Biliary Dyskinesia

Most commonly, problems with the gallbladder causing symptoms are due to gallstones. However, biliary dyskinesia can cause symptoms very similar to those of gallstones, without any stones or abnormality seen on imaging studies. If this is the case, your doctor should evaluate you for biliary dyskinesia.

Biliary dyskinesia is a disorder of the digestive system in which bile physically can not move normally in the proper direction from the liver to the gallbladder and intestine. Most commonly, the muscular coordination within the gallbladder in response to eating is abnormal. Poor bile exit from contraction of the gallbladder can produce right upper abdominal pain after meals, nausea, vomiting, indigestion, gassiness, and decreased appetite.

The true incidence of biliary dyskinesia in the United States is unknown, although the condition occurs more frequently in females than males and in individuals aged 40-60 years. In general, 10-15% of patients undergoing laparoscopic cholecystectomy have biliary dyskinesia.

 

Diagnosis:

The diagnosis of biliary dyskinesia is made by something called a HIDA scan. This type of imaging is known as cholescintigraphy.

This is imaging of the entire liver and bile systems, including gallbladder and bile ducts. A radioactive tracer is injected through a vein and then allowed to circulate to the liver (which takes one hour), after which you are given another tracer which acts as an already digested meal (CCK) to see how fast it takes your gallbladder to fill up, where it is excreted into the bile ducts and stored by the gallbladder until released into the duodenum. The CCK stimulates emptying of the gallbladder, allowing an ejection fraction to be calculated. A gallbladder ejection fraction of less than 35% is considered abnormal.

Treatment:

If you are diagnosed with biliary dyskinesia, you should be referred to a general surgeon for evaluation for cholecystectomy.

Your discussion with your surgeon will include a “risk- benefit” analysis of surgery, given The patient’s examination and radiologic tests were reviewed. The patient has biliary  We discussed the recovery period and that oftentimes it takes longer to recover from this surgery with this disease process, and that if their symptoms persist, they may need to be seen by a gastroenterologist to evaluate for other sources of abdominal pain. They understand and wish to proceed.

References:

Mayo clinic

Healthline

NIH