Polyps in the gallbladder: treatment, symptoms, surgery
Polyps in the gallbladder detected by ultrasound in approximately 6% of the population of the globe, and the vast majority of patients with these entities, women older than 35 years. Most often, the polyps of this localization are detected by accident, when the patient goes to the doctor about other diseases of the biliary tract. The purpose of the ultrasound examination entails the detection of polyps, which does not manifest itself and is not bothered.
Quite a large prevalence of such a process stems from the fact that the ultrasound is not always possible reliably to distinguish true polyps from similar formations associated with the deposition of cholesterol crystals in the mucosa or inflammatory changes. However, the doctor’s conclusion about the presence of polyp always requires great caution, because the risk of malignancy (malignancy) in some cases, polyps reaches 30-33%.
Causes and types of polyps
Causes of polypoetry in the gallbladder is still not clear, though assumed the role of the inflammatory process (cholecystitis), carriage stones, metabolic disorders. By the way, polyps are detected much more often in chronic cholecystitis, cholelithiasis, pancreatitis, biliary dyskinesia. Probably, so occurs because the stagnation of content, violation of the timely and complete emptying of the gallbladder, the mechanical effect on the body wall of stones contribute to permanent injury and maintain chronic inflammation, which is a consequence of excessive reproduction of the cells of the inner layer and the formation of a polyp.
Another reason for polypoetry can be disorders of lipid metabolism. We all know that bile is not only rich in active substances that help break down fats in the intestine, but and cholesterol, which under adverse conditions may be deposited in the cells of the mucosa. This phenomenon is called cholesterosis and reflects the presence of cholesterol and its esters in cells, which increase considerably in size and form growths, towering above the surface of the mucous membrane.
Almost all patients with a polyp of the gallbladder may indicate errors in diet, which primarily consist in the abuse of animal fats. In this regard, it is believed about the role of diet as a cause of polypoetry. In some cases, and fails to establish why there was a polyp, and then it is called idiopathic.
Depending on the characteristics of the structure, appearance, possible causes there are several types of gallbladder polyps:
In addition, a picture of a polyp can give the presence of benign tumors – papilloma, which grows on the surface of the mucous membrane in the form of papillae.
Cholesterol polyp is the most common. This kind of formulations is not a tumor, but only reflects the focal deposition of cholesterol crystals in the cells of the inner layer of the bladder. In fact, such exaltation and are not polyps, they typically do not require active surgical tactics, however, the complexity of differential diagnosis in ultrasound have contributed to mistaken for a true polyp. The deposition of cholesterol in the wall of the gallbladder is called cholesterosis, and when it is accompanied by propovedniki growths, talking about polypous cholesterosis.
Inflammatory polyp occurs in response to constant irritation of the gallbladder wall. Typically, this irritant will become stones cholelithiasis, but there may be parasites living in the bile duct, and even bile. Inflammatory polyps, like cholesterol, are not tumor, but to exclude the possibility of atypical changes in their cells virtually impossible.
True tumors that give the ultrasonic picture in propovednik outgrowths are considered adenoma (adenomatous polyps) and papilloma. Adenomatous polyps represent the local excess multiplication of the cells of the mucous membrane, forming the hearth of tumor growth. The adenomas are often found phenomenon of atypia, which indicates the propensity for malignant transformation. Papilloma is a benign tumor of the epithelium lining the gall bladder from the inside. Papillary proliferation of this tumor look at ultrasound as a polyp.
Manifestations and diagnosis of polyps
Of course, the majority of patients with such entities concerned with the question of how dangerous their presence. Not looking at what by themselves, the polyps usually don’t cause any disturbances, and asymptomatic, the risk of malignancy, when almost every third polyp can become cancer, making it as dangerous, but because the alarm is quite justified.
Specific symptoms suggestive of a polyp of the gallbladder, no. Sometimes patients may disturb heaviness in the right hypochondrium, nausea, dyspepsia, when errors in the diet. If the polyp is located at the mouth of the bile duct and large enough to block the flow of bile, the possible attacks of biliary colic with severe pain in the abdomen, nausea, vomiting, bitterness and dryness in the mouth. Since polyps typically occur when existing cholecystitis or cholelithiasis, the among the symptoms are manifestations of these diseases.
If you suspect the presence of gallbladder polyps the patient will conduct ultrasound examinations. A promising and more informative method of diagnosis is considered to be endoscopic ultrasonography when the patient is swallowing a flexible conduit with a sensor that enters into the duodenum. The distance from the wall of the intestine to the gallbladder are much less than in the study through the abdominal wall, and the use of higher ultrasound frequencies allows the user to thoroughly inspect all layers of the bladder wall, to establish the presence of polyps, their size and location.
Approaches in the treatment of gallbladder polyps
The gallbladder polyps insidious that any worry the patient is not delivered, and meanwhile, the risk of malignancy according to some reports up to 33%. Of course, not every polyp can become cancer, but most experts in the detection of such changes immediately offered radical treatment – removal of gallbladder with polyps.
Many patients because of fear of surgical intervention they go «breaking bad» so-called traditional methods, biding time and ignoring the regular ultrasound. As time goes on, a polyp can not only grow, but also give rise to cancer, therefore, is generally considered to be that to cure the polyp can only be surgically removed, and surveillance is often only delays the need for surgery, which is, however, possible for this period to prepare.
The period of the operation and its feasibility depend on the type and size of tumors. So, if the patient is diagnosed polypoid cholesterols, we can restrict wait-and-see tactic, but only if the size of polyps less than 1 cm and their number is not more than five. The absolute majority of patients will be offered surgery, the indication for which are:
Surgery polyps the gallbladder involves cholecystectomy (removal of organ), which can be performed via laparoscopic access with minimal surgical trauma. In obese patients with adhesive process in the abdominal cavity, abundant filling of the bladder stones surgeon may choose a standard cholecystectomy in an open way, to avoid complications during the extraction of the bladder from the abdominal cavity.
There is evidence of the ability of endoscopic polypectomy with the help of special instruments introduced into the cavity of the gall bladder, in which there is preservation of the body. However, data on consequences and long term outcome of such operations is not enough to ensure that the method was used throughout.
Treatment without surgery is possible if the size of the polyp less than 1 cm and its structure is not suspicious of cancer. The patient should be required to carry out regular ULTRASOUND monitoring: every six months for two years and annually for the whole life, while signs of increased formation is not observed. If you suspect adenomatous growth pattern, regular ultrasound is recommended every three months. There are also more stringent recommendations, meaning a monthly ultrasound for six months, then every three months, six months and once a year in stable condition and no signs of growth.
Polyps are often combined with an inflammatory process in the gall bladder, bile ducts, pancreas, and it is therefore appropriate to treat those illnesses. Conservative therapy involves diet. Food should be gentle, small portions in several stages. Should be excluded from the diet of fried and fatty meals, smoked meats, butter, alcohol, strong coffee, plenty of condiments. Preference should be given to lean meats and fish, better if they are steamed or boiled. The diet should be a sufficient amount of vegetables and fruits, but sweets, pastries, ice cream it is better to limit.
Medicines, is able to get rid of a polyp does not exist, but in the complex treatment of cholecystitis and cholelithiasis, which may be accompanied by poledourisbasil may be given antispasmodics, remedies that dissolve gallstones, anti-inflammatory drugs, etc.
Allowed treatment of folk remedies, but it is particularly noteworthy that the disappearance of polyps, it will not and will only help to alleviate the aforementioned diseases of the gallbladder. The use of any vegetable composition must be strictly coordinated with the physician. Usually in pathology of the gallbladder using chamomile flowers, rose hips, elecampane, birch buds, St. John’s wort, a variety of choleretic herbs.
I would like to remind you that the gallbladder polyps, though occur unbeknownst to the patient, still require alertness and careful supervision by a specialist. Self-medication, and neglect of regular examinations, is unacceptable, therefore, to avoid the development of cancer of the gallbladder, you should implement all recommendations of the attending physician.