Gallbladder hypersensitivity

Introduction The causes of gallbladder dyskinesia are: the disorder of the neural network in the gallbladder wall, the hypersensitivity reaction of the gallbladder, and the early stage of gallbladder inflammation. Biliary tract dyskinesis syndrome includes dysfunction of biliary dysfunction (dysinesis), abnormal biliary tone (dystonia), and ataxic (ataxic) Coordination barriers). The disease is more common in women, and its clinical manifestations are very similar to gallstones, mainly manifested as abdominal pain, paroxysmal cramps in the upper abdomen or upper right abdomen.

Cause

(1) Causes of the disease

1. Gallbladder motor function enhancement

Such dysfunction is generally associated with an allergic reaction to the gallbladder or inflammation of the gallbladder.

(1) gallbladder motor hyperfunction: normal gallbladder tension, but hyperactive movement of the fat meal, so the gallbladder emptying accelerated, 15 minutes after the meal, most of the emptying.

(2) Gallbladder tension is too high: the muscle tension of the gallbladder is too high, but the emptying time is not affected, and it can be normal, accelerated or delayed.

2. Gallbladder motor function is reduced

(1) Gallbladder motor function decline: normal gallbladder tension, but postprandial contraction is weakened, and emptying is slow.

(2) decreased gallbladder tension and decreased motor function: when the fasting, the gallbladder tension is reduced, the volume is increased, and the emptying after meals is slow.

3.Oddi sphincter dysfunction

(1) Oddi sphincter tension is too low: gallbladder filling is poor when gallbladder angiography.

(2) Oddi sphincter spasm: mostly due to mental factors, but can also be secondary to adjacent organs such as papillitis, duodenitis, bulbar ulcers, duodenal parasites such as Giardia, Nematode infections, etc.

(two) pathogenesis

1. Basis of biliary system movement: The anatomical structure of the intrahepatic and extrahepatic biliary system is as follows: bile ducthexel tube interlobular bile ducthepatic ducthepatic duct gallbladderguinal duct tubecholedochal pancreatic ductduodenum, The biliary system accepts the bile secreted by the liver and functions as a storage, concentration, and transporter, and regulates the rate at which bile enters the upper small intestine. This process can be affected by many factors inside and outside the body, and can lead to dysfunction of the biliary system.

The Oddi sphincter consists of three parts, the common bile duct sphincter, the pancreaticobiliary sphincter and the ampullary sphincter. The ampullary sphincter is the ring muscle and the other two parts have both the ring muscle and the oblique muscle. The smooth muscle of the gallbladder wall is divided into two layers: the inner longitudinal and the outer ring; the common hepatic duct and the cystic duct also have some smooth muscles, but much less than the common bile duct and gallbladder. There is no consensus on the role of bile flow; the pancreatic duct is close to twelve. The intestine submucosa forms the biliary and pancreatic ampulla, about 2 to 17 mm, through the nipple opening in the duodenum descending segment, a few of the pancreatic duct and the common bile duct do not meet, but open in the duodenum.

The bile flow of the extrahepatic biliary tract conforms to the principle of fluid mechanics. The pressure is equal to the flow rate multiplied by the resistance. Therefore, in the case where the pressure is relatively fixed, the resistance increases and the flow rate decreases. The resistance in the biliary system is largely related to the Oddi sphincter tone. The sphincter pressure exceeds 10 to 30 mmHg of the biliary tract, and the pressure can reach 100 mmHg in the contraction of 2 to 8 times/min. Some of the aforementioned distal biliary system structures generate a certain amount of pressure and determine the flow of bile from the bile duct into the duodenum or gallbladder, or temporarily stored in the biliary tract. Stones and their damage and other injuries can also affect the entry of bile into the gallbladder.

2. Factors affecting the motor function of the biliary system: The movement of the biliary system is affected by various factors inside and outside the body. Under normal circumstances, bile flow in the extrahepatic biliary tract can be affected by some of the following intrinsic factors:

(1) Pressure of liver bile secretion, pressure in the bile duct.

(2) The amount of liver bile.

(3) Degree of biliary closure.

(4) Gallbladder wall elasticity, gallbladder muscle tension and contraction function.

(5) Condensation of gallbladder and bile.

(6) Tension and reactivity of the bile duct sphincter.

(7) Tension and movement of the duodenal wall.

(8) Closure of the duodenal papilla.

(9) Effects of digestive tract peristalsis and other parts of the digestive tract on the biliary system.

(10) The amount of cholecystokinin released, the efficiency of transport, and the rate of inactivation.

an examination

Related inspection

CT examination of liver, gallbladder and spleen by abdominal vascular ultrasonography

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.

3, abdominal vascular ultrasound examination of abdominal aortic aneurysm, can measure the anteroposterior diameter, long diameter and wide diameter of the tumor, can be used as the preferred method of dissection abdominal aortic aneurysm.

Differential diagnosis

Differential diagnosis:

1, 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.

2, biliary dysfunction: biliary tract dyskinesis syndrome (biliary tract dyskinesis syndrome) including biliary dysfunction (dyskinesis, that is, abnormal biliary emptying speed), biliary tract abnormalities (dystonia, biliary muscle tension abnormalities) and biliary ataxia (ataxic, the coordination disorder between the 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.

3, gallbladder wall fibrosis: When the gallbladder wall inflammation and fibrosis, the gallbladder is in a state of contraction, the so-called chronic acalculous cholecystitis.

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