Functional disorders of the biliary tract in children. Types of bile disorders in children.
Not coordinated, weak or rapid contraction of the gallbladder (CGB) and its sphincters, which is controlled by the endocrine and nervous systems, not always accompanied by clinical symptoms. It occurs in healthy children too, it is norm option – not pathology, but the continued existence of this dysfunctions usually causes of morphological changes. Violation of passage of bile at the same time happens because of failure working of complex set of regulatory actions as neuroendocrine (hormones gastrin, secretin, glucagon, etc.) and nervous system too (vagosympathetic and interoceptive exposure).
During cholecystosonography, depending on the condition of the biliary tract motility in children, are the following types of problems:
I – a little changes in motility of biliary tract within norm (normotensive normorkinetic type);
III – Increasing TSO together with the increase in contractile function of the gallbladder (hypertonic hyperkinetic type);
IV – an isolated reduction in TSO (hypotonic normorkinetic type);
V – TSO reduction with increased contractility of the gallbladder (hypotonic hyperkinetic type);
VI – isolated increase in contractile function of the gallbladder (normotensive hyperkinetic type);
VII – isolated delay of bile flow with increased TSO (delay of release of bile within 15 minutes; the delayed hypertensive normorkinetic type);
VIII – the flow of bile at a later time (after 15 minute) with increased contractile function of the gallbladder (delayed hypertonic hyperkinetic type).
It should be noted that after meal test has turned a paradoxical response – 16.6% of children – instead of cutting the sphincter of Oddi and increasing relaxation of the gallbladder has its volume after 5 minute decreases, and VII and VIII when observed delayed spasm of the sphincter of Oddi.
The increase in gallbladder volume occurs after the 15 minutes (16.7% of children). This allows you to highlight these types separately, as a variant of the individual standards.
In children with biliary dysfunction defined by two variants contractility DGP:
IX – increasing TSO with reduced ability of the DGP (hypertonic hypokinetic type);
X – an isolated decrease in the ability of the DGP (normotensive hypokinetic type).
Some of the identified types of biliary tract disfunctions do not violate the passage of bile. This is because of the features of vegetative regulation inherent in this age. These data suggest that the predictive criteria prenosological state violations of the biliary tract is the deadline for reducing the gallbladder and the presence of hypokinetic type of it movement, like a marker of impaired biliary tract function in young students is not so much the state of the sphincters as the gallbladder, it is a hypokinetic contraction.