DOCSLIB.ORG

Biliary Motility

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Biliary Motility Gut, 1990,31,571-582 571 Biliary motility P A Grace, G J Poston, R C N Williamson Gut: first published as 10.1136/gut.31.5.571 on 1 May 1990. Downloaded from The delivery ofbile to the duodenum depends on the ampulla, which in turn is followed by another hepatic secretion of bile plus onward propulsion contraction. He likened this rhythmical contrac- through the biliary tract. Biliary kinetics involve tion and relaxation of the sphincter segment to a series of complex interrelationships between systole and diastole, with filling of the ampula gall bladder, cystic duct, common bile duct, occurring during diastole and propulsion of bile sphincter of Oddi and upper small intestine, into the duodenum during systole.6 Using low with control modulation by various neural and compliance manometric techniques, Toouli has hormonal agents. The application of modern shown that during fasting the human sphincter techniques to the study of biliary motility has ofOddi exhibits phasic contractions ofperistaltic allowed a composite physiological picture to type which propel bile into the duodenum and emerge. Moreover, alterations in biliary motility prevent reflux of duodenal contents into the bile are increasingly implicated in the aetiology of and pancreatic ducts.7 gall stones and postcholecystectomy symptoms. The present review examines recent develop- ments in the understanding of biliary motility Physiological motility and discusses the detailed events involved in delivering bile to the duodenum. BILE DUCT Bile flow is governed by a combination ofhepatic secretion, gall bladder contraction and sphincter Anatomical considerations of Oddi activity. The biliary tract is a low The anatomy of the biliary tree has been studied pressure system undergoing minimal pressure extensively in several species including man.'4 changes, whether during fasting or after feeding, The considerable species variation in biliary despite substantial changes in bile flow.38 The structure and function should prevent uncritical human liver secretes at least 1000 ml of bile per extrapolation from one species to another. Most day. Secretion decreases when the common duct vertebrates possess hepatic ducts, cystic duct, pressure rises above 10 cm of water, and with gall bladder, common bile duct, and sphincter of occlusion of the duct the pressure stabilises at http://gut.bmj.com/ Oddi, but for some reason the gall bladder is about 30 cm of water.9 Thus pressure is main- absent in certain species including horse, deer, tained at a relatively low level even in the rat, and pocket gopher. Among mammals there presence of outflow obstruction. Surgeons are three different patterns in the relationship recognise prolonged biliary obstruction by the between the termination of the bile and pan- presence of white bile, which indicates that creatic ducts: (1) the two ducts join to form a hepatic secretion has virtually ceased, residual common channel; (2) the common bile duct and pigment has been reabsorbed and the duct is full on October 1, 2021 by guest. Protected copyright. pancreatic duct are distinct but share a common ofmucus derived from its own epithelium. entrance into the duodenum; (3) the biliary and pancreatic ducts open separately into the duo- denum.2 All three patterns can be seen in man, GALL BLADDER but type predominates. In man thickened muscle at the proximal and Pattern ofemptying distal margins of the sphincter of Oddi make up Recent data have shown that filling and empty- the 'sphincter choledochus' and the 'sphincter ing of the gall bladder are complex processes. ampullae' respectively. Boyden4 divided the The human gall bladder does not empty com- sphincter choledochus into a superior portion, pletely in response to food entering the duo- which encircles the distal common duct just denum, and there are frequent changes in its before it enters the duodenum, and an inferior absolute storage volume and rate of emptying.'0 portion surrounding the submucosal intra- Furthermore, partial emptying and refilling duodenal portion of the common duct. The occur synchronously with the migrating sphincter ampullae surrounds the ampullary myoelectric complex (MMC) of the intestine duct at the duodenal papilla. Cineradiographic during the interdigestive period. Thus, entry studies have shown the interaction of the various and exit of bile from a healthy gall bladder Department of Surgery, Royal Postgraduate human sphincters during the passage of bile into resemble more the gentle ebb and flow ofthe tide Medical School, the duodenum.5 Thus, a contraction begins in than myocardial systole and diastole. Hammersmith Hospital, the middle of the intramural portion of the duct Gall bladder tone reflects the inherent compli- Du Cane Road, London W12 ONN and propagates both upwards and downwards. ance of the smooth muscle and fibroelastic tissue The or retention the which in Correspondence to: Professor superior sphincter pushes within its wall, turn are modulated by R C N Williamson, bile in its segment up into the extramural bile autonomic and hormonal mechanisms. The Department of Surgery, Royal Postgraduate Medical School, duct, while the inferior or evacuation sphincter static compliance of the gall bladder, measured Hammersmith Hospital, and the sphincter ampullae propel the bile in by pressure volume relationships, takes 12-16 Du Cane Road, London W12 ONN. their segments into the duodenum.5 hours to adjust to the volume ofthe organ." Over Accepted for publication Hess6 has observed that each contraction ofthe shorter periods of two to four hours compliance 10 July 1989 human sphincter is followed by passive filling of remains relatively constant despite large fluctua- 572 Grace, Poston, Williamson tions in volume." This property of slow tone ing." Thus CCK regulates the length oftime that adjustment would allow refilling during the bile stays in the gall bladder and remains subject period of increased bile secretion after gall to the concentrating capability of its mucosa. bladder contraction. Gall bladder emptying Cholecystokinin therefore regulates the bile acid/ starts as the stomach begins to empty, and gall cholesterol saturation index by gall bladder Gut: first published as 10.1136/gut.31.5.571 on 1 May 1990. Downloaded from bladder refilling starts when gastric emptying is volume change24 rather than by altering the nearly complete. 2 absorption or secretion of water and electrolytes Lanzini and colleagues'" have now defined the across the gall bladder mucosa.25 So, at low bile events occurring in bile flow between meals. acid secretion rates the bile secreted by the liver Most hepatic bile is diverted into the gall bladder becomes more saturated with cholesterol: bile not only during fasting but also after meals. This acid secretion rates are low when the enterohe- storage process alternates at short intervals with patic circulation of bile acids is sluggish, for ejection of bile from the gall bladder into the instance at night, as nocturnal fasting is associ- duodenum. Thus, the gall bladder behaves like ated with diminished CCK secretion and there- a set of bellows, and this property may be fore decreased gall bladder volume changes. important for thorough mixing ofits contents. Cholecystokinin acts directly on receptors in the muscle coat of the gall bladder.26 Optimal binding of '25I-CCK-33 occurs at pH 5 5 and The role ofcholecystokinin requires the presence of magnesium.26 Binding Sixty years ago Ivy and Oldberg'3 observed that of '25I-Bolton Hunter-CCK-8 to the CCK the intravenous injection of an extract of upper receptor requires the expenditure of cellular gastrointestinal mucosa caused contraction and energy.27 There is both regional and cellular evacuation of the gall bladder in cats and dogs. heterogeneity of CCK receptors throughout the Their classical cross-circulation studies showed gut. There is a 20-fold decrease in sensitivity to that acid injected into the duodenum of one the C-terminal residue of CCK-8 from gall animal caused gall bladder contraction in the bladder muscle to ileal circular muscle. Chole- parabiotic partner. They proposed the name cystokinin receptors on cholingeric neurones in 'cholecystokinin' for the hormone or active ileal muscle are between 80-300 times more principle that caused the gall bladder to contract. sensitive to CCK-8 than the adjacent muscle In 1968 Jorpes and Mutt isolated cholecysto- cells.28 Multiple exposures of guinea pig gall kinin (CCK) and described the chemical bladder to CCK-8 appear to increase the number sequence of its amino acids." Cholecystokinin is of CCK receptors (sensitisation), whereas in the released from the duodenum by luminal acid and guinea pig ileum the opposite is seen (desensi- nutrients, in particular fat and amino acids.'5 tisation), associated with changes in the The half life of CCK in the plasma of both man cholinergic receptors.29 These findings probably http://gut.bmj.com/ and dog is about 2 5 minutes.'5 The kidney is its relate to the primary neuronal nature of CCK major site of uptake from the systemic circula- receptors in the ileum and the combined neuronal tion.'5 The predominant forms of CCK (CCK-8, and muscular location of CCK receptors in the CCK-33, CCK-39, and CCK-58) are all released gall bladder. There is a wide range of binding by the upper gastrointestinal mucosa. In porta- capacity of CCK to its receptor between one gall caval transposition studies in dogs, Sakamoto bladder and another, but in general the binding and colleagues showed that nearly all CCK-8 in affinity of 125I-D-Tyr-Gly+[(Nle)28 30 CCK-26- on October 1, 2021 by guest. Protected copyright. the portal circulation is metabolised on first 33] to gall bladder muscle has a Kd of around passage through the liver'6 and maintains a 1 nmol and 50% of this binding can be inhibited systemic activity; it is probably these forms of by 0 9 nmol CCK-8, 0-8 imol gastrin-17 and CCK that are primarily responsible for stimulat- 5 [imol CCK (gastrin)-4.30 The gall bladder ing gall bladder contraction and pancreatic muscle CCK receptor has been shown by covalent secretion.
Load more

Recommended publications
  • Gallbladder Disease in Children
    Seminars in Pediatric Surgery 25 (2016) 225–231 Contents lists available at ScienceDirect Seminars in Pediatric Surgery journal homepage: www.elsevier.com/locate/sempedsurg Gallbladder disease in children David H. Rothstein, MD, MSa,b, Carroll M. Harmon, MD, PhDa,b,n a Department of Pediatric Surgery, Women and Children's Hospital of Buffalo, 219 Bryant St, Buffalo, New York 14222 b Department of Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York article info abstract Biliary disease in children has changed over the past few decades, with a marked rise in incidence— — Keywords: perhaps most related to the parallel rise in pediatric obesity as well as a rise in cholecystectomy rates. In Cholelithiasis addition to stone disease (cholelithiasis), acalculous causes of gallbladder pain such as biliary dyskinesia, Biliary dyskinesia also appear to be on the rise and present diagnostic and treatment conundrums to surgeons. Pediatric biliary disease & 2016 Elsevier Inc. All rights reserved. Gallbladder Acalculous cholecystitis Critical view of safety Introduction In these patients, the etiology of the gallstones is supersaturation of bile due to excess cholesterol, and this variety is the most The spectrum of pediatric biliary tract disease continues to common type of stone encountered in children today. The prox- change. Although congenital and neonatal conditions such as imate cause of cholesterol stones is bile that is saturated with biliary atresia and choledochal cysts remain relatively constant,
    [Show full text]
  • Diseases of the Gallbladder
    Curtis Peery MD Sanford Health Surgical Associates Sioux Falls SD 605-328-3840 [email protected] Diseases of the Gallbladder COMMON ISSUES HEALTH CARE PROVIDERS WILL SEE!!! OBJECTIVES Discuss Biliary Anatomy and Physiology Discuss Benign Biliary disease Identify and diagnose common biliary conditions Clinical Scenarios Update in surgical treatment Purpose of Bile Aids in Digestion Bile salts aid in fat and fatty vitamin absorption Optimizes pancreatic enzyme function Eliminates Waste Cholesterol Bilirubin Inhibits bacterial growth in small bowel Neutralizes stomach acid in the duodenum Biliary Anatomy Gallbladder Function Storage for Bile Between Meals Concentrates Bile Contracts after meals so adequate bile is available for digestion CCK is released from the duodenum in response to a meal which causes the gallbladder to contract Gallbladder Disease Gallstones- Cholesterol or pigment stones from bilirubin Cholelithiasis- gallstones in the gallbladder Biliary colic- pain secondary to obstruction of the gallbladder or biliary tree Choledocholithiasis – presence of a gallstone in the CBD or CHD Cholecystitis- Inflammation of the gallbladder secondary to a stone stuck in the neck of the gallbladder Cholangitis- infection in the biliary tree secondary to CBD stone(May result in Jaundice) Gallstone Pancreatitis- pancreatitis secondary to stones passing into the distal CBD Biliary dyskinesia- disfunction of gallbladder contraction resulting in biliary colic GALLSTONES Typically form in the gallbladder secondary
    [Show full text]
  • Sphincter of Oddi: ERCP Plus Sphincterotomy – Yes Or No
    Sphincter of Oddi: ERCP Plus Sphincterotomy – Yes or No Note: For debate purposes, the pro and con positions for patient management will be taken by the invited authors. However, actual decisions regarding patient care must involve discussion of the risks and benefits of each treatment considered. Case Presentation – Case developed by Ihab I. El Hajj, MD, MPH, Indiana University, Indianapolis, IN A 57-year-old Caucasian female with history of smoking and COPD, was in her usual state of health until two years ago, when she experienced recurrent “attacks” of right upper quadrant pain, nausea and occasional vomiting, suggestive of biliary colic. The patient was evaluated by her primary care physician and initial work- up, which included basic blood work, liver chemistries and transabdominal ultrasound, were negative. The patient responded partially to prn Zofran and omeprazole 40 mg once then twice daily. With the persistence of her symptoms, the patient was referred to a gastroenterologist. Esophagogastroduodenoscopy (EGD) with gastric biopsies revealed chronic inactive gastritis without Helicobacter pylori. HIDA scan suggested biliary dyskinesia with an ejection fraction of 22%. An elective laparoscopic cholecystectomy was performed. An intra- operative cholangiogram showed no filling defect in the common bile duct (CBD) and pathology demonstrated chronic cholecystitis with no gallstones. The patient was symptom-free for six months after surgery. She subsequently developed vague upper abdominal pain, intermittent nausea and irregular bowel movements. Labs, colonoscopy and repeat EGD were ASGE Leading Edge — Volume 4, No. 4 © American Society for Gastrointestinal Endoscopy normal. The patient was treated for suspected irritable bowel syndrome. She failed several medications including hyoscyamine, dicyclomine, amitriptyline, sucralfate, and GI cocktail.
    [Show full text]
  • The Spectrum of Gallbladder Disease
    The Spectrum of Gallbladder Disease Rebecca Kowalski, M.D. October 18, 2017 Overview A (brief) history of gallbladder surgery Anatomy Anatomical variations Physiology Pathophysiology Diagnostic imaging of the gallbladder Natural history of cholelithiasis Case presentations of the spectrum of gallstone disease Summary History of Gallbladder Surgery Gallbladder Surgery: A Relatively Recent Change Prior to the late 1800s, doctors treated gallbladder disease with a cholecystostomy, due to the fear that removing the organ would kill patients Carl Johann August Langenbuch (director of the Lazarus Hospital in Berlin, Germany) practiced on a cadaver to remove the gallbladder, and in 1882, performed a cholecystectomy on a patient. He was discharged after 6 weeks in the hospital https://en.wikipedia.org/wiki/Carl_Langenbuch By 1897 over 100 cholecystectomies had been performed Gallbladder Surgery: A Relatively Recent Change In 1985, Erich Mühe removed a patient’s gallbladder laparoscopically in Germany Erich Muhe https://openi.nlm.ni h.gov/detailedresult. php?img=PMC30152 In 1987, Philippe Mouret (a 44_jsls-2-4-341- French gynecologic surgeon) g01&req=4 performed a laparoscopic cholecystectomy In 1992, the National Institutes of Health (NIH) created guidelines for laparoscopic cholecystectomy in the United Philippe Mouret States, essentially transforming https://www.pinterest.com surgical practice /pin/58195020154734720/ Anatomy and Abnormal Anatomy http://accesssurgery.mhmedical.com/content.aspx?bookid=1202&sectionid=71521210 http://www.slideshare.net/pryce27/rsna-final-2 http://www.slideshare.net/pryce27/rsna-final-2 http://www.slideshare.net/pryce27/rsna-final-2 Physiology a http://www.nature.com/nrm/journal/v2/n9/fig_tab/nrm0901_657a_F3.html Simplified overview of the bile acid biosynthesis pathway derived from cholesterol Lisa D.
    [Show full text]
  • Albany Med Conditions and Treatments
    Albany Med Conditions Revised 3/28/2018 and Treatments - Pediatric Pediatric Allergy and Immunology Conditions Treated Services Offered Visit Web Page Allergic rhinitis Allergen immunotherapy Anaphylaxis Bee sting testing Asthma Drug allergy testing Bee/venom sensitivity Drug desensitization Chronic sinusitis Environmental allergen skin testing Contact dermatitis Exhaled nitric oxide measurement Drug allergies Food skin testing Eczema Immunoglobulin therapy management Eosinophilic esophagitis Latex skin testing Food allergies Local anesthetic skin testing Non-HIV immune deficiency disorders Nasal endoscopy Urticaria/angioedema Newborn immune screening evaluation Oral food and drug challenges Other specialty drug testing Patch testing Penicillin skin testing Pulmonary function testing Pediatric Bariatric Surgery Conditions Treated Services Offered Visit Web Page Diabetes Gastric restrictive procedures Heart disease risk Laparoscopic surgery Hypertension Malabsorptive procedures Restrictions in physical activities, such as walking Open surgery Sleep apnea Pre-assesment Pediatric Cardiothoracic Surgery Conditions Treated Services Offered Visit Web Page Aortic valve stenosis Atrial septal defect repair Atrial septal defect (ASD Cardiac catheterization Cardiomyopathies Coarctation of the aorta repair Coarctation of the aorta Congenital heart surgery Congenital obstructed vessels and valves Fetal echocardiography Fetal dysrhythmias Hypoplastic left heart repair Patent ductus arteriosus Patent ductus arteriosus ligation Pulmonary artery stenosis
    [Show full text]
  • General Medicine - Surgery IV Year
    1 General Medicine - Surgery IV year 1. Overal mortality rate in case of acute ESR – 24 mm/hr. Temperature 37,4˚C. Make appendicitis is: the diagnosis? A. 10-20%; A. Appendicular colic; B. 5-10%; B. Appendicular hydrops; C. 0,2-0,8%; C. Appendicular infiltration; D. 1-5%; D. Appendicular abscess; E. 25%. E. Peritonitis. 2. Name the destructive form of appendicitis. 7. A 34-year-old female patient suffered from A. Appendicular colic; abdominal pain week ago; no other B. Superficial; gastrointestinal problems were noted. On C. Appendix hydrops; clinical examination, a mass of about 6 cm D. Phlegmonous; was palpable in the right lower quadrant, E. Catarrhal appendicitis. appeared hard, not reducible and fixed to the parietal muscle. CBC: leucocyts – 3. Koher sign is: 7,5*109/l, ESR – 24 mm/hr. Temperature A. Migration of the pain from the 37,4˚C. Triple antibiotic therapy with epigastrium to the right lower cefotaxime, amikacin and tinidazole was quadrant; very effective. After 10 days no mass in B. Pain in the right lower quadrant; abdominal cavity was palpated. What time C. One time vomiting; term is optimal to perform appendectomy? D. Pain in the right upper quadrant; A. 1 week; E. Pain in the epigastrium. B. 2 weeks; C. 3 month; 4. In cases of appendicular infiltration is D. 1 year; indicated: E. 2 years. A. Laparoscopic appendectomy; B. Concervative treatment; 8. What instrumental method of examination C. Open appendectomy; is the most efficient in case of portal D. Draining; pyelophlebitis? E. Laparotomy. A. Plain abdominal film; B.
    [Show full text]
  • Functional Gallbladder Disorder: Gallbladder Dyskinesia
    Functional Gallbladder Disorder: Gallbladder Dyskinesia a b, Stephanie L. Hansel, MD, MS , John K. DiBaise, MD * KEYWORDS Functional biliary pain Gallbladder Cholecystectomy Cholescintigraphy The occurrence of abdominal pain thought is to resemble gallbladder pain but in the absence of gallstones confronts the clinician with regularity and results in significant health care costs.1 The estimated prevalence of this disorder is about 8% in men and 21% in women according to population-based studies involving persons with biliary-like pain and normal gallbladder ultrasounds.2–4 The pathogenesis of this condition, referred to by various names including gallbladder dyskinesia, chronic acal- culous gallbladder dysfunction, acalculous biliary disease, chronic acalculous chole- cystitis, and biliary dyskinesia, is poorly understood. The term functional gallbladder disorder is currently the accepted Rome consensus nomenclature for this condition and will be used throughout this article. The aim of this article is to clarify the identifi- cation and management of patients with suspected functional gallbladder disorder. CLINICAL PRESENTATION A critical question that has plagued clinicians for many years is what exactly consti- tutes biliary-like abdominal pain? Biliary-like abdominal pain originally was described as a pain in the right upper quadrant that was colicky in nature and associated with fatty food intake and various nonspecific gastrointestinal (GI) symptoms.5 In contrast, the definition recently endorsed by the Rome committee on functional biliary and pancreatic disorders describes biliary-like pain as episodic, severe, steady pain located in the epigastrium or right upper quadrant that lasts at least 30 minutes and is severe enough to interrupt daily activities or require consultation with a physician (Box 1).6,7 The pain may be accompanied by nausea and vomiting, radiate to the back or infrascapular region, or awaken the patient from sleep.
    [Show full text]
  • Abdomen Imaging Guidelines Effective 05/22/2017
    CLINICAL GUIDELINES Abdomen Imaging Policy Version 20.0.2018 Effective May 17, 2018 eviCore healthcare Clinical Decision Support Tool Diagnostic Strategies: This tool addresses common symptoms and symptom complexes. Imaging requests for individuals with atypical symptoms or clinical presentations that are not specifically addressed will require physician review. Consultation with the referring physician, specialist and/or individual’s Primary Care Physician (PCP) may provide additional insight. CPT® (Current Procedural Terminology) is a registered trademark of the American Medical Association (AMA). CPT® five digit codes, nomenclature and other data are copyright 2016 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values or related listings are included in the CPT® book. AMA does not directly or indirectly practice medicine or dispense medical services. AMA assumes no liability for the data contained herein or not contained herein. © 2018 eviCore healthcare. All rights reserved. Imaging Guidelines V20.0.2018 Abdomen Imaging Guidelines Abbreviations for Abdomen Imaging Guidelines 4 AB-1: General Guidelines 6 AB-2: Abdominal Pain 11 AB-3: Abdominal Sepsis (Suspected Abdominal Abscess) 18 AB-4: Flank Pain, Rule Out or Known Renal/Ureteral Stone 20 AB-5: Gastroenteritis 24 AB-6: Mesenteric/Colonic Ischemia 26 AB-7: Post-Operative Pain with-in 60 Days Following Abdominal Surgery – Abdominal Procedure 29 AB-8: Abdominal Lymphadenopathy 31 AB-9: Bariatric Surgery 34 AB-10: Blunt Abdominal Trauma 36
    [Show full text]
  • Biliary Pain Work-Up and Management in General Practice Michael Crawford
    The right upper quadrant Biliary pain Work-up and management in general practice Michael Crawford Background Pain arising from the gallbladder and biliary tree is a Pain arising from the gallbladder and biliary tree is a common common presentation in general practice. Differentiating clinical presentation. Differentiation from other causes of biliary pain from other causes of abdominal pain can abdominal pain can sometimes be difficult. sometimes be difficult. There is substantial variability in the type, duration and associations of pain arising from the Objective gallbladder. Furthermore, there is overlap with a number This article discusses the work-up, management and after care of of other common abdominal conditions, such as peptic patients with biliary pain. ulcer disease, gastro-oesophageal reflux and irritable Discussion bowel syndrome. It is often not possible to be certain that The role for surgery for gallstones and gallbladder polyps is a particular symptom is related to gallbladder pathology described. Difficulties in the diagnosis and management before cholecystectomy. of gallbladder pain are discussed. Intra- and post-operative complications are described, along with their management. The Clinical presentations of pain issue of post-operative pain in particular is examined, focusing Gallstones on the timing of the pain and the relevant investigations. Gallstones are a common problem, with an estimated prevalence of Keywords 25–30% in Australians over the age of 50 years.1 Risk factors for the general surgery; gastrointestinal disease; gallbladder; biliary development of gallstones include: tract; pain • female gender • increasing age • family history • rapid changes in weight • ethnicity. Most people with gallstones do not experience pain, with only about 6% undergoing a cholecystectomy over a 30 year period in one observational study.2 Confirming that the gallbladder is the source of pain can be challenging.
    [Show full text]
  • Role of the Sphincter of Oddi, Gallbladder and Cholecystokinin
    Biliary Dyskinesia: Role of the Sphincter of Oddi, Gallbladder and Cholecystokinin Shakuntala Krishnamurthy and Gerbail T. Krisbnamurthy Nuclear Medicine Department, Tuality Community Hospital, Hillsboro, Oregon; and Nuclear Medicine Section/Imaging Service, Veterans Affairs Medical Center, and University ofArizona, Tucson, Arizona years until Boyden's detailed work put an end to uncertainty The availability of objective and quantitative diagnostic tests in (8). The functional role of the sphincter of Oddi is now widely recent years has allowed more precise documentalion of biliary accepted. The sphincter consists of three parts: one surrounding dyskinesia. Biliary dyskinesiaconsists of two disease entities situ atedattwodifferentanatomicallocations:sphincterofOddispasm, the intraduodenal part ofthe distal CBD, called the choledochal at the distal end of the common duct, and cystic duct syndrome,in sphincter; one at the distal end of the pancreatic duct (duct of thegallbladder.Bothconditionsarecharacterizedby a paradoxical Wirsung), called pancreatic sphincter; and one surrounding the responsein which the sphincterof Oddi and the cystic duct contract common channel, called the ampullary sphincter. The distal end (andimpedebileflow)insteadof undergoingthe normaldilatation, of the common duct, surrounded by the ampullary sphincter, when the physiologicaldose of cholecystokinin is infused. Quanti opens into second part of the duodenum at the postero-medial tative cholescintigraphycan clearly differentiateone disease entity wall at an elevation
    [Show full text]
  • Ministry of Healthcare of Ukraine Ukrainian Medical Stomatological Academy
    Ministry of Healthcare of Ukraine Ukrainian Medical Stomatological Academy Approved at the meeting of Internal Medicine №1 Department “____”__________2019 yr. Protocol № ____ from ___________ The Head of the Department Associate Professor Maslova H.S. ______________ Methodical guidelines for students’ self-studying to prepare for practical (seminar) classes and on the lessons Academic discipline Internal medicine Module № 1 Topic of the lesson Chronic cholecystitis and functional biliary disorders. Cholelithiasis. Course IV Faculty of foreign students training Poltava-2019 1. Relevance of the topic: Chronic cholecystitis is a prolonged, subacute condition caused by the mechanical or functional dysfunction of the emptying of the gallbladder. It presents with chronic symptomatology that can be accompanied by acute exacerbations of more pronounced symptoms (acute biliary colic), or it can progress to a more severe form of cholecystitis requiring urgent intervention (acute cholecystitis). There are classic signs and symptoms associated with this disease as well as prevalences in certain patient populations. The two forms of chronic cholecystitis are with cholelithiasis (with gallstones), and acalculous (without gallstones). Functional biliary disorders are controversial topics. They have gone by a variety of names, including acalculous biliary pain, biliary dyskinesia, dysmotility. 2. Certain aims: - To be able to assess the typical clinical picture of chronic calculous and acalculous cholecystitis and functional biliary disorders, to determine
    [Show full text]
  • Gallbladder and Sphincter of Oddi Disorders Peter B
    Gastroenterology 2016;150:1420–1429 Gallbladder and Sphincter of Oddi Disorders Peter B. Cotton,1 Grace H. Elta,2 C. Ross Carter,3 Pankaj Jay Pasricha,4 Enrico S. Corazziari5 1Medical University of South Carolina, Charleston, South Carolina; 2University of Michigan, Ann Arbor, Michigan; 3Glasgow Royal Infirmary, Glasgow, Scotland; 4Johns Hopkins School of Medicine, Baltimore, Maryland; and 5Universita La Sapienza, Rome, Italy The concept that motor disorders of the gallbladder, cystic duct, and sphincter of Oddi can cause painful syndromes is E1. Diagnostic Criteria for Biliary Pain attractive and popular, at least in the United States. How- Pain located in the epigastrium and/or right upper ever, the results of commonly performed ablative treat- quadrant and all of the following: ments (eg, cholecystectomy and sphincterotomy) are not uniformly good. The predictive value of tests that are often 1. Builds up to a steady level and lasting 30 minutes GALLBLADDER AND SOD used to diagnose dysfunction (eg, dynamic gallbladder or longer scintigraphy and sphincter manometry) is controversial. Evaluation and management of these patients is made 2. Occurring at different intervals (not daily) difficult by the fluctuating symptoms and the placebo effect 3. Severe enough to interrupt daily activities or lead of invasive interventions. A recent stringent study has to an emergency department visit shown that sphincterotomy is no better than sham treat- ment in patients with post-cholecystectomy pain and little 4. Not significantly (<20%) related to bowel or no objective abnormalities on investigation, so that the movements old concept of sphincter of Oddi dysfunction type III is dis- 5. Not significantly (<20%) relieved by postural carded.
    [Show full text]