Diagnosis of Biliary Dyskinesia

In order to verify the diagnosis a set of additional methods should be used:

• Biochemical blood tests – during an intense “flare up” of the disease, levels of conjugated bilirubin and alkaline phosphatase may rise. This happens as a result of reabsorption of the bile as it is unable to leave the biliary ducts and flow into duodenum.
• Ultrasound imaging of the gallbladder and liver – this allows to exclude gallstones as the cause of obstruction of the biliary ducts. Ultrasound is the main method for finding gallstones, and its reliability exceeds 95%.

• Duodenoscopy is used in order to collect bile samples from the gallbladder. This procedure can also be used as a treatment by washing out the bile that remained in the gallbladder for too long. For this purpose a warm mineral water is used. This procedure has to be done first thing in the morning before the patient has any meals.
  
  
  
  
  
  
  
• Secretin test – this test involves injecting a special hormone called secretin intravenously. Secretin causes an increase in bile secretion. After that if there is something which prevents the bile from leaving the gallbladder, it can be easily detected using ultrasound imaging.
• Cholescintigraphy - is a very popular method which involves using a radioactive isotope 99Tc to visualize the gallbladder and the biliary system. This method can detect gallstones and any malformation of the biliary system. It can also be used to perform gallbladder ejection fraction which determines how fast the bile leaves the gallbladder and how much of it is left behind once the gallbladder contracts. If more than 40% of the bile is left behind, than a gallbladder dyskinesia is diagnosed. It can also determine whether the patient has hyper- or hypokinetic form of gallbladder dyskinesia.
• Sphincter of Oddi manometry should always be used in order to diagnose biliary or pancreatic sphincter of Oddi dysfunction. This procedure is performed by using an endoscope to reach the duodenum. Then a catheter (a small plastic tube) is passed through the endoscope and guided into the bile ducts and pancreatic ducts. This catheter is connected to a computer which can read the pressure exhibited on the end of the tube. If the pressure exhibited on the tube by the sphincter is too big, the doctor may choose to perform a sphincterotomy (make a small incision in the sphincter) in order to reduce the pressure. This procedure often relieves the patient of all the symptoms of biliary dyskinesia.