Biliary Dyskinesia

Question 1

In simple terms what is biliary dyskinesia?

Answer 1

A functional gallbladder disorder.

Affects the gallbladder’s ability to move bile out into the bile ducts.

Reduced motility can cause bile to back up into the gallbaldder, just as if it were obstructed by a gallstone.

diagnosed when no other cause can explain the patient’s symptoms

Question 2

Symptoms of biliary dyskinesia?

Answer 2

Right Upper Quadrant abdominal pain (location of gallbladder just under right ribcage, some people feel it in the middle of their abdomen, other in right shoulder or back)

Episodic pain that builds to a peak

Bloated stomach

N+V

Unintended weight loss

others include: headaches, fatigue, anxiety, depression, chronic acid reflux, IBS

Question 3

Aetiology of biliary dyskinesia?

Answer 3

• unknown however sometimes specific nerves (e.g. vagus nerve) doesnt work as they shoult.

in most cases its impossible to know exactly where the problem is

Question 4

How is biliary dyskinesia diagnosed?

Answer 4

1. Right upper quadrant pains similar to biliary colic but have normal ultrasound examination of the gallbladder (no stones, sludge, microlithiasis, gallbladder wall thickening or CBD dilation)

Rome III criteria for functional gallbladder disorders should be considered including:

• pain episodes lasting >30 mins
• recurrent symptoms that occur at variable intervals
• pain that is severe enough to interrupt daily activity or lead to ED visits
• pain that builds up to a steady level
• pain not relieved by bowel movements, postural changes, or antacids
• exclusion of other structural diseases that could explain the symptoms
• normal liver enzymes, conjugated bilirubin, and amylase/lipase

Question 5

Supportive criteria for the diagnosis of biliary dyskinesia (Rome III diagnostic criteria)?

Answer 5

association of pain with N+V

radiation of pain to the infrascapular region

pain that wakes the patient in the middle of the night

Question 6

When is cholecystectomy considered in patients with biliary dyskinesia?

Answer 6

patients who have biliary type right upper quadrant pain, without structural abnormalities by ultrasound and abnormal HIDA scan

an abnormal ejection fraction is considered to be less than 38%

Question 7

Treatment options: biliary dyskinesia?

Answer 7

Cholecystectomy is the only known effective treatment

Observation, exploration of etiologies of the primary contributor to the patien’s symptoms.

dietary manipulation for those thought to have functional bowel motility issues