Internal Medicine

0521779407-B01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:52

Biliary Tract Motility Disorders 235

Biliary Tract Motility Disorders..........................

GEORGE TRIADAFILOPOULOS, MD

history & physical

■clinical syndromes of biliary or pancreatic obstruction related to

mechanical or functional abnormalities of the sphincter of Oddi

(SO)

■terms papillary stenosis, sclerosing papillitis, biliary spasm, biliary

dyskinesia, post-cholecystectomy syndrome and sphincter of Oddi

stenosis or dysfunction (SOD) used interexchangeably

■sphincter of Oddi stenosis an anatomic abnormality associated with

narrowing of the SO; sphincter of Oddi dyskinesia a spastic distur-

bance of the SO, leading to intermittent biliary obstruction

■female gender and generalized intestinal dysmotility most frequent

risk factors

■SOD may affect patients who have undergone cholecystectomy

(post-cholecystectomy syndrome)

Signs & Symptoms

■sphincter of Oddi dysfunction may cause biliary pain and pancre-

atitis

■RUQ pain most common symptom: steady, not colicky and subsides

within a few hours

■radiation of pain to back, epigastrium and the right shoulder may

occur

■nausea and vomiting may be present

■pain may be in the epigastrium radiating to the back and relieved

with fetal position

■complaints of gas, bloating or dyspepsia nonspecific and should not

be attributed to a biliary motor disorder

■localized tenderness in the RUQ or epigastrium with or without a

positive Murphy’s sign

■jaundice unusual

tests

Basic Tests

■increased bilirubin, amylase, lipase, aminotransferases and alkaline

phosphatase