OVERVIEW
Gallbladder motility dysfunction is a group of syndromes resulting from disorders of metabolic or primary gallbladder contraction and dilatation without alteration of bile composition, and belongs to the category of benign biliary tract disorders. The typical symptom is biliary abdominal pain, which is objectively characterized by dysfunction of gallbladder emptying. It occurs intermittently, often in women between 20 and 50 years of age.
Gallbladder movement is regulated by various factors such as nerves and body fluids. The movement of the gallbladder is innervated by sympathetic, parasympathetic and peptidergic nerves. Body fluids are mainly regulated by hormones such as cholecystokinin, gastrin and gastrin. When the nerve, body fluid dysfunction can lead to biliary insufficiency.
Causes
The cause of this disease is not yet fully understood, and its common etiologic factors are:
1. Primary gallbladder smooth muscle lesions;
2. secondary gallbladder smooth muscle lesions caused by chronic cholecystitis or bile changes;
3. abnormalities in neural or hormonal regulation.
In addition, low basal metabolism, low or lack of acidity in gastric juices, muscle weakness or unaccustomed exercise, hypercholesterolemia, prolonged intravenous hypernourishment, and prolonged use of growth-suppressing hormones may also contribute to the development of the disease.
Symptoms
The clinical manifestations of this disease are very similar to those of gallbladder stones, which are commonly seen in middle-aged women. The main symptom is paroxysmal colicky pain in the epigastrium or the right upper abdomen, which may radiate to the back or under the shoulder blades, and in some patients may be accompanied by nausea, vomiting and belching, and the patient often keeps changing her position. The pain may be triggered by eating greasy food and relieved by antispasmodics. Physical examination reveals only limited pressure pain in the epigastrium or right upper abdomen, with no signs of limited peritonitis. Sometimes an enlarged gallbladder can be palpated under the right costal margin.
Examination
1. Laboratory examination
White blood cell count and classification, liver and kidney function, blood amylase are normal.
2. Abdominal ultrasound fat meal method
Abdominal ultrasound can accurately calculate the volume of gallbladder, and the contraction of gallbladder after fat meal and the change of gallbladder volume can indirectly reflect the function of gallbladder movement. Under normal circumstances, after fat meal or static injection of cholecystokinin octapeptide, the index of the gallbladder can reach more than 70%, such as less than 40% is abnormal.
3. Retrograde cholangiopancreatography
Except organic lesions of upper gastrointestinal tract and biliary or pancreatic lesions, retrograde cholangiopancreatography can be used to drain bile to observe whether there is any change in bile composition, except bile salt deposits.
4. Nuclide scanning
Detecting the function of gallbladder movement, this method is the most accurate method to detect the emptying of gallbladder. It can not only show the anatomical structure of the gallbladder, but also reflect the functional status of the gallbladder and its ability to respond to food/gastrointestinal hormones, which cannot be done by other diagnostic imaging methods.
Diagnosis
The diagnostic criteria for gallbladder motility dysfunction are: severe pain in the upper abdomen and right upper abdomen, accompanied by the following manifestations: each episode of symptoms lasts at least 30 minutes, with complete relief between episodes; at least one episode of symptoms in the past 12 months; severe pain that interferes with the patient’s daily life; absence of organic causes that can explain the patient’s symptoms; and dysfunction of the gallbladder’s emptying function. Gallbladder motility dysfunction can be categorized into the following four groups ① Hypermotility Manifested by hypermotility reflexes Faster than normal emptying 15 minutes after a fatty meal. The gallbladder image is no longer visible beyond 60 minutes. ② tension hyperfunction fasting gallbladder presents a long neck image clearly smaller than normal fat meal emptying may be normal. (iii) Hypermotility The empty abdomen is normal in shape and size, and the tense function is normal, with slow emptying after a fat meal. Post-tension hypokinesia of the gallbladder is characterized by a large, U-shaped gallbladder in the empty abdomen. The neck is not clear and empties very slowly after a fat meal.
Differential diagnosis
This disease needs to be differentiated from peptic ulcer, chronic gastritis, gallbladder stones, and functional dyspepsia.
Treatment
For those with a clear etiology, treat the cause; for those without a clear etiology, try to restore the gallbladder emptying function.