BILIARY DISQUINESIAS

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	BILIARY DISQUINESIAS
	*BILIARY DISQUINESIAS*

BILIARY DISQUINESIAS

Disquinesias biliary

Introduction

Digestive Apparatus

The digestive apparatus must like function assure the digestion or assimilation different foods.

The digestion consists of reducing all foods in elementary substances simpler, able to happen to the blood to be used by the organism:

• Is like a power plant (power paper),

• Is for forming the necessary materials for the construction of the cellular architecture (plastic paper).

PHYSIOLOGY

As we already know, the function of the digestive apparatus is to assure the digestion. The assimilation of different foods is obtained by its degradation in simple elements: fatty acid lipids, glúcidos in simple sugars (bears), prótidos in amino acids.

The set of these transformations needs combined mechanical and chemical actions. The mechanical actions consist of movements of mixed (stomach) and peristálticos (internal). The chemical actions require to digestive enzymes (also called diastasas). Lipasas degrades lipids, glucidasas glúcidos and the proteases the proteins.

The digestion begins in the mouth. By the mastication, the teeth crush and divide - mechanical action the foods, facilitating the contact with the enzyme to salivar, the ptialina (glucidasa) - chemical action -. Therefore, the saliva (1 l to 1.5 ls per day) attacks sugars and dampens the mucosa. It transforms foods into a doughy nourishing skittle.

The esophagus is a simple one via of step. The liquids descend by the effect of their own weight. The solid foods are impelled by the peristálticos movements, towards the stomach, tensile cavity that performs 3 functions simultaneously:

• gastric Motilidad, assuring the mixed one the foods that gives rise to the formation of quimo. This mechanical action is under the dependency of the parasimpático nervous system.

• Degradation of foods, being responsible the gastric juice that forms from:

• Acid hydrochlorate,

• protective Mucus of the mucosa and

• Pepsina, proteolytic enzyme.

The secret stomach 2 ls of gastric juice per day. The secretion is regulated by the nerves vague (order nervous) and by the gastrina (hormonal order).

• Storage of foods:

The stomach stores foods and releases quimo very progressively. The gastric evacuating becomes through píloro, in small amounts. This progressive liberation in the duodeno allows to the intestine an optimal yield. The gastric evacuation needs a total of 5 to 6 hours, depending on the composition of the food.

The essential of the digestion takes place in the duodeno and the rest of the intestine. The duodeno simultaneously receives the pancreáticos bile and enzymes. Let us see the paper of each one of them.

Intestinal Digestiòn

• the bile is secretada by the hepatocitos, it is stored in the biliary vesicle and it is excreted when the food ingestion takes place. It is constituted essentially by biliary salts and cholesterol. Its paper is the one of emulsionar greasy, transforming them into micro-drops that are more easily degradables by lipasas pancreáticas and intestinal. The bile prepares, this way, the digestion of the greasy bodies.

• On the other hand alkaline his pH neutralizes the acidity of quimo gastric.

• the pancreático juice.

The páncreas are the main source of enzymes of the digestion as they are lipasas, colesterolesterasas, glucidasas (amylase) and several proteases: tripsina, quimotripsina carboxipeptidasas, elastasa.

The pancreático juice allows the degradation of the glúcidos ones and the prótidos ones. He is only the able one to degrade fats.

• the intestinal juice.

The enterocitos also synthesize enzymes of degradation like glucidasas, proteases and perhaps lipasas.

Let us remember that they produce secretina that triggers the pancreática secretion.

With the digestion one has obtained that the complex foods can be absorbed and be assimilated.

Intestinal absorption

How takes place this absorption or assimilation?

• the intestinal vellosidades.

By its system of you fold covered by a carpet of intestinal vellosidades, the organism increases of considerable way the faying surface of the intestinal mucosa with the food. The set of vellosidades - that constitute the absorption organ represents a surface of 250 m2. He is widely vascularizado and the cells of coating - enterocitos- is specialized in the absorption function.

• the absorption.

The nutrients cross the enterocitos. Amino acids and bears are absorbed by the capillaries and follow the route sanguineous (vein carries towards the liver).

Fatty acids and glicerol are absorbed, and once in the enterocito they become to recombine forming triglicéridos; these surrounded by proteins form then microscopic drops or quilomicrones that through the lymphatic route reaches the veins and the heart, without happening through the liver.

The heavy intestine

Five to six hours after to have produced the ingestion of the food, quimo intestinal reaches the heavy intestine. The cólico transit lasts 24 hours approximately.

The nonsecret colon no digestive enzyme nevertheless, has an important paper in the reabsorción of water and mineral salts. The dehydration of quimo produces a more consistent intestinal content. The hardness of lees depends on the duration of the cólico transit.

The heavy intestine is colonized by an important saprófita bacterial flora that it acts on the glucídicos remainders of the digestion causing reactions of fermentation and on the protídicos remainders causing reactions of rotting. Both reactions are accompanied by a gas liberation.

Defecación

It is triggered when the rectal blister is full. The defecación needs the liberation the anal sphincter, constituted partly by fluted muscular fibers. It is the only element of the alimentary canal that has a voluntary operation.

The fecal skittle, is compound of food remainders nondigested.

Definition

Disquinesias biliary regroups a set of pathologies of the biliary routes that attend with upheavals in the biliary motilidad.

These biliary functional upheavals seem to be due badly to an operation of the contraction of the vesicle or colédoco. It can be also espasmos of the sphincter of Oddi or the vesicular sphincter located to the entrance of the cystic conduit.

Here the functional pathological forms will only treat, nonlitiásicas.

Two clinical pictures are described:

• Disquinesias hypotonic: the vesicle and the conduit colédoco are contracted insufficiently.

• Disquinesias hypertonic: the vesicle and colédoco are contracted too much frequently with too much violence or.

Most frequent they are disquinesias hypotonic.

Review

The liver is essential for the life. Nevertheless, it can assure his functions with a yield only 10% of the total of his functional capacities. Also it is equipped, in case of acute episodes, possibilities of fast regeneration, resisting during long time the chronic aggressions.

The hepatocitos assure two great functions: a function of synthesis and a function of excreción.

In them they are possible to be synthesized a great number of substances: proteins (albumen, globulins, proteins of the sanguineous, antitripsina coagulation, etc...), glúcidos: essentially glycogen, form of reserve and essential source of glucose, lipids (biliary cholesterol and acids) and urea. The insufficiency to hepatocelular - or insufficiency hepática- is translated in a reduction of the synthesis functions.

The excreción functions also have a great importance. The liver, that receives through the blood a great number of substances, excretes a great part of them outside the organism. For it, it uses two routes of elimination. After the metabolic transformation in the hepatocito, some substances are secretadas through the bile, others happen to the general circulation, finally being excreted, through the kidneys, by tinkles it. This route of elimination is interesting since she is the one that uses, many medicines.

The essential functions of the liver can be outlined of the following way:

Function of chemical decontamination

The liver releases of the blood the toxic substances of exogenous origin:

• Conservantes and nourishing colorantes

• Alcohol

• Some medicines, etc...

or of endogenous origin (produced by the metabolism).

Control of glucemia

Thanks to the liver, glucemia stays in the levels of 1 g by liter. The sugars of the digestion, contributed through the vein carry, are stored in the hepatocito in glycogen form (= polymeric of glucose): this function of the liver is the denominated glucogénica function. The liberation of the glycogen in glucose form allows to satisfy the power necessities with the organism.

Action on lipids

The liver synthesizes so much the cholesterol as its derivatives, the biliary salts.

Hematopoyética function

The liver regulates the metabolism of the iron and the synthesis of the hemoglobina. Also, it destroys red globules.

Sanguineous coagulation

The liver takes part in the sanguineous coagulation, making proteins of the coagulation: the fibrinógeno and the prothrombin.

2. Biliary vesicle

Since we have already seen, the bile synthesized in the hepatocitos is one of the 2 routes of excreción used to eliminate some substances, through the biliary conduits. It is formed by a 90-95% of organic water, electrolytes and compounds: biliary bilirrubina, acids, cholesterol and phospholipids.

The acids (or salts) biliary play a role in the regulation of the cholesterol and all the stages of their metabolism: intestinal absorption, hepática synthesis and excreción by the biliary routes.

The biliary salts follow the cycle whole-hepa'tico being reabsorbidas, specially at level of íleon. The fecales losses of these represent only between 20 and a 25% of the total amount.

The functions of the biliary salts are:

• colerético Effect, to stimulate the biliary secretion.

• Solubilización of biliary lipids (cholesterol).

• Solubilización and absorption of nourishing lipids in the intestine (triglicéridos, liposolubles cholesterol, phospholipids, vitamins). Emulsionan the insoluble fats, transforming them into microparticles (micelas) more easily degradables by lipasas pancreáticas and intestinal.

The alteration of its secretion can originate:

• Colestasis

• biliary Calculations

• Malabsorción of fats

The bilirrubina is a remainder of the catabolism of the hemoglobina of old red globules, destroyed by the macrophages of the reticulo-endotelial system. It is a yellow pigment formed by the juxtaposition of four pirrólicos nuclei. The increase of its plasmática concentration is the person in charge of the ictericia (yellow coloration of the skin and the mucous).

Once captured in the liver, it is united glucurónico acid to be excreted by means of the bile to the intestine.

Clinical signs

The clinical signs are of two types:

• Dolores, that can generate hepáticos cólicos attenuated that do not go accompanied of ictericia fever nor.

• diverse dispépticos Upheavals: nauseas, swelling, upheavals of the transit.

Often, they are the cause of migrañosas crises (migraña intestinal).

Treatment

1. Hygienic-dietetic treatment

• Evitar the excesses in the table: abundant meals and hiperfagia.

• Suprimir greasy and exciting foods or drinks: alcohol, coffee, spices.

• Evitar the foods that cause cólicas reactions: fresh bread, féculas, sauces.

• Evitar the excess of physical or intellectual work.

2. Bases for the treatment

It is necessary to act at two levels:

• Asegurar the drainage the biliary routes by means of colagogos and coleréticos. All increase the coleresis, that is to say, the excreción of the bile in the duodeno. The majority is of vegetal origin, and presents/displays in addition a slight laxative effect.

The colagogos facilitate the excreción of the bile, already formed, by means of the drained one of the biliary vesicle with opening of the sphincter of Oddi.

• Luchar against the pain by means of antispasmodics.

3. Fitoterapia

Medicinal plants that can be used in the treatment of disquinesias biliary

They can be of utility coleréticos of vegetal origin like Artichoke, Boldo, Fumaria, black Radish and Whiteness of Linden tree. Also antispasmodic plants like Angelica, Hinojo, Melisa, Menta and Milenrama.

Plants adapted for this disease

Artichoke

Boldo

Fumaria

Black radish

Angelica

Hinojo

Milenrama

Mint

Whiteness of Linden tree

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