Physiotherapy for gallbladder and biliary dyskinesias

Dyskinesia of the gallbladder and biliary tract is a pathological condition manifested by a violation of the tone and motor-evacuation function of the gallbladder and bile ducts, caused by inflammatory-dystrophic diseases of the hepatobiliary and duodenopancreatic zones, dysfunction of the autonomic nervous system, and developmental anomalies of the gallbladder.

The complex of therapeutic measures, including the use of the effects of therapeutic physical factors, in patients with this pathology includes methods that promote either stimulation of the tone of the gallbladder and bile ducts (in the hypotonic-hypokinetic form) or relaxation of their hypertonicity (in the hypertonic-hyperkinetic form).

In case of reduced motor-evacuation function of the gallbladder and bile ducts, the following physiotherapy methods are indicated:

• electrophoresis of drugs that stimulate the smooth muscles of the biliary tract (pilocarpine, carbachol);
• diadynamic therapy of the gallbladder area with “syncope rhythm” current;
• amplipulse therapy (SMT therapy) of the same area;
• interference therapy using the transverse method (epigastric region - back);
• high-intensity pulsed magnetic therapy of the gallbladder area.

In case of increased motor-evacuation function of the gallbladder and bile ducts, relaxing methods of physiotherapy are indicated:

• electrophoresis of papaverine, platifillin;
• UHF therapy of the right hypochondrium;
• paraffin applications to the abdominal area;
• pine baths.

In case of hypertonicity of the gallbladder and bile ducts, laser (magnetolaser) therapy of the right hypochondrium area using infrared emitters according to the method described below is indicated and is very effective.

Information-wave impact using the Chrono-DMW device is also shown using the following method. The emitter is placed in contact, stably on the projection area of the gallbladder in the right hypochondrium. The radiation generation frequency is 10 Hz, the exposure time is 20 minutes, the course of treatment is 10-15 daily procedures once a day in the morning.

A general practitioner (family doctor) quite often has to treat patients with this pathology in outpatient and home conditions. The following procedures, which are used by physiotherapy, are the most practical and at the same time quite effective for the hypotonic-hypokinetic form of dyskinesia.

1. Electrophoresis using the Elfor-I device (El for™) of 0.1-0.5% pilocarpine hydrochloride solution from the positive electrode in the right hypochondrium. The negative electrode is placed on the back in the lower thoracic spine (ThVl, - ThlX). The electrode size is 15x20 cm. Current strength is 5 mA, duration of exposure is 10-15 min, once a day in the morning (before 12 noon, but 2 hours after breakfast). The course of treatment is 10 procedures daily.
2. Electroneurostimulating therapy using the DiaDENS-T device. The method is contact, stable, impact on the bare skin surface with one field on the area of the right hypochondrium. The mode is constant at a frequency of electrical impulses of 77 Hz. The voltage of the electric current is strictly individual (according to subjective sensations in the form of a slight "tingling" under the electrode). The exposure time is 10 minutes, 1 time per day (in the morning on an empty stomach). The course of treatment is 10 procedures daily.

For the hypertonic-hyperkinetic form of dyskinesia, the following physiotherapeutic interventions are recommended.

1. Electrophoresis using the Elfor-I (El-for™) device of 0.5% papaverine hydrochloride solution or 1-2% no-shpa solution with a positive electrode (+) in the right hypochondrium. The procedure technique is similar to that for the hypotonic-hypokinetic form of biliary dyskinesia.
2. Magnetic therapy using the device "Pole-2D". The method of action is contact, stable, action with one field on the area of the right hypochondrium. The duration of the procedure is 20 minutes, 1 time per day (in the morning on an empty stomach), the course of treatment is 10 daily procedures.
3. Laser (magnetolaser) therapy. Uses the effect of infrared emitters (wavelength 0.8 - 0.9 µm) by contact and stable method on the exposed skin of the patient's body.

Fields of influence: I - the outer edge of the right rectus abdominis muscle 3 cm below the edge of the right costal arch; II - 1/3 of the distance from the middle of the right costal arch to the navel; III - the middle of the right hypochondrium.

PPM 10 - 50 mW/cm2 ^. Magnetic nozzle induction 20 - 40 mT. Optimum radiation modulation frequency is 10 Hz, however, the use of ILI in continuous radiation generation mode is also effective. Exposure time per field is 5 min, once a day (in the morning on an empty stomach). The course of treatment is 10 procedures daily.

Regardless of the form of dyskinesia of the gallbladder and bile ducts, to normalize the patient's psychoemotional status, it is advisable to carry out information-wave exposure using the Azor-IK device using a method that we have successfully tested:

• in the morning after waking up - exposure to two fields on the frontal lobes (EMF modulation frequency 21 Hz, 15 minutes per field);
• before going to bed at night - exposure to two fields on the frontal lobes (EMF modulation frequency 2 Hz, 20 minutes per field).

The duration of the treatment course is 10 procedures daily.

It is possible to perform sequential procedures for dyskinesia of the gallbladder and biliary tract on the same day in outpatient and home settings:

• electrophoresis of drugs in the epigastric region + information-wave impact on the frontal lobes of the brain 2 times a day (in the morning - 21 Hz, in the evening - 2 Hz) using the Azor-IK device;
• electroneurostimulating therapy using the DiaDENS-T device + information-wave impact on the frontal lobes of the brain 2 times a day (in the morning - 21 Hz, in the evening - 2 Hz) using the Azor-IK device;
• laser (magnetic laser) therapy + information-wave impact on the frontal lobes of the brain 2 times a day (in the morning - 21 Hz, in the evening - 2 Hz) using the Azor-IK device;
• magnetic therapy (PMT) of the collar area + information-wave impact on the frontal lobes 2 times a day (in the morning - 21 Hz, in the evening - 2 Hz) using the Azor-IK device.

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