Biliary Dyskinesia

Biliary dyskinesia is a functional disorder of the gallbladder.  This means that there is no blockage or anatomical problem of the gallbladder.  Imaging of the gallbladder is often normal.  The gallbladder is not working correctly to eject bile and help with digestion.

What is biliary dyskinesia?

There is a breakdown in the functioning of the gallbladder.  Normally the gallbladder will store bile made by the liver.  The gallbladder will then eject the bile into the bile duct.  This bile then reaches the intestine and helps with digestion.

In biliary dyskinesia, the gallbladder does not eject enough bile.  There is back up of bile and distention of the gallbladder.  This is similar to what a gallstone does when it blocks the gallbladder.   There can also be problems with digestion.

Symptoms of biliary dyskinesia

Symptoms are that of gallbladder attacks.  The pain is similar to patients who have gallstones.  Pain is usually severe in the right upper abdomen.  This can be associated with nausea and vomiting.  Pain is often associated with eating fatty meals.  Blood tests are often normal.  The pain often goes away on its own after hours.

How is biliary dyskinesia diagnosed?

Biliary dyskinesia is diagnosed with a nuclear medicine HIDA scan and measurement of gallbladder ejection fraction.  We inject a small amount of radiopharmaceutical into the patients vein.  This then travels to the liver, is excreted into the bile ducts, fills the gallbladder and moves into the intestines.

We then administer cholecystokinin which causes the gallbladder to release the stored bile and injected radiopharmaceutical.  We measure how much of the radiopharmaceutical is ejected from the gallbladder after 1 hour.  We measure something called a gallbladder ejection fraction.  An ejection fraction below 40% indicates gallbladder dysfunction or dyskinesia.

Nuclear medicine HIDA scan for biliary dyskinesia

HIDA scan is used to diagnose biliary dyskinesia as outlined above.  The HIDA scan is done with the addition of a gallbladder ejection fraction calculation.  A low gallbladder ejection fraction indicates gallbladder dysfunction.

What else can look like biliary dyskinesia in radiology?

Imaging the gallbladder shows normal anatomy.  It is only the function of the gallbladder which is abnormal.  The diagnosis is confirmed by typical clinical symptoms and a low gallbladder ejection fraction on the nuclear medicine HIDA scan.

Other testing will be needed to exclude any other conditions before a diagnosis of biliary dyskinesia is made.  This may include CT and MRI imaging of the abdomen.

What causes biliary dyskinesia?

The exact cause is unknown.  Many causes have been proposed like hormonal imbalances, stress, obesity and inflammation.

Is biliary dyskinesia dangerous?

The condition is not dangerous in itself.  It can cause severe symptoms which can mimic more serious conditions.

What type of doctor treats biliary dyskinesia?

A general surgeon who is skilled in gallbladder surgery.

Biliary dyskinesia treatment

The most effective treatment is removal of the gallbladder or cholecystectomy.

Biliary dyskinesia: summary

Biliary dyskinesia is a functional disorder of the gallbladder of unknown cause.  The gallbladder has no anatomic abnormalities and imaging and lab tests are often normal.

The diagnosis is made by a nuclear medicine HIDA scan with addition of gallbladder ejection fraction calculation.  A low gallbladder ejection fraction indicates gallbladder dyskinesia or dysfunction.  Definitive treatment is removal of the gallbladder.