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Biliary dyskinesia is a disorder of the gallbladder. The gallbladder stores bile from the liver and releases it into the small intestine, where it breaks down fats taken in during a meal. Bile travels from the gallbladder through the common bile duct to the small intestine. If bile is not secreted from the gallbladder or cannot get through the common bile duct, it will back up in the gallbladder, causing biliary dyskinesia.
When a person ingests a meal, a hormone known as cholecystokinin is secreted by cells in the small intestine. Cholecystokinin binds to receptors distributed in the muscle of the gallbladder and this causes the gallbladder to contract. The bile is emptied from the gallbladder and travels to the small intestine. If a patient is suffering from biliary dyskinesia, the gallbladder does not contract properly.
There are three round muscles at the end of the common bile duct that are known as the sphincter of Oddi. In addition to causing the gallbladder to contract, the hormone cholecystokinin binds to receptors on the sphincter of Oddi and signals these muscles to relax. Bile can then flow into the small intestine. If the muscles of the sphincter of Oddi do not function properly, bile will not pass through the common bile duct; it will remain in the gallbladder.
Pain and abdominal cramping are the primary symptoms of gallbladder disease. Biliary dyskinesia, which does not involve the formation of gallstones, is sometimes referred to as acalculous gallbladder disease. The physician will need to do a complete examination with diagnostic testing to rule out gallstones before treatment can begin.
Diagnostic testing involves blood work to evaluate liver function and levels of bilirubin. An ultrasound may be done to rule out the presence of gallstones. If the patient does not have gallstones, further testing will need to be done to make a diagnosis.
In many cases, the patient will be referred for nuclear medicine testing in which a radioactive substance is injected into the bloodstream. This radioactive substance will collect in the gallbladder. The physician will then be able to track the flow of the substance and the rate of secretion from the gallbladder.
Once the patient has been diagnosed with biliary dyskinesia, the most common treatment is removal of the gallbladder. Gallbladder removal is a surgical procedure known as laparoscopic cholecystectomy. This surgery is done as an outpatient procedure while the patient is under general anesthesia. Most patients will experience normal digestion and a reduction in abdominal pain following this surgery.