Symptoms of biliary dyskinesia

Symptoms of biliary dyskinesia in children largely determine the clinical manifestations of many pathological processes, including anomalies and inflammatory cholepaties. The range of symptoms varies from complete absence to a vivid clinical picture, which causes anxiety to the patient.

The main symptoms are:

• abdominal pain (blunt or acute) in the right hypochondrium, in the epigastric region;
• pain after eating and after a load, characterized by irradiation up, in the right shoulder;
• bitter taste in the mouth, nausea, vomiting;
• signs of cholestasis;
• enlargement of the liver;
• soreness in palpation;
• Bubbling symptoms are a symptom of Ortner, a symptom of Murphy, a symptom of Boas.

The nature of the symptoms depends on the form of dyskinesia.

Dependence of symptoms on the form of biliary dyskinesia

Characteristics of clinical symptoms	Hypertensive form of DZHVP	Hypotonic form of DZHVP
The nature of pain	Paroxysmal (cramping, pricking, cutting)	Aching
Duration of pain	Short-term (5-15 min)	Prolonged
The provoking factors	Negative emotions, physical activity	Disorders of the age-related diet, diet
Other symptoms	Soreness in palpation in the right hypochondrium	Soreness and a feeling of heaviness in the right hypochondrium
Bubble symptoms	Positive	Positive

Blunt pain after eating is more typical for hypokinetic and hypotonic disorders, severe pain after exercise (physical or emotional) indicates hyperkinetic disorders. Nausea is observed relatively often, but the development of vomiting indicates the severity of the process. Bitterness in the mouth is a reflection of motor disorders in the upper parts of the digestive tract as a whole. Symptoms of cholestasis, depending on the nature of the underlying pathological process, may be absent or be expressed in varying degrees.

The course of dyskinesia of the bile ducts in children is distinguished by a certain polymorphism, especially when the changes in the bile ducts and the dystonia of the sphincter of Oddi are combined. When examining the patient, pain is revealed at the projection point of the gallbladder - the point of intersection of the outer edge of the rectus rectus muscle on the right with a rib arc (with the increase in the liver - with the edge of the liver).

• Kerr's symptom is soreness upon palpation on inspiration at the projection point of the gallbladder.
• A symptom of Murphy is the intensification of pain in the region of the right hypochondrium with pressure on the anterior abdominal wall in the projection of the gallbladder during a deep inhalation with a retracted abdomen (the patient interrupts the breath due to pain intensification).
• Symptom Ortner-Grekova - soreness at pokolachivanii on the edge of the right rib arc (for comparison, they make effleurage on both ribs).
• Symptom Georgievskogo-Mussi (frenikus-symptom) - tenderness when palpation between the legs of the sternocleidomastoid muscle on the right; The pain radiates downward.
• Symptom Ryshman - pokolachivanie edge of the palm along the edge of the edge arch with a delay in inspiration.
• The symptom of Boas is soreness when pressing a finger to the right of VIII-X thoracic vertebrae and hyperesthesia in the lumbar region to the right.
• Symptom Lepene - painfulness when tapping with a bent forefinger at the point of projection of the gallbladder.
• Zakharyin's symptom is soreness at the point of intersection of the right rectus abdominis muscle with a rib arc.

In addition, tenderness is observed during palpation in the epigastric region and in the Shoffar-Riva zone (the choledochocampiatic triangle, the choledocho- pancreatic zone, the pyloroduodenal region) - the zone between the median line and the upper right bisector is slightly higher than the navel.

Dyspeptic phenomena are associated with several factors:

• violation of bile in the duodenum;
• violation of digestion of fats (with diarrhea, constipation, flatulence, rumbling in the abdomen);
• duodeno gastric and gastroesophageal reflux (bitterness in the mouth, heartburn, vomiting bilious, belching bitter);
• pathological viscero-visceral reflexes from the gallbladder to the stomach and intestines, causing atony of the stomach and intestines (burping of food, constipation, flatulence).

Diarrheal syndrome is observed more often with hypokinetic dyskinesia of the biliary tract, with sphincter dysfunction of Oddi. It is caused by the late release of bile in the inter-digestive period. Obstipation syndrome (constipation) often occurs with cholestatic processes, as a result of visceral-visceral reflexes that cause atony of the intestine in the expressed painful syndrome of a spastic character and hypermotor DZHVP. Flatulence often accompanies violations of motor and evacuation function of the small and large intestine with dyskinesia of bile ducts of an organic and functional nature. It occurs as a result of enzymatic cleavage of the chyme with the formation of gas when the small intestine is colonized by bacteria due to the loss of bactericidal properties of bile in hypokinetic DZHVP.

[1], [2]