Under akalkulösem biliary pain is meant biliary colic in the absence of gallstones due to structural or functional disorders. Sometimes they are treated with a laparoscopic cholecystectomy.
(See also Overview biliary function.)
Under akalkulösem biliary pain is meant biliary colic in the absence of gallstones due to structural or functional disorders. Sometimes they are treated with a laparoscopic cholecystectomy. (See also Overview biliary function.) Biliary colic can occur in the absence of gallstones, particularly in young women. Akalkulöse biliary pain accounts for up to 15% of laparoscopic cholecystectomy. Common causes of such bile pain: Microscopic stones that are not detected by routine ultrasound examination abnormal gallbladder emptying An overly sensitive biliary sphincter develop Oddi dysfunction hypersensitivity of the adjacent duodenum may gallstones that have already gone off spontaneously, some patients ultimately other functional gastrointestinal Diseases. Diagnosis unclear Most sonography and possibly Choleszintigraphie and / or ERCP The best diagnostic approach remains unclear. The suspected akalkulösen biliary pain exists in patients with biliary colic, in which no gallstones can be detected by diagnostic imaging. The imaging should sonography and, where available, (small stones <1 cm) include endoscopic ultrasonography. Abnormal laboratory values ??can evidence an abnormality of the biliary tract (eg. B. elevated alkaline phosphatase, bilirubin, ALT or AST), or a pancreatic anomaly (eg. As increased lipase) enter during an episode of acute pain. The Choleszintigraphie with a cholecystokinin infusion measures the gallbladder emptying (ejection fraction); potentially including pregnant substances such as calcium channel blockers, opioids and anticholinergics should not be taken simultaneously. An endoscopic retrograde cholangiopancreatography (ERCP) with biliary manometry can detect a sphincter of Oddi dysfunction. Therapy unclear, but occasionally a laparoscopic cholecystectomy laparoscopic cholecystectomy improves treatment outcomes in patients with microscopic stones and probably in abnormal Gallenblasenmotilität. The role of laparoscopic cholecystectomy or endoscopic sphincterotomy remains open. Drug therapies have no proven benefit.