Biliary dyskinesia overview: Difference between revisions
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=== CT === | === CT === | ||
[[Computed tomography|CT scan]] is not helpful in [[gallbladder]] or biliary diseases. | [[Computed tomography|CT scan]] is not helpful in [[gallbladder]] or biliary diseases. | ||
=== Ultrasound === | === Ultrasound === | ||
[[Ultrasound]] is required in these patients in order to exclude structural conditions such as [[gallstone disease]] or [[cancer]]. [[Ultrasound]] may be used in order to diagnose [[Sphincter of Oddi|sphincter of oddi (SOD)]] disorders by measuring the [[Common bile duct|common bile duct (CBD)]] diameter. | [[Ultrasound]] is required in these patients in order to exclude structural conditions such as [[gallstone disease]] or [[cancer]]. [[Ultrasound]] may be used in order to diagnose [[Sphincter of Oddi|sphincter of oddi (SOD)]] disorders by measuring the [[Common bile duct|common bile duct (CBD)]] diameter. | ||
=== Other Imaging Findings=== | === Other Imaging Findings=== | ||
[[HIDA scan|Hepatobiliary iminodiacetic acid (HIDA)]] with an abnormal [[gallbladder]] ejection fraction (<40%) is a supportive criteria for diagnosing biliary dyskinesia but is not required for the [[diagnosis]] anymore.<ref name="pmid30846030">{{cite journal| author=Clark CJ| title=An Update on Biliary Dyskinesia. | journal=Surg Clin North Am | year= 2019 | volume= 99 | issue= 2 | pages= 203-214 | pmid=30846030 | doi=10.1016/j.suc.2018.11.004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30846030 | [[HIDA scan|Hepatobiliary iminodiacetic acid (HIDA)]] with an abnormal [[gallbladder]] ejection fraction (<40%) is a supportive criteria for diagnosing biliary dyskinesia but is not required for the [[diagnosis]] anymore.<ref name="pmid30846030">{{cite journal| author=Clark CJ| title=An Update on Biliary Dyskinesia. | journal=Surg Clin North Am | year= 2019 | volume= 99 | issue= 2 | pages= 203-214 | pmid=30846030 | doi=10.1016/j.suc.2018.11.004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30846030 }} </ref> [[Non-invasive (medical)|Noninvasive]] procedures that may be used to evaluate and diagnose [[Sphincter of Oddi|SOD]] disorders are: [[ultrasound]], [[HIDA scan]], and [[Magnetic resonance cholangiopancreatography|MRCP]].<ref name="pmid16842450">{{cite journal| author=Sgouros SN, Pereira SP| title=Systematic review: sphincter of Oddi dysfunction--non-invasive diagnostic methods and long-term outcome after endoscopic sphincterotomy. | journal=Aliment Pharmacol Ther | year= 2006 | volume= 24 | issue= 2 | pages= 237-46 | pmid=16842450 | doi=10.1111/j.1365-2036.2006.02971.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16842450 }} </ref> | ||
=== Other Diagnostic Studies === | === Other Diagnostic Studies === | ||
[[Endoscopic retrograde cholangiopancreatography|ERCP]] and [[Sphincter of Oddi|Sphincter of Oddi (SOD)]] manometry may be used to rule out functional biliary [[Sphincter of Oddi|sphincter of Oddi (SOD)]] disorder in patients who have had a cholecystectomy.<ref name="pmid30846030">{{cite journal| author=Clark CJ| title=An Update on Biliary Dyskinesia. | journal=Surg Clin North Am | year= 2019 | volume= 99 | issue= 2 | pages= 203-214 | pmid=30846030 | doi=10.1016/j.suc.2018.11.004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30846030 }} </ref> Although [[Sphincter of Oddi|SOD]] manometry is the diagnostic tool for evaluating [[Sphincter of Oddi|SOD]] disorders, it is an [[Invasive (medical)|invasive]] procedure and has risk for [[Complication (medicine)|complications]]. | [[Endoscopic retrograde cholangiopancreatography|ERCP]] and [[Sphincter of Oddi|Sphincter of Oddi (SOD)]] manometry may be used to rule out functional biliary [[Sphincter of Oddi|sphincter of Oddi (SOD)]] disorder in patients who have had a cholecystectomy.<ref name="pmid30846030">{{cite journal| author=Clark CJ| title=An Update on Biliary Dyskinesia. | journal=Surg Clin North Am | year= 2019 | volume= 99 | issue= 2 | pages= 203-214 | pmid=30846030 | doi=10.1016/j.suc.2018.11.004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30846030 }} </ref> Although [[Sphincter of Oddi|SOD]] manometry is the diagnostic tool for evaluating [[Sphincter of Oddi|SOD]] disorders, it is an [[Invasive (medical)|invasive]] procedure and has risk for [[Complication (medicine)|complications]]. | ||
==References== | ==References== |
Revision as of 11:02, 13 August 2020
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Overview
Biliary dyskinesia is a failure of proper movement of the sphincter of Oddi.
Failure of the biliary sphincter can be distinguished from the pancreatic sphincter.
Diagnosis
History and Symptoms
Physical Examination
Laboratory Findings
The initial laboratory work-up should include: liver function tests (AST, ALT and, total bilirubin), amylase, and lipase.
CT
CT scan is not helpful in gallbladder or biliary diseases.
Ultrasound
Ultrasound is required in these patients in order to exclude structural conditions such as gallstone disease or cancer. Ultrasound may be used in order to diagnose sphincter of oddi (SOD) disorders by measuring the common bile duct (CBD) diameter.
Other Imaging Findings
Hepatobiliary iminodiacetic acid (HIDA) with an abnormal gallbladder ejection fraction (<40%) is a supportive criteria for diagnosing biliary dyskinesia but is not required for the diagnosis anymore.[1] Noninvasive procedures that may be used to evaluate and diagnose SOD disorders are: ultrasound, HIDA scan, and MRCP.[2]
Other Diagnostic Studies
ERCP and Sphincter of Oddi (SOD) manometry may be used to rule out functional biliary sphincter of Oddi (SOD) disorder in patients who have had a cholecystectomy.[1] Although SOD manometry is the diagnostic tool for evaluating SOD disorders, it is an invasive procedure and has risk for complications.
References
- ↑ 1.0 1.1 Clark CJ (2019). "An Update on Biliary Dyskinesia". Surg Clin North Am. 99 (2): 203–214. doi:10.1016/j.suc.2018.11.004. PMID 30846030.
- ↑ Sgouros SN, Pereira SP (2006). "Systematic review: sphincter of Oddi dysfunction--non-invasive diagnostic methods and long-term outcome after endoscopic sphincterotomy". Aliment Pharmacol Ther. 24 (2): 237–46. doi:10.1111/j.1365-2036.2006.02971.x. PMID 16842450.