What causes biliary dyskinesia?

The main cause of dyskinesia of the bile ducts in children is a violation of the interaction of the nervous and paracrine systems that ensure the sequence of contractions and relaxation of the gallbladder and the sphincter system, leading to discoordination of their activity and disruption of the bile passage into the intestine. DZHVP - functional diseases, as in the bile excretory system there are no organic changes and signs of the inflammatory process. The main causes of biliary dyskinesia:

• anatomical features that disrupt emptying (kinks and deformations of the gallbladder, anomalies in the structure of the biliary tract);
• functional disorders of the muscular apparatus, especially the sphincter;
• dyscholia (cytogenic, hepatogenic) - change in the composition of bile.

Bile is a complex colloidal system. Its main components (60% of organic matter) are bile acids: 35% is chenodeoxycholic acid, 35% is cholic acid, 25% is deoxycholic acid. The bile contains also phospholipids (25% of the organic substances of bile), proteins (5%), bilirubin (5%) and cholesterol. Entering the gastrointestinal tract, bile performs numerous digestive functions: emulsification of fats, activation of pancreatic enzymes, ensuring optimal pH in the duodenum, ensuring the absorption of lipids in the small intestine, stimulating intestinal motility, increasing absorption of fat-soluble vitamins, suppressing the activity of putrefactive microflora in the large intestine . Bile secretion is an important link in the elimination of many xenobiotics, in the regulation of the exchange of cholesterol and other metabolic processes in the human body. Bile secretion occurs both under the influence of food, and in the inter-digestive period. In the process of digestion, secretion of bile and motility of the bile ducts increases, the gallbladder contraction and coordinated relaxation and reduction of sphincters occur.

Some exogenous and endogenous factors cause disturbance of motility of the biliary tract. The emergence of dyskinesias is associated with the transferred infectious diseases - epidemic hepatitis, dysentery, salmonellosis. Particular importance is given to giardiasis of the intestine, various disorders in the diet. A certain role in the emergence and development of DZHVP belongs to the centers of chronic infection (chronic tonsillitis, sinusitis, etc.). Dependence of the pathology of the bile ducts on various neurotic conditions is traced. The causes of dyskinesia may be allergic reactions, intestinal biocenosis disorders, insufficient physical activity.

Close interrelation between the biliary system, stomach, duodenum and pancreas is carried out by neurohumoral factors - primarily intestinal peptide hormones. Cholecystokinin-pancreosimin reduces the gallbladder, contributing to the bile in the duodenum. Gastrin, secretin, glucagon have somewhat less stimulating effect. Enkephalins, angiotensins, neurotensin, vasoactive neurohumoral peptide inhibit the motility of the gallbladder. Violation of the production of peptide hormones and disorders of their interrelations lead to changes in the contractile function of both the gallbladder and other parts of the bile excretory system and pancreatic ducts. This causes an increase in pressure in the gallbladder and hypertension of the sphincter apparatus, contributing to the emergence of a pain syndrome of a different nature.

The following factors influence the allocation of bile from the gallbladder:

• pressure gradient in the duodenum;
• neurohumoral factors (cholecystokinin, gastrin, secretin);
• central nervous system (conditioned reflexes to the form of food);
• the autonomic nervous system (sympathetic, parasympathetic);
• endocrine glands (pancreas, thyroid, pituitary gland).

Classification of biliary dyskinesia in children

Dyskinesia of bile ducts in children is divided into primary and secondary.

1. The primary diseases are diseases, which are based on violations of neurohumoral regulatory mechanisms.
2. Secondary dyskinesias are caused by organic lesions of the liver, stomach, duodenum, arising as viscero-visceral reflexes. In addition, the motor activity of the bile ducts depends on the functional state of the duodenum.

In the practical activities of the pediatrician, the most common pathological conditions characterized by DZHVP and changes in adjacent digestive organs are most common. It should be borne in mind that DZHVP can be only one of the special cases of motor disorders of the entire gastrointestinal tract.

The main causes of biliary dyskinesia:

• vegetative dysfunction (the most common cause of functional cholepaties);
• pathology of the gallbladder, dyskinesia against the background of organic disorders;
• pathology of other digestive organs (in connection with disorders of nervous and / or humoral regulation).

Disturbances of biliary tract motility are subdivided as follows:

• dysfunction (dyskinesia) of the gallbladder - hypo- and hyperkinetic (hypo- and hypermotor);
• dysfunction (dystonia) of the sphincter of Oddi (hypo- and hypertonic).

Evaluation of motility is based on the measurement of the diameter (normally reduced by! / 3) and volume (decreases by 33-66%) of the organ.

[1], [2], [3], [4], [5]