OVERVIEW
Gallbladder cholesterol deposition is a special type of chronic cholecystitis. It is also called strawberry gallbladder because a large number of cholesteryl ester particles are deposited in the basement membrane of the epithelial cells of the gallbladder mucosa, resulting in the formation of small yellow nodules that resemble strawberries on the outside.
Etiology
The etiology of this disease is not clear, it may be related to the stimulation of high cholesterol concentration in the bile and the phagocytosis of cholesterol crystals by macrophages in the gallbladder mucosa, which gradually form yellow polypoid lesions, accumulating or protruding on the surface of the mucosa; or it may be related to the increase in the activity of Acetyl-Coenzyme A cholesteryl ester acyltransferase (ACAT) of the cells of the gallbladder mucosa, which increases the synthesis of cholesteryl esters.
Cholesterol deposition within the basement membrane of the gallbladder mucosal epithelial cells stimulates the tissue cells to over-expand, forming small yellow nodules with fine tips attached to the gallbladder. They are categorized as diffuse or limited bulging, single or multiple. Cholesterol deposition mostly occurs in the body and neck of the gallbladder, the diameter is less than 1cm, slow growth, brittle, easy to fall off, forming stones.
Symptoms
Most of them are asymptomatic, but a few of them have clinical manifestations similar to chronic cholecystitis, such as right upper abdominal discomfort, bloating, hidden pain, dyspepsia, etc. Occasionally, there is slight pressure pain in the right upper abdominal area, accompanied by gallbladder stones or liver function abnormalities. Polyps located in the neck of the gallbladder may block the gallbladder duct and cause acute cholecystitis, and there are cases in which the polyps are dislodged and embedded in the jugular abdominal cavity, which may lead to pancreatitis attacks. The possibility of cancer is small.
Examination
General laboratory tests are usually without abnormalities.
1. Cholangiography
The filling defect in the gallbladder can be seen, which is close to the wall of the gallbladder and does not change with the body position, and the function of the gallbladder is often normal.
2. Abdominal CT examination
Conventional scanning spacing is too wide, easy to miss the diagnosis, so it is not listed as a routine examination, mainly used to identify with gallbladder cancer.
3. Endoscopic ultrasonography
Very small bright spots or bright spot aggregation is the echogenic feature of cholesterol polyp, with or without anechoic area, while the acoustic image of adenomyosis and adenoma or adenocarcinoma of the gallbladder manifests as a strongly echogenic mass, multiple microcysts or comet’s tail sign.
4.Ultrasound examination
Typical sonogram is papillary or globular strong echogenic light mass on the wall of gallbladder without acoustic shadow, the light mass does not change with body position, some lesions are connected with the wall of gallbladder with fine tips, which can be single or multiple, with the diameter of 5mm~10mm. some cases are coexisted with gallstones, which can be accompanied with acoustic shadow. the diagnosis of ultrasonography is highly accurate.
Diagnosis
The diagnosis can be made according to the clinical manifestations and signs of dyspepsia, fullness in the middle and upper abdomen or dull pain in the right upper abdomen, assisted by B-mode ultrasound or X-ray cholecystography.
Differential diagnosis
This disease should be differentiated from gallbladder polyps and gallbladder cancer.
Complications
This disease can cause gallbladder stones, liver function abnormalities, acute cholecystitis attacks, and pancreatitis if the polyp is dislodged and embedded in the jugular abdomen of the gallbladder.
Treatment
Currently there is no effective therapeutic drug, cholecystectomy is recommended for those with obvious clinical symptoms, large single polyps, short-term rapid growth, gallbladder neck polyps and suspected cancer.
1. See cholecystostomy for preoperative preparation of acute patients.
2. Chronic patients should correct anemia, improve nutritional status, and adopt liver-protecting treatment with high sugar, high protein and high vitamin before operation. Prepare 300～500ml of blood before operation.
Prevention
This disease occurs in the middle-aged and old people, mainly because of overweight, lack of exercise, the body’s metabolism is relatively slow, the control of biliary tract nerve function and gallbladder, bile duct contraction force is weakening, so that cholesterol and bile in the bile is easy to silt into stone. There are a few middle-aged and elderly women due to the body estrogen directly affect liver enzymes, so that the liver cells secretion of bile composition changes, which will also increase the chance of developing gallstones.
Gallbladder cholesterol deposits are a common form of gallbladder polyposis, which is a benign lesion that is usually not cancerous.