gallbladder dyskinesia
Introduction
Introduction Cystic duct syndrome refers to the incompleteness of the cystic duct, non-calculus, mechanical obstruction, causing poor bile discharge and elevated gallbladder pressure. Clinical syndrome. Intrinsic is also called cystic duct partial obstruction syndrome, gallbladder dyskinesia syndrome, primary chronic cysticulitis.
Cause
Cause
(1) Causes of the disease
The etiology has congenital and acquired factors, and the latter factors are more common. It has been confirmed that many structural abnormalities can lead to incomplete obstruction of the cystic duct, such as inflammatory adhesion of the cystic duct, distortion of the cystic duct, and adhesion of the gallbladder to surrounding organs. The cystic duct-funnel connection is acute, limited, and cystic duct fibrosis. Due to partial obstruction of the cystic duct, bile outflow is blocked, and bile retention in the gallbladder causes an increase in internal pressure of the gallbladder, resulting in a series of clinical symptoms.
(two) pathogenesis
In patients with cystic duct syndrome, gallbladder enlargement is often seen in open surgery, and there is a certain degree of dilatation. After the finger presses the gallbladder, bile can not be empty. The gallbladder itself can be abnormal. The pathological examination of the cystic duct often sees mild to moderate inflammatory changes, thickened wall or more typical hyperplastic changes.
Examine
an examination
Related inspection
Oral gallbladder angiography liver, gallbladder, spleen CT examination
Clinical manifestation
The prominent symptom of the syndrome is pain, which can be located in the gallbladder or upper abdomen and occasionally radiates to the back. Fat can induce significant pain after a meal, so some patients have a sharp drop in food intake and weight loss. Sometimes severe pain is a paroxysmal attack that is indistinguishable from biliary colic. Some patients can wake up during sleep and the pain lasts for hours. Nitroglycerin or anticholinergic drugs may relieve pain, but the effect is not completely certain, and the effective time is also very short. Sometimes there is tenderness in the gallbladder area, but it rarely touches the enlarged gallbladder.
diagnosis
According to typical pain, gallbladder angiography without stones and gallbladder filling, fat bile can not be fully empty after the meal, cystic duct syndrome should be suspected, but other auxiliary examinations are needed for the diagnosis.
Diagnosis
Differential diagnosis
First, gallbladder contraction dysfunction: diagnosis of biliary tract hypotension syndrome can be found after fat meal gallbladder contraction dysfunction. The biliary hypotony syndrome, also known as Chiray syndrome, refers to a group of syndromes in which biliary tract tension is delayed, gallbladder emptying is delayed, and indigestion occurs, which can not tolerate fatty foods and has pain in the right upper quadrant. Intrinsic to the category of biliary dysfunction syndrome, also known as gallbladder retardation syndrome. Oral gallbladder angiography or B-mode ultrasound can be found in gallbladder enlargement, and gallbladder systolic dysfunction after fat meal. In the case of biliary organic diseases except cholelithiasis, biliary ascariasis, biliary infection, etc., the intrinsic can be considered.
Second, gallbladder wall fibrosis: When the gallbladder wall inflammation and fibrosis, the gallbladder is in a state of contraction, the so-called chronic acalculous cholecystitis.
1. There is no positive sign in the gallstones of the gallbladder. When a few stones are too large, the gallbladder can be touched.
2, gallbladder tube stones, right upper abdomen tenderness, Murphy sign positive, right upper abdomen can touch the enlarged gallbladder, there is tenderness, such as the occurrence of gallbladder perforation can have signs of acute peritonitis such as total abdominal tenderness, rebound tenderness, muscle tension. Some patients may have jaundice.
Third, the gallbladder wall thinning: papillary adenocarcinoma may be caused by malignant papillary or polyps, the tumor grows into the gallbladder cavity, affecting the emptying of the gallbladder, the surface of the tumor is ulcerated, easy to cause infection. If the tumor blocks the gallbladder neck, it can enlarge the gallbladder and thin the gallbladder wall, similar to gallbladder abscess or effusion.
Fourth, lazy sac: also called the inactive gallbladder, one of the main types of biliary dysfunction, accounting for about 8%. This type is characterized by an increase in the volume of the gallbladder in the fasting state, and the appearance resembles a "U" shape, and the contraction and emptying of the gallbladder after the fat meal are slowed down. However, in patients with chronic acalculous cholecystitis, if there is a thinning of the gallbladder wall and severe damage to the mucosa, the gallbladder is not even seen at all.
Five, biliary dysfunction: including biliary dysfunction (dyskinesis, that is, abnormal biliary emptying speed), biliary tract abnormalities (dystonia, that is, biliary muscle tension abnormality) and biliary ataxia (ataxic, that is, coordination between various parts of the biliary tract ). The disease is more common in women, its clinical manifestations and gallstones are very similar, mainly for abdominal pain, paroxysmal cramps in the upper abdomen or right upper abdomen, some patients may be accompanied by nausea and vomiting, may be induced by eating greasy food, often lasting 2 ~3h, the symptoms are relieved after the antispasmodic drug.
