Biliary Dyskinesia
(Problems with gallbladder squeezing)
A problem that occurs mostly in older children and adults is biliary dyskinesia. This happens when the gallbladder does not squeeze properly and the bile does not drain out of the gallbladder properly. It may be that biliary dyskinesia has some connection to chronic cholecystitis (see above). There is often a delay in diagnosis of patients with this condition because ultrasound does not show gallstones. These patients have a history of nausea and intermittent right upper abdominal pain that usually occurs after meals.
The diagnosis of biliary dyskinesia may be difficult and may not be exact. It may be diagnosed with cholescintigraphy (see above) combined with the injection of a medicine called cholecystokinin. This hormone causes the gallbladder to squeeze. Normally when the gallbladder squeezes most of the bile is squeezed out into the intestine to help digest food. Patients with biliary dyskinesia may only squeeze out about 35-40% or less of the total gallbladder contents. This is called an ejection fraction. If a child appears to have symptoms of this condition and the ejection fraction is less than 35-40%, gallbladder removal is recommended, although the patient and family should understand that 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.
Article and graphics adapted from O'Neill: Principles of Pediatric Surgery. © 2003, Elsevier.