Biliary Dyskinesia

Condition: Biliary Dyskinesia

Overview (“What is it?”)

  • Definition:  Biliary dyskinesia is a condition in which the gallbladder does not squeeze well and the bile does not drain out of the gallbladder properly. The term “dyskinesia” is a combination of two terms “dys” which means abnormal and “kinesia” which refers to movement (abnormal movement). The gallbladder is an organ located underneath the liver in the upper right part of the belly just below the ribcage. The liver makes bile and gallbladder normally stores bile. In response to a meal, the gallbladder releases bile released into the small intestine to aid in breaking down (digestion) of foods.
  • Epidemiology:  Biliary dyskinesia occurs mostly in older children and adults. It has become a common diagnosis in children and in some hospitals is the most common reason for gallbladder removal. It may be related to chronic inflammation of the gallbladder (cholecystitis). Usually, in biliary dyskinesia, there is no stones in the gallbladder.
biliary dyskinesia

Figure 1. Biliary dyskinesia (also called gallbladder dyskinesia)


Signs and Symptoms (“What symptoms will my child have?”)

  • Abdominal pain (usually in the region of the right upper belly, by the place where the gallbladder is located) that typically occurs after meals, particularly fatty meals. The pain can be sudden (acute) or can be frequent, and recurrent over a long period of time (chronic). This is called “biliary colic".
  • Nausea, vomiting and not wanting to eat (poor appetite) can also be seen in children with biliary dyskinesia.
     

Diagnosis (“What tests are done to find out what my child has?”)

  • Physical examination usually is unremarkable unless the child is having symptoms. During painful episodes, the patient may complain of right upper abdominal tenderness.
  • Ultrasound:  Can look for gallstones, which can cause similar symptoms. There are no stones in biliary dyskinesia. In this test, a probe is applied on the belly directly overlying the gallbladder. The probe uses sound waves to get an image of the gallbladder.
  • HIDA scan (also known as cholescintigraphy or hepatobiliary scintigraphy) tests how well the gallbladder empties. In this test, a tracer is injected into the blood of the child. This tracer is taken up by the liver and is concentrated in the gallbladder (like bile). After the tracer is given, the patient is given injection of a medicine called cholecystokinin (CCK) or allowed to eat a fatty meal like a hamburger. Both CCK and a fatty meal are signals for the gallbladder to squeeze. This may cause your child pain when the CCK is injected. Normally when the gallbladder squeezes, it dumps out most of the bile. In biliary dyskinesia, the gallbladder may only squeeze out about 35-40% or less of the total gallbladder contents. Incomplete and sluggish emptying causes the gallbladder to be irritated and cause pain. This tracer for this test has a small amount of radioactivity which will NOT be harmful to your child as it is cleared from the body quickly and completely with the poop.
  • Blood tests:  May be ordered to check your child’s white blood cell count, bilirubin levels, liver function tests and pancreatic enzymes. In most cases, these tests are normal in biliary dyskinesia.
  • Conditions that mimic this condition: Cholelithiasis (gallstones), cholecystitis (infection or inflammation of the gallbladder), hepatitis (inflammation of the liver), gastritis (inflammation of the stomach), stomach or duodenal ulcers, and pancreatitis (inflammation of the pancreas).

Treatment (“What will be done to make my child better?”)

  • If a child appears to have symptoms of this condition and the ejection fraction on the HIDA scan is low, surgery to remove the gallbladder is recommended.
  • Laparoscopic cholecystectomy (removal of the gallbladder) is the standard of care today. The surgery is performed through small incisions in the abdomen using a camera and special tools.
  • Risks of surgery:  Conversion to open surgery (larger incision in the abdomen), common bile duct injury, bile leaks, bleeding, and infection. Some of these complications can require further surgery. These complication risks are low but should be discussed by your surgeon.

Long-Term Outcomes (“Are there future conditions to worry about?”)

Even after surgical removal of the gallbladder, there is no guarantee that symptoms will resolve. This is because the diagnosis may not be exact, and it may be difficult to tell whether the cause of symptoms is from the gallbladder or is due to another problem such as acid problems in the stomach. It is therefore important to rule out other causes of belly pain before your child undergoes removal of the gallbladder.

References:

  1. O'Neill: Principles of Pediatric Surgery. ©'2003, Elsevier.
  2. Holcomb: Ashcraft’s Pediatric Surgery, Sixth Edition. ©o2014, Elsevier Inc.
  3. Coran: Pediatric Surgery, Seventh Edition © 2012, 2006 by Saunders, an imprint of Elsevier Inc.
  4. NIH Medline, https://www.nlm.nih.gov/medlineplus/ency/article/000273.htm.

Updated: 11/2016
Authors: Romeo C. Ignacio, Jr., MD; M. Vu, MD
Editors: Patricia Lange, MD; Marjorie J. Arca, MD