Biliary dyskinesia: diagnosis and management in pediatric patients

Biliary dyskinesia is a functional disorder of the gallbladder that is sometimes a diagnosis of exclusion that overlaps with other GI and intestinal problems such as dyspepsia or dysmotility.

Diagnostic symptoms include intense right upper quadrant pain that often peaks between 30 and 60 minutes after onset and takes several hours to resolve afterwards.

The pain can be associated with nausea and vomiting and diaphoresis and oftentimes occurs at infrequent intervals, not necessarily related to any type of food intake or fasting.

The symptoms of biliary dyskinesia can often interrupt the activities of daily living of the patients or even lead to emergency department visits.

Biliary dyskinesia most often affects adolescents and teenagers, but sometimes can affect younger children.

The diagnostic workup of biliary dyskinesia includes a liver function panel including transaminases and bilirubin levels, as well as a right upper quadrant ultrasound and cholecystokinin HIDA scan.

The definitive therapy for biliary dyskinesia is laparoscopic cholecystectomy.

In up to 40% of patients, symptoms will not resolve after cholecystectomy.

Postoperatively, patients are typically admitted for a 23-hour observation period to control pain and make sure they can tolerate a diet.

In some very limited situations, when discussed preoperatively, some patients do request to go home the same day.

Patients typically return to their normal state of health in approximately two weeks after surgery, although patients oftentimes will return to school or their normal activities in only several days.