To date, diseases associated with the gallbladder, are very common, both in women and men. Earlier this indicator was not so high, but today every fifth woman and every tenth man have these problems. The gallbladder plays a very important role in digestion, namely, during food intake it decreases and its contents enter the intestine. And the sphincter of Oddi is responsible for the flow of bile, he is in the duodenum.
But if there are irregularities in the work and spasm of the sphincter, Oddi generally stops normal work, because of what bile ceases to enter the intestine. Later, normal digestion becomes impossible, a number of organs suffer and significant harm is done to the organism as a whole. This process can lead to the formation of stones in the gallbladder.
Reasons for provoking sphincter dysfunction Oddi
Today there are many reasons that can disrupt the work of the sphincter of Oddi, but the most notable are the following:
- Changes in bile
- Passage disorders
- Increased bacterial growth in the intestine
- Surgical interventions previously
- Passage disorders
- Dyskinesia( spasms)
- Structural disorders or changes associated with stenosis
With topographic anatomy of the liver you will be introduced to the video:
How to showdo you have the pain associated with the sphincter of Oddi?
This feeling has a duration of half an hour to several hours. When exacerbated, there is pain throughout the upper abdomen. This can happen in the form of seizures or as constant pains as tolerable enough, and very acute, to the point that you can not do without an emergency call for help from a doctor. Often, dysfunction of the sphincter of Oddi can be accompanied by nausea and vomiting. It is not always possible to predict how the disease will manifest itself.
This can happen right after the operation to remove the gallbladder, but it sometimes happens that the aggravation happens after many years. And, according to the sensation, it can be similar to the preoperative period. There is a chance that there will be an acute inflammation of the pancreas, which has a recurring ability. Signs of dysfunction:
- Painful attacks
- Changes in hepatic enzymes( increased 2-fold)
- Slowly removing contrast agent
- Choledoch dilated
Usually the disease is divided into 2 main types - biliary and pancreatic. In the first case, the signs in many ways resemble the situation when the narrowing of the ducts occurs. That is, approximately as in the case of stones in the bile ducts, chills, pain in the area of the ribs on the right side can occur.
Pancreatic form of the disease involves pain after eating and periodic inflammation of the pancreas. In both cases, other disorders may occur with the disease, since there is a disorder of the gastrointestinal tract and complications for work for many organs.
Biliary dysfunction of the sphincter of Oddi
This pathology is most common in people who have had a chance of suffering cholecystectomy, but there will be standard signs of biliary pain. According to one version, the development of this pathology occurs as a result of loss of reservoir capacity, that is, the impossibility of compensating the pressure in the bile ducts, which the gallbladder must perform.
At present, the question of whether Oddi's sphincter dysfunction can be an independent clinical phenomenon in the pre-operative period remains on the agenda, there is as yet no definitive answer. Most of the patients are middle-aged women who have suffered cholecystectomy over the past few years.
Biliary dysfunction has 3 groups, each of which has its clinical and laboratory features. In the first type, one can observe biliary pain, changes in hepatic functional tests, an increase of up to 12 millimeters of the bile duct, and the contrast is rejected within 45 minutes. The second type is also characterized by biliary pain, changes in liver tests can also be observed inherent in the first type of malaise, but in this case only 1 of them can happen. The third type is characterized by only the usual bouts of biliary pain.
Pancreatic dysfunction of the sphincter of Oddi
Pancreatic dysfunction, like biliary, is divided into 3 main groups. In the first case one can observe the following points:
- Amylase and Lipase 1.5 times as large
- Pancreatic pains
- Pancreatic ducts wider by 6 millimeters in the head area of
- Pancreas body is wider by 5 millimeters
The second case is characterized by the same features as forFirst, the difference is that in addition to pancreatic pain, only 1 of the symptoms can occur. In the third type of pancreatic dysfunction of the sphincter of Oddi, only pancreatic pain is felt.
How is the diagnosis established for problems with the sphincter of Oddi?
An accurate diagnosis can sometimes establish a laborious process that requires several studies, and this is done in the department of gastroenterology. The whole point is that the disease can have various forms and each of them requires careful investigation and attention. In some cases, cholangiopancreatography should be performed.
But this procedure can lead to complications, so it is not used often, mostly in extreme cases. In order for a physician to make a final verdict on the establishment of a disease associated with the sphincter of Oddi, the results of the following studies are needed:
- Visualization( AS, CT)
Almost always in patients with sphincter problems of Oddi there is a constriction that occurs as a resultchronic inflammation and fibrosis.
When starting diagnosis, the first thing you need are liver samples and signs of amylase activity in the serum. Then follow procedures such as ultrasound and computed tomography in the abdominal area. You may also need to go through endosonography. This is necessary in order to make sure of the absence of other diseases, especially the presence of stones in the bile ducts.
Enzymes in the blood serum are usually examined during the pain attacks themselves, as during this period their activity tends to increase. But sometimes it can indicate other diseases, for example, cancer, kidney stone disease or liver problems. And if the disease is an expansion of the biliary tract. This can tell the results of ultrasound or computed tomography.
Spasms and other problems of the sphincter of Oddi can be determined with the help of manometry. The essence of this method is to measure the contractile abilities of the sphincter of Oddi. But this method is not practiced in all clinics and its minus is that it can lead to complications. Therefore, non-invasive methods are more often used. There are several, for example, a common measurement of the diameter of the bile duct after its stimulation. Deposits can be avoided if we perform cholangiography, this is a magnetic resonance method.
Methods of treatment of sphincter Oddi
Regarding the treatment of spasms and other diseases of the sphincter of Oddi, it can be said that for each patient it is selected individually, as it is currently being studied. For each individual case, one can not say for certain that no complications will occur, that is, treatment is not completely determined and can only be considered as a preliminary measure. Among the number of drugs used are nitroglycerin and nifedipine.
Treatment of the sphincter of Oddi is mainly to relieve pain, but about 30% of all patients experience complications. In case the sphincter narrows. Treatment may be generally ineffective. Such a method as sfunukteroplastika, implies surgical intervention. You can do a sphincter lift or an incision in general, but this method is not suitable for all patients. But on the question whether it is possible to cure the sphincter of Oddi completely, the answer will be rather negative. Treatment usually involves a sphincterotomy, but as practice shows, at least 55% of cases can be achieved at best with no pain, which is also a good indicator.
Most often, in case of complications, inflammation of the pancreas can be observed.it happens somewhere in 25% of all cases. The spasm of the sphincter of Oddi can still be treated with spasmolytics. One of the drugs of spasmolytic action is Duspatalin. Take it 2 times a day for 200 mg. The course of treatment involves a long 24 weeks. The drug works in a way that reduces the possibility of penetration of smooth muscle cells and stops the depolarization of potassium cations, this prevents the possibility of developing hypotension.
This method can really completely normalize and stabilize the work of the sphincter of Oddi. Spasms and other disorders of the sphincter of Oddi is by far a topic far from completion. There are still many studies to be done, to develop more effective drugs, but after reading this article, you probably learned something new and perhaps very important. The main thing to remember is that you should not try to engage in self-medication if you do not have the proper education and knowledge in this area.
If you feel any of the aforementioned ailments, be sure to see a doctor, only he can more accurately establish the correct diagnosis and make the right decisions. The methods indicated in this article are taken from the world medical practice and the data in statistics may be inaccurate, since the number of patients with sphincter dysfunction of Oddi has changed in comparison with the data of the past years.
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