STUDIES ON BILIARY DYSKINESIA

Abstract

In 35 patients with the so-called gall duct syndrome, in whom no stone was roentgenologically detected in the biliary system and neither inflammatory findings, gall sand, nor bacillus (by 48 h. culture in blood agar) was observed in the duodenal fluid, roentgenography with Biligrafin was made to examine the bladder and duct as an entity. The appearance of these organs was roentgenographically classified into three types: tonic, flaccid and normal. Next in each type the therapeutic effects of various agents were examined and the improvement in the treatment was attempted. The results obtained were as follows:1. The most frequent abnormality was the prolongation of the common duct visible time accompanied with the dysfunction of the gall bladder contraction which was found in 34% of the patients. Other abnormalities were, in the order of the frequencies: dilatations of the hepatic duct (29%), gall bladder (26%), and common duct (23%), insufficient cholecystography (17%), and abnormally shaped (14%), contracted (9%) and ptosed gall bladder (3%).2. There was a parallelism between the dilatation of the hepatic duct and that of the common duct. However, the prolongation of the common duct visible time did not always parallel its dilatation. In no case with the dilated gall bladder the prolongation of the common duct visible time was observed. No correlation was found either between the dilatation of the common duct and that of the gall bladder or between the disturbance of the contracting function or morphological abnormality of the gall bladder and the density of its shadow on the roentgenogram.3. With special reference to the chronological change in the density of the roentgenographical shadow of the common duct, dyskinesia was classified. The frequencies were: tonic 34%, flaccid 26%, and normal 40%.4. Therapeutic effects. A cholagogue (magnesium sulfate solution) and choleretic (dehydrocholic acid) were effective both in the tonic and flaccid types, especially in the latter. No effect was observed in the normal type. Antibiotics (Mycilin, Chloromycetin) were not effective in any type. Autonomic nervous system blockades (Buscopan, atropin) were effective only in the tonic type. Chlorpromazine or meprobamate was effective in the normal type and not so effective in the tonic and flaccid types. Grelan and barbiturates showed no specific therapeutic effect in any type.