 ml / kg 30 minutes before meals for 1 month) or hydrocholeretics:

• magnesium sulfate 20% solution, 1/2 tablespoon 2-3 times a day;
• xylitol 5 g 2 times a day after meals for 2 weeks;
• sorbitol 2.5 g (child 5-10 years); 5 g (15 years) 2 times a day for 30 minutes before meals for 2 weeks.

[9], [10], [11], [12], [13], [14]

Physiotherapy

When hyperkinetic form of dyskinesia of the gallbladder is prescribed electrophoresis with procaine, paraffin applications, radon and coniferous baths. With hypokinetic disturbances, electrophoresis with magnesium sulfate, faradization, galvanization, Bernard's diadynamic currents, neck-collar region massage, mud applications on the right hypochondrium area is shown.

Sanatorium and resort treatment of biliary dyskinesia in children

Sanatorium treatment is widely used for cholepaties in children. Apply mineral water treatment (balneotherapy-krenoterapiya, hydrotherapy, hydrotherapy in the form of showers, baths, etc.).

Indications: cholangitis, cholecystitis without exacerbation; dyskinesia of bile ducts.

Contraindications:

• cholelithiasis in the presence of frequent and prolonged severe attacks with violation of bile outflow and signs of active infection;
• liver failure;
• fever;
• exacerbation of the inflammatory process in the stomach or intestine;
• chronic renal failure;
• a serious condition of the child.

When assigning mineral water, it is necessary to pay attention to the following factors: general mineralization of water (the sum of all substances dissolved in water should be not less than 2 g / l), the ionic composition of water (hydrocarbonate, chloride, sulfate, sodium, calcium, magnesium, combined water) , the content of biologically active components (iron, cobalt, copper, manganese, iodine, bromine, fluorine, silicon). The most commonly used for therapeutic purposes are hydrocarbonate, hydrocarbonate chloride, hydrocarbonate-sulfate waters of small (2-5 g / l) or medium (5-15 g / l) mineralization (Borjomi, Essentuki 4 and 17, Arzni, Jermuk , Slavyanovskaya, Smirnovskaya and others). Depending on the degree of mineralization, water can be hypo-, iso-and hypertonic. Hypo- and isotonic waters have a diuretic effect; hypertensive poorly absorbed and exert laxative effect. The nature of the mineral water depends on the pH (alkaline water pH above 8.5, acid - 5.5, neutral - 6.8-7.2). Mineral water, taken in a warm form, has a secretion-stimulating effect. Cold water stimulates the motor function of the stomach, quickly evacuated, poorly absorbed, having a laxative effect. Cholicheskretornoe action has a small mineral water, choleretic - water high mineralization. The combination of sulfate and magnesium in water increases the ejection of bile from the bladder, while relaxing the sphincter of Oddi. When you take mineral water inside the gallbladder shrinks, the peristalsis of the bile ducts increases, which facilitates the emptying of the gallbladder, reducing stagnation of bile and the tendency to form stones. Hydrocarbonate water reduces the viscosity of bile and inflammation in the gallbladder. Mineral water is dosed from the calculation of 3-5 ml / kg per reception or as follows:

• children aged 6-8 years - 50-100 ml;
• at the age of 9-14 years - 120-150 ml;
• over 12 years - 150-200 ml per reception.

Usually, water intake is prescribed 3 times a day. In the first 5-6 days, in order to avoid a sharp choleretic effect, water is used in a half dose. It is taken in a warmed up to 36-42 ° C in the form 1 h before meals for 4-6 months. Mineral water can be used for tjubazha in order to improve the outflow of bile.

Radon baths in children do not use.

Complications and side effects in the treatment of biliary dyskinesia

Some medicines may have undesirable effects or cause side effects.

• Cholenzyme is contraindicated in patients with increased sensitivity to proteins of cow's milk.
• Oxaphenamid is not used in dystrophic processes in the liver.
• Hepabene has a relaxing effect.
• Platyphylline is not prescribed for violations of kidney function.
• Papaverin is contraindicated in cases of violations of atrioventricular conduction.
• Gimecromone is not used for peptic ulcer and hemolytic anemia.

[15]

Dispensary supervision

The duration of dispensary observation is at least 2 years. The courses of cholagogue therapy are shown 2 times a year, balneotherapy, sanitation in specialized sanatoriums, control ultrasound of the bile ducts once a year.

[16]

What prognosis are biliary dyskinesia?

With a properly specified form of dysfunction, the prognosis is favorable. Adequate treatment of biliary dyskinesia leads to a complete normalization of the existing disorders.