David L Chengelis MD Surgery

Biliary Dyskinesia

Basics

The gallbladder is stimulated to contract, pushing concentrated bile into the bile duct, by many factors, usually food.  Generally, in between meals, the gallbladder gradually fills with bile, and upon eating, contracts to empty its contents.  If the gallbladder does not contract properly and thus does not empty its bile, pain can ensue.  This abnormal contraction may cause no symptoms, but in some people, it may result in vague cramping in the upper abdomen.  Some people may have sharp, episodic pains under the right rib cage.  Usually, food causes the symptoms.  The word Dyskinesia used for this diagnosis literally means "abnormal motion". 

Diagnosis
The symptoms of biliary dyskinesia can be the exact symptoms of many other illnesses such as symptomatic gallstones and other stomach disorders.  Therefore, testing is required to rule out other illnesses and help confirm this condition.  A routine abdominal ultrasound used to rule out gallstones is done.  Often, upper endoscopy of the stomach is performed.  Routine blood tests as described in the section on gallstones are helpful.  Usually, all these tests are normal.  No gallstones, sludge or polyps are seen in the gallbladder on ultrasound.  The next step involves nuclear medicine, tests which measure the gallbladder's uptake of bile and its ability to contract and expel bile.  Abnormal nuclear tests in the patient with a convincing history point to the diagnosis.

Treatment.
Laparoscopic cholecystectomy, removal of the gallbladder, is the treatment of biliary dyskinesia.   Careful consultation with the surgeon is very important before this surgery as the tests and history to diagnosis this condition are not as ironclad as gallstones.  Some patients may not have a resolution of all their symptoms after removal of the gallbladder.   

Laparoscopic Cholecystectomy

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