Biliary Dyskinesia
Tardive dyskinesia, which is the result of the side effects of certain antipsychotic or neuroleptic medications used to treat schizophrenia, is one of many movement disorders. Tardive dyskinesia can share symptoms with other such movement disorders, although the cause is virtually always due to side effects of certain medications, which is not necessarily true of many other movement disorders.
Neuroleptic medications, which are essentially dopamine antagonists or inhibitors, are also used to treat two specific digestive disorders: diabetic gastroparesis (full or partial paralysis of the stomach muscles) and more commonly, gastroesophageal reflux disease. This is the connection between tardive dyskinesia and another essentially unrelated movement disorder that affects the gallbladder called biliary dyskinesia.
The Gallbladder
The purpose of the gallbladder is to aid in the digestive process by collecting and concentrating bile from the liver. Bile is released when food with high fat content enters the stomach. This helps facilitate the breakdown of fat molecules sothey can be absorbed in the digestive tract.
The valve that controls the flow of bile into the upper small intestines is called the Sphincter of Oddi (named for the late 19th - early 20th century Italian physician who first described its physiological function). When this valve fails to operate correctly, there is a backup of bile in the gallbladder, causing serious abdominal cramping and pain.
Biliary dyskinesia is only one of several types of "Sphincter of Oddi" Disorders (SODs). As is the case with other movement-related conditions, the muscles that allow the organ to contract and function do not operate properly.
Causes and Symptoms
Biliary dyskinesia is more often a symptom than a disorder in and of itself. The symptom may be indicative of gallstones, pancreatitis or related to gallbladder surgery and symptoms may be brought on by certain kinds of food. Chronic inflammation may be a cause. There is also evidence to suggest that stress is a significant factor. At least one theory points to dopamine receptor dysfunction. It is possible that the gallbladder fails to receive the proper signal from the brain when bile enters the chamber.
The most obvious sign of an SOD is a sharp, intermittent cramp-like pain just beneath the right bottom rib. However, many patients experience few, if any symptoms. Others may feel only a vague discomfort or dull ache in this region. Most often, this pain is localized and appears approximately 40 minutes or so after the patient has eaten a meal high in fat content. Nausea may also occur, though actual vomiting is rare.
Diagnosis, Risk Factors and Treatment
Most types of gallbladder disorders have similar symptoms. An extensive differential diagnosis is usually necessary in order to rule out other conditions such as gallstones or even cancer. A physician will usually run blood tests first, then follow up with an ultrasound examination. If these results come out negative, there will be testing and imaging in order to measure gallbladder function. A procedure called a cholecystokinin cholescintigraphy may be performed. This involves injecting a substance into the bloodstream that is taken up by liver cells and the substance will show up in a CAT scan.
While there are many risk factors for gallbladder disease in general, there are few known to be specific to biliary dyskinesia. Obesity, age and gender are all known to be factors. Older women who are overweight are more likely to suffer from biliary dyskinesia than men.
The usual treatment for biliary dyskinesia is laparoscopic cholcystectomy, which is complete removal of the gallbladder. However, in some patients, this type of surgery is not the cure, but the cause as symptoms have been known to develop after such surgery has been performed.
© 2010 TardiveDyskinesia.com Last Modified Thursday, May 21st, 2009
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