Biliary dyskinesia overview: Difference between revisions
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=== 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) | [[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]] disorders (SOD) 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. [[Non-invasive (medical)|Noninvasive]] procedures that may be used to evaluate and diagnose [[ | [[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. [[Non-invasive (medical)|Noninvasive]] procedures that may be used to evaluate and diagnose [[sphincter of Oddi]] disorders (SOD) are: [[ultrasound]], [[HIDA scan]], and [[Magnetic resonance cholangiopancreatography|MRCP]]. | ||
=== Other Diagnostic Studies === | === Other Diagnostic Studies === | ||
[[Endoscopic retrograde cholangiopancreatography|ERCP]] and [[ | [[Endoscopic retrograde cholangiopancreatography|ERCP]] and [[sphincter of Oddi]] manometry may be used to rule out functional biliary [[sphincter of Oddi]] disorder (SOD) in patients who have had a cholecystectomy. Although [[sphincter of Oddi]] manometry is the diagnostic tool for evaluating [[sphincter of Oddi]] disorders (SOD), it is an [[Invasive (medical)|invasive]] procedure and has risk for [[Complication (medicine)|complications]]. | ||
== Treatment == | == Treatment == | ||
=== Medical Therapy === | === Medical Therapy === | ||
Medical therapy mostly includes of [[symptomatic treatment]] of [[abdominal pain]] and [[Intravenous therapy|IV]] [[Opiate|opiates]] are the drug of choice, although some studies have suggested that [[Opiate|opiates]] cause [[ | Medical therapy mostly includes of [[symptomatic treatment]] of [[abdominal pain]] and [[Intravenous therapy|IV]] [[Opiate|opiates]] are the drug of choice, although some studies have suggested that [[Opiate|opiates]] cause [[sphincter of Oddi]] contraction. | ||
=== Surgery === | === Surgery === | ||
[[Laparoscopic]] [[cholecystectomy]] is used to treat biliary dyskinesia. Endoscopic biliary [[sphincterotomy]] is performed in patients with [[sphincter of Oddi]] disorder (SOD) diagnosed by manometry. | |||
=== Cost-Effectiveness of Therapy === | === Cost-Effectiveness of Therapy === |
Revision as of 11:58, 13 August 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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 disorders (SOD) 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. Noninvasive procedures that may be used to evaluate and diagnose sphincter of Oddi disorders (SOD) are: ultrasound, HIDA scan, and MRCP.
Other Diagnostic Studies
ERCP and sphincter of Oddi manometry may be used to rule out functional biliary sphincter of Oddi disorder (SOD) in patients who have had a cholecystectomy. Although sphincter of Oddi manometry is the diagnostic tool for evaluating sphincter of Oddi disorders (SOD), it is an invasive procedure and has risk for complications.
Treatment
Medical Therapy
Medical therapy mostly includes of symptomatic treatment of abdominal pain and IV opiates are the drug of choice, although some studies have suggested that opiates cause sphincter of Oddi contraction.
Surgery
Laparoscopic cholecystectomy is used to treat biliary dyskinesia. Endoscopic biliary sphincterotomy is performed in patients with sphincter of Oddi disorder (SOD) diagnosed by manometry.