Case 1: Ultrasound in unit physical examination revealed a growth in the gallbladder. From the ultrasound, the growth is not moving in the gallbladder cavity, it is growing on the gallbladder wall. Physical examination report: gallbladder occupying lesion, gallbladder polyp? Further outpatient examination at the hospital is recommended. Usually good health, if not for the physical examination and found gallbladder polyps she usually has no discomfort at all. After hearing that she had a polyp, she was very nervous and did not eat well or sleep well these days.
Case 2: The gallbladder polyp was found almost 10 years ago, and it has been closely reviewed in the past few years, the polyp grew slowly from 0.3 cm to 0.5 cm. In the last 2 months, I felt uncomfortable in my upper right abdomen and went to the hospital for ultrasound and found that the polyp had grown to 1.2 cm at some time.
It is true that most of the gallbladder polyps are found in the occasional ultrasound physical examination, and about 5% of people are examined for gallbladder polyps in the organization’s physical examination. How do you get gallbladder polyps? To treat or not …… we will answer these questions of concern in detail.
1.How are the symptoms of gallbladder polyps?
Gallbladder polyps generally have mild symptoms, or even no symptoms. A few patients have upper abdominal discomfort, may be accompanied by abdominal pain, discomfort or pain in the right upper abdomen or the right quarter of the rib cage, a few can be accompanied by radiation to the right shoulder and back. Polyps located in the neck of the gallbladder can appear biliary colic, in combination with stones can have biliary colic attacks and acute and chronic inflammatory attacks.
2.Why do you have gallbladder polyps?
In recent years, the detection rate of gallbladder polyps has increased, and has become a common disease. The reason is on the one hand due to the increase in the popularity of medical checkups, on the other hand, it may be related to the Chinese diet structure and dietary patterns and changes in the living environment and other unknown factors, these factors include high cholesterol diet, long-term alcohol abuse, excessive consumption of stimulant diet, dietary disorders, etc. It is also pointed out that: the widespread use of pesticides and fertilizers, the proliferation of food additives, ionizing radiation and the formation of gallbladder polyps may have relationship.
3 Gallbladder polyps must be malignant?
In fact, gallbladder polyps or gallbladder polyp-like changes is a general term, a few polyps and gallbladder cancer or related. In clinical practice, there are the following cases.
The first one: cholesterol polyps: about 65%, also known as pseudopolyposis. The current theory is that such polyps are not cancerous. It is mulberry-shaped, brittle and fragile, with a thin tip like cotton thread, which can be easily dislodged, mostly within 10 mm, mainly multiple, and mostly located in the body of the gallbladder. Most patients with cholesterol polyps are asymptomatic or have mild symptoms, and the gallbladder functions well. Cholesterol polyps are diet related and patients with high cholesterol diet or fatty liver are prone to cholesterol polyps. Patients with cholesterol polyps are advised to: abstain from alcohol, eat a regular diet, eat breakfast, and eat a low cholesterol diet. Excessive cholesterol intake (egg yolk, fatty meat, scaleless fish, animal offal, etc.) can aggravate the metabolism of liver and gallbladder causing excess cholesterol to crystallize, accumulate and precipitate in the gallbladder wall, thus forming cholesterol polyps. If these polyps are smaller than 0.5 cm and the number is small, try taking medication. For cholesterol polyps less than 1 cm, they can be reviewed by ultrasound every 6 months to a year to observe the changes in size, shape, and number.
The second type: non-cholesterol benign polyps: about 30%, also known as true polyps. Mainly refers to: adenoma of gallbladder, adenomyoma, inflammatory polyp, adenomatous hyperplasia. Among them, inflammatory polyps are formed by long-term gallbladder stone stimulation combined with chronic cholecystitis. Adenoma of gallbladder is a benign tumor, which is precancerous, and the cancer rate is about 30%. Adenomatous hyperplasia and adenomatous hyperplasia also have the risk of cancer. In this type of patients, medication is ineffective, biliary preservation and medication are not recommended, and cholecystectomy is recommended.
The third type: polypoid early gallbladder adenocarcinoma: about 5%, in fact, this type is not strictly speaking the category of what we call gallbladder polyps anymore. At present, it is sometimes difficult to identify polypoid early gallbladder cancer mixed with gallbladder polyps by ultrasound alone, and if necessary, thin enhancement CT or MRI enhancement scan should be done. Ultrasound features of cancerous polyps are: about 80% of them are larger than 10 mm and solitary; about 70% are located in the neck of gallbladder; about half are accompanied by gallbladder stones. Once such a lesion is suspected, it should be treated by surgery as soon as possible.
4.Can medicine treat gallbladder polyps?
For multiple cholesterol polyps, some medications may relieve the symptoms of combined chronic cholecystitis to some extent, and may have some effect on some cholesterol crystals less than 5mm or to prevent new occurrence. Drugs are not effective for true polyps.
5.How to check and review gallbladder polyps?
In most cases, B-ultrasound can determine early whether something in the gallbladder is a stone or a polyp, and is even more sensitive than CT and MRI for the number, shape and size. However, to further clarify the type and nature of the polyp, especially the latter two types mentioned above, a thin-enhanced CT or MRI-enhanced scan may be needed to help with the diagnosis. Admittedly, sometimes these tests are not 100% definitive and require the physician’s judgment in the context of the patient’s condition. In some cases, the nature of the polyps cannot be determined, so it is necessary to review the ultrasound once every 3 months for close observation.
6.Does gallbladder removal have any effect on health afterwards?
The age of gallbladder removal patients ranges from teenagers to 80 years old, and cholecystectomy has become a common abdominal surgery. Some people have mild diarrhea and bloating in the short term after gallbladder removal, especially after eating a lot of greasy and high-fat food. This phenomenon can gradually compensate for the missing function of the gallbladder through liver secretion and dilation of the common bile duct, and most of the diarrhea and bloating can diminish or disappear in a few months after surgery. There is no clear evidence from evidence-based medicine that gallbladder removal can cause other diseases in human body, and the current level of medical science believes that removal of gallbladder does not cause any adverse effects on human body.
7.What kind of gallbladder polyps should be operated?
Gallbladder polyp is a common disease, neither too worried nor careless. Now we have increased health awareness, units or personal physical examination found gallbladder polyps multiple, feel the growth of multiple polyps must be bad, not afraid of nervousness. From clinical experience, in general, multiple polyps may be better than single, multiple polyps are mostly benign cholesterol polyps; and if it is a single in turn to be highly alert. If it is multiple less than 1 cm, the patient is advised to observe it, but not just leave it alone. About six months to do ultrasound, observation period to improve the habits and diet structure which is the most important. If you have uncomfortable symptoms, you can try to take some medications to relieve the symptoms. It is generally believed that multiple gallbladder polyps less than 1 cm in diameter can be suspended without surgery.
The surgical treatment of gallbladder polyps has two considerations, one is to prevent cancer or cancer leakage, which mainly refers to the latter two types of polyps mentioned earlier. On the other hand, if the uncomfortable symptoms are not relieved by medication, secondary chronic cholecystitis affects normal work and life, and other factors such as gastric disease can be excluded can be considered gallbladder removal.