Sphincter of Oddi dysfunction
Sphincter of Oddi dysfunction | |
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gall bladder has been removed, and the liver has been lifted off the tree. | |
Specialty | Gastroenterology, general surgery |
Sphincter of Oddi dysfunction refers to a group of
Individuals with sphincter of Oddi dysfunction present with abdominal pain resembling that of structural or inflammatory disorders of the gallbladder, biliary tree or pancreas. Among other characteristics, the pain is typically in the upper part of the abdomen or in the right upper quadrant of the abdomen, lasts 30 minutes or longer, and is not associated with a structural abnormality that could lead to these symptoms. The disorder is classified into two subtypes: functional biliary sphincter of Oddi disorder, where there is no disturbance in pancreatic enzyme measurements, such as amylase and lipase; and, functional pancreatic sphincter of Oddi disorder, where pancreatic enzyme measurements are elevated.
Attacks can be precipitated by opioid analgesics,[1] particularly in patients having undergone a cholecystectomy or bariatric surgery.
Classification
Functional disorders of the gallbladder, bile duct and pancreas have been defined and classified by the Rome criteria for functional gastrointestinal disorders.[2] The criteria outline three variants of functional disorders of the gallbladder, bile duct and pancreas, termed functional gallbladder disorder, functional biliary sphincter of Oddi disorder and functional pancreatic sphincter of Oddi disorder. All of the following criteria need to be met for as part of the definition of a functional disorder of the gallbladder:[2]
- the pain must be located in the upper part of the abdomen and/or the right upper quadrant of the abdomen
- episodes of pain must last at least 30 minutes
- the symptoms must be recurrent, and occur at differing intervals
- the pain must incrementally increase to a "steady level"
- the pain must be severe enough the patient's daily activities are affected, or that the patient must attend the emergency department
- the pain must not be relieved by any of bowel movements, change in posture, or antacids; and,
- other structural disorders that could explain the symptoms must be excluded.
Functional gallbladder disorder
Individuals are classified as having a functional gallbladder disorder if the above criteria are met, if the gallbladder is present, and if the testing of liver enzymes, conjugated bilirubin, and pancreatic enzymes (amylase and lipase) are normal.[2]
Functional biliary sphincter of Oddi disorder
If all of the above criteria are met, individuals are classified as having a functional biliary sphincter of Oddi disorder, if the testing of pancreatic enzymes (amylase and lipase) is normal.[2]
The old Milwaukee classification of biliary sphincter of Oddi dysfunction (SOD) used to divide the condition into three subtypes:
Characteristics
Sphincter of Oddi dysfunction may be suggested by pain which seems to come from a biliary origin, which may or may not be associated with transient increases of liver or pancreatic enzymes. Common bile duct dilation and episodes of pancreatitis are also signs.[5]
Pathophysiology
Two mechanisms are involved in the development of sphincter of Oddi dysfunction, either or both of which may be contributory to the condition:
Diagnosis
For diagnosis, measures of liver biochemistry and pancreatic enzymes are performed. Along with ruling out structural abnormalities, normally by performing an abdominal ultrasound and endoscopic retrograde cholangiopancreatography (ERCP). Measurements of bile transit when performing ERCP are taken to help evaluate different treatment options.[5] Sphincter of Oddi dysfunction is best diagnosed using manometry-an internal test done to measure the pressures within surrounding ducts to determine whether or not the muscle is functioning normally.
Treatment
Medication (to prevent spasms) or sphincterotomy (surgical procedure to cut the muscle) are the standard treatments for sphincter of Oddi dysfunction. One or the other may be better based on the classification of the condition.
See also
References
- ^ https://web.archive.org/web/20080731060352/http://www.anzca.edu.au/fpm/events/fpm-events/1-CBell.pdf[full citation needed]
- ^ a b c d Rome Foundation. "Rome III Diagnostic Criteria for Functional Gastrointestinal Disorders" (PDF). Rome Foundation. Retrieved March 16, 2014.
- PMID 12858608.
- PMID 24867013.)
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: CS1 maint: multiple names: authors list (link - ^ PMID 12974506.
- S2CID 205465037.