lazy gallbladder
Introduction
Introduction Activating gallbladder: also known as "lazy 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. Biliary tract dyskinesis syndrome includes dysfunction of biliary dysfunction (dysinesis), abnormal biliary tone (dystonia), and ataxic (ataxic) Coordination barriers).
Cause
Cause
(1) Causes of the disease
1. The gallbladder motor function is enhanced, and such dysfunction is generally associated with allergic reaction of the gallbladder or gallbladder inflammation.
(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 gallbladdercabiliary tubecholedochal tubepancreatic ductduodenum The biliary system accepts bile secreted by the liver and functions as a storage, concentration, and transport, 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 of the inner longitudinal and outer rings. The common hepatic duct and 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 in and out of 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.
Among the above complex and interrelated factors, some factors are particularly important. include:
1 bile secretion pressure and Oddi sphincter resistance are important factors in determining biliary function.
2 The gallbladder regulates the pressure of the extrahepatic biliary tract, and its shape and volume change with the pressure in the bile duct tree.
3 The gallbladder receives thin bile and slowly enters it, and concentrates and stores it.
4 After the normal gallbladder is stimulated by a fat meal, the concentrated bile can be discharged halfway in 15 minutes.
5 After gently pressing the gallbladder area by hand, the gallbladder can be emptied, but suddenly press hard.
6 After removal of the functional gallbladder, the common bile duct can undergo a certain degree of expansion.
The amplitude, duration and frequency of the gastrointestinal tract peristalsis are also closely related to the bile duct base pressure and bile flow. However, after the peristaltic impulse exceeds a certain value, the increase in frequency or duration may not promote bile flow, or even May make it slow down.
Many hormones and peptides have an effect on the Oddi sphincter. The effect of cholecystokinin on the sphincter is extensive. It can cause the gallbladder to contract and reduce the tension and contraction of the Oddi sphincter including the pancreatic sphincter. The secretin has no significant effect on the biliary sphincter, but it has an inhibitory effect on the pancreatic sphincter, while the biliary sphincter only exerts an inhibitory effect at the drug dose. In addition, hormones and peptides studied by animal experiments include gastrin, pentagastrin, histamine and prostaglandin E1. Both histamine and prostaglandin E1 can reduce the contractile viability of the sphincter, and prostaglandin E2, motilin and bombesin have similar effects. Serotonin and endorphin have different effects on different parts of the Oddi sphincter.
The study of the effects of some drugs on sphincters. Butyl porphyrin blocks the contractile activity of the sphincter and lowers the basal pressure. Sublingual nitroglycerin reduces the basal pressure and contraction amplitude of the sphincter, but does not reduce the frequency. Morphine increases both the frequency of contraction and the basal pressure. Zosin (analgesic) only increased the basal pressure, while buprenorphine (buprenorphine) had no effect on the sphincter. Meperidine reduced the frequency of contraction, and stability did not affect the basal pressure and contractile activity. For Oddi sphincter dyskinesia, nifedipine (heart pain) can reduce various activities of the sphincter, but it does not have this effect in normal people. Local perfusion of ethanol in the biliary tract can significantly increase the basal pressure, but ethanol through the stomach and intravenously The effects of entering the body vary.
Examine
an examination
Related inspection
Oral gallbladder angiography gallbladder ultrasound cholangiography abdominal vascular ultrasound
Laboratory inspection:
Liver function and pancreatic enzyme examination: abdominal pain, alkaline phosphatase and transaminase were significantly increased, and no abnormal findings were found in cholangiography, suggesting that there may be Oddi sphincter dysfunction. However, in fact, the clinical situation is not so typical. The mild impairment of liver function is neither specific nor sensitive. Even after the application of morphine and neostigmine, typical pain and liver function damage and pancreatic enzyme elevation High is often inconsistent.
Other auxiliary inspections:
1. Retrograde cholangiopancreatography: Retrograde cholangiopancreatography is the best method to show the secretion of bile and pancreatic juice. It can be confirmed whether there are mechanical or organic changes, but it is of little value in confirming motor dysfunction. Oddi sphincter dysfunction is not easily found by this test. It has been suggested that the prolapse position after retrograde cholangiopancreatography, the delay of the patient's contrast agent efflux (more than 45min) can be used as a means of judging the biliary emptying disorder, but due to the amount of contrast injection and pre-existing medication. Interference, so it has not yet been unified, and its value needs to be further explored.
2, radionuclide scanning: radionuclide scanning is a more useful method to confirm partial obstruction of the common bile duct. After fasting for 4 hours, the patient was injected with radionuclide (99mTc) and recorded for 90min. The examination revealed a delay in emptying. The sensitivity and specificity for confirming partial obstruction of the common bile duct were 67% and 85%, respectively. In contrast to normal people, the common bile duct can be dilated after a fat meal or cholecystokinin (CCK) in the presence of common bile duct obstruction. Dynamic radionuclide scanning, if a delay in the emptying of the common bile duct is detected, is of value in demonstrating partial obstruction of the common bile duct. It has recently been found that it is important to calculate the percentage of gallbladder emptying after injection of CCK, especially when the emptying ratio is reproducible at 45 min. However, radionuclide scanning also has its drawbacks, that is, in the late stage of substantial liver disease, there may be delays in the discharge of nuclide, and at the same time, it is expensive and gamma-ray irradiation is also a disadvantage.
Diagnosis
Differential diagnosis
Should pay attention to the identification of ulcer disease, hepatic syndrome and so on.
1. The typical clinical manifestations of upper gastrointestinal ulcers include upper abdominal pain and upper abdominal discomfort. Most people may have various symptoms of dyspepsia, but some have no symptoms until complications occur. Gastroscopic examination is the main method for diagnosing upper gastrointestinal ulcers, and is of great significance for diagnosis and differential diagnosis.
2. Hepatic syndrome is a category of irritable bowel syndrome. 79.2% had neuropsychiatric symptoms, and 24.5% of patients were related to mental trauma. Many people were afraid of hepatitis B.
