Symptoms of biliary dyskinesias

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

Main symptoms:

• abdominal pain (dull or sharp) in the right hypochondrium, in the epigastric region;
• pain after eating and after exercise, typically radiating upward to the right shoulder;
• bitterness in the mouth, nausea, vomiting;
• signs of cholestasis;
• enlarged liver;
• pain on palpation;
• vesicular symptoms - Ortner's symptom, Murphy's symptom, Boas' symptom.

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 biliary dyskinesia	Hypotonic form of biliary dyskinesia
Nature of pain	Paroxysmal (cramping, stabbing, cutting)	Aching
Duration of pain	Short-term (5-15 min)	Long lasting
Provoking factors	Negative emotions, physical activity	Violations of age-related diet, nutrition regimen
Other symptoms	Pain on palpation in the right hypochondrium	Pain and heaviness in the right hypochondrium
Blistering symptoms	Positive	Positive

Dull pain after eating is more typical for hypokinetic and hypotonic disorders, severe pain after exertion (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 the motor disorder of the upper digestive tract as a whole. Signs of cholestasis, depending on the nature of the underlying pathological process, may be absent or expressed to varying degrees.

The course of biliary dyskinesia in children is characterized by a certain polymorphism, especially with a combination of changes in the bile ducts and dystonia of the sphincter of Oddi. When examining the patient, pain is detected at the projection point of the gallbladder - the point of intersection of the outer edge of the rectus abdominis muscle on the right with the costal arch (with an enlarged liver - with the edge of the liver).

• Kerr's symptom - pain on palpation during inhalation at the projection point of the gallbladder.
• Murphy's symptom - increased pain in the right hypochondrium when pressing on the anterior abdominal wall in the projection of the gallbladder during a deep breath with the abdomen drawn in (the patient interrupts the breath due to increased pain).
• Ortner-Grekov's symptom - pain when tapping along the edge of the right costal arch (for comparison, tapping is performed on both costal arches).
• Georgievsky-Mussi symptom (phrenicus symptom) - pain on palpation between the legs of the sternocleidomastoid muscle on the right; pain radiates downwards.
• Riesman's symptom - tapping the edge of the costal arch with the edge of the palm while holding the breath.
• Boas' symptom - pain when pressing with a finger to the right of the VIII-X thoracic vertebrae and hyperesthesia in the lumbar region on the right.
• Lepene's symptom - pain when tapping with a bent index finger at the projection point of the gallbladder.
• Zakharyin's symptom - pain at the point of intersection of the right rectus abdominis muscle with the costal arch.

In addition, pain is observed upon palpation in the epigastric region and in the Chauffard-Rivet zone (choledochopancreatic triangle, choledochopancreatic zone, pyloroduodenal region) - the zone between the midline and the right upper bisector slightly above the navel.

Dyspeptic phenomena are associated with several factors:

• obstruction of bile flow into the duodenum;
• impaired digestion of fats (this causes diarrhea, constipation, flatulence, and rumbling in the stomach);
• duodenal gastric and gastroesophageal reflux (feeling of bitterness in the mouth, heartburn, vomiting of bile, belching of bitterness);
• pathological viscero-visceral reflexes from the gallbladder to the stomach and intestines, causing atony of the stomach and intestines (belching of food, constipation, flatulence).

Diarrhea syndrome is more often observed with hypokinetic dyskinesia of the biliary tract, with dysfunction of the sphincter of Oddi. It is caused by untimely secretion of bile in the interdigestive period. Obstipation syndrome (constipation) often occurs with cholestatic processes, as a result of viscero-visceral reflexes causing intestinal atony with severe pain syndrome of a spastic nature and hypermotor biliary dyskinesia. Flatulence often accompanies disorders of the motor-evacuation function of the small and large intestines with dyskinesia of the biliary tract of an organic and functional nature. It occurs as a result of enzymatic breakdown of chyme with the formation of gas when the small intestine is populated by bacteria due to the loss of bactericidal properties of bile with hypokinetic biliary dyskinesia.

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