[Music] sphincter of ODI dysfunction or sod for short is a group of rare conditions that occur when the sphincter of ODI spasms Narrows or relaxes inappropriately the sphincter of ODI is a muscular valve located between the biliary tree and small intestine it's responsible for regulating the flow of bile and pancreatic juices into the small intestine and preventing reflux of intestinal content into the biliary tree with sod normal flow of bile and pancreatic juices is disrupted leading to biliary pain which is pain typically located in the upper right abdominal quadrant there are three types of sod type one consists of biliary pain elevated liver enzymes and a dilated common bile duct type two includes biliary pain and either elevated liver enzymes or a dilated common bile duct and type three includes biliary pain only the cause of sod is unclear though risk factors include being assigned fale at Birth age 20 to 50 years and a history of gallbladder removal the classic manifestation of sod includes intermittent attacks of biliary pain which is a type of kaky abdominal pain that is typically located in the upper right quadrant and can radiate to the back and shoulder the pain can be mild to severe lasts greater than 30 minutes and can resolve spontaneously these attacks feel and look similar to gallbladder attacks though some individuals with sod may not have a gallbladder other Associated signs and symptoms may include nausea vomiting and pancreatitis which is inflammation of the pancreas diagnosis of sod begins with a thorough history and physical examination typically other more common causes of biliary pain are ruled out first including gall stones if sod is suspected blood tests and imaging may be done to Aid in diagnosis blood tests may show elevated liver and pancreatic enzymes in those with types one or two Imaging of the abdomen including ultrasound CT and MRI may be done as well as a hia scan which can assess how the liver gallbladder and biliary tree are functioning the gold standard to confirm sod is an endoscopic retrograde cango pancreatography or ercp with manometry an ercp involves placing a camera down an individual's throat into their intestine to visualize the sphincter of ODI while also conducting manometry which assesses the pressure and constriction of the muscle it's important to note that while ercp with manometry is a strong diagnostic tool some individuals with sod may not have high sphincter pressure so it's important to consider all history physical examination and diagnostic evaluation results before ruling sod out response to treatment varies greatly between individuals and depends on the type of sod so a combination of non-invasive and invasive interventions can be used non-invasive treatments may include medications meant to relax the sphincter like calcium channel blockers or tricyclic anti-depressants invasive treatments can include a sphincterotomy which involves surgically cutting the sphincter of ODI to allow it to relax and botulinum toxin injections into the muscle to prevent spasms or narrowing due to the high variability in response to treatment for those that don't respond to Conventional treatments referrals should be made for management that can involve lifestyle modifications pain control and psychosocial support lifestyle modifications that may help minimize attacks include a lowfat diet pain control may include consult with a pain specialist and combination of non-pharmacologic and pharmacologic pain control methods while psychosocial support can include cognitive behavior therapy and other alternative therapies to help individuals manage the condition all right as a quick recap sphincter of ODI dysfunction is a group of rare conditions with an unknown cause that occur when the sphincter of ODI spasms Narrows or relaxes inappropriately preventing the normal flow of bile and pancreas itic juices into the intestines signs and symptoms include intermittent attacks of biliary pain typically located in the upper right quadrant that can be mild to severe last more than 30 minutes and can resolve spontaneously diagnosis is typically made through ercp and treatment can include non-invasive and invasive interventions helping current and future clinicians Focus learn retain and Thrive learn more