All about polyps in the gallbladder: symptoms, causes and treatment

Polyp is a benign neoplasm, which is a consequence of hyperplasia of the mucous membranes.

They can affect various internal organs, including the gallbladder. Whether such diagnosis is dangerous, and what to do in a similar situation?

Often polyps in the gallbladder are found in women older than 35 years. They can appear in men, but in this case their character will be slightly different. For women, hyperplastic polyps are most common, for men - cholesterol.

What it is?

Polyps are extensions of the superficial mucosa of the gallbladder, which can be single and multiple. Such neoplasms can reach rather large sizes (1-2 cm), or else form small meshes from small growths 1-2 mm in height.

Despite the benign nature of polyps, in the absence of treatment, they are capable of becoming malignant. As a consequence, the patient can develop gall bladder cancer.

Classification

Polyps in the gallbladder can be represented by:

Adenomatous neoplasms. Such growths are considered benign, but are prone to malignancy. Occur due to proliferation of glandular structures of HP. Because of the high risk of degeneration into a cancerous tumor, such polyps require special attention from the physician, and must necessarily be treated.
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Papillomas, which are also benign in nature and papilliform. With prolonged absence of treatment, they are able to become malignant.
Polyps of inflammatory origin. Such growths are referred to the category of pseudotumors arising on the background of inflammatory processes occurring in the cells of the external epithelium of the gallbladder. Such neoplasms can be formed under the influence of concrements, parasitic invasion and other unfavorable factors.
Cholesterol polyps, which are also referred to as pseudotumors. Such neoplasms often resolve during pharmacotherapy. The complexity of this type of growth is that during ultrasound they are often mistaken for true polyps. These formations are formed due to the accumulation of cholesterol deposits, so they can also be confused with gallstones.

Cholesterol polyps are the most common, and are best suited to conservative therapy.

Causes

By filtering the blood, a continuous process of bile formation occurs in the hepatic tissues. On the bile ducts, it enters the HP, where the yellow-brown liquid accumulates. When the food reaches PDK, the gallbladder contract and the release of bile, which promotes digestion and splitting of food, occurs.

With the development of pathological processes, HP decreases in volumes, while losing the function of bile concentration in parallel. As a result, the liquid begins to stagnate, which provokes the appearance of mucous neoplasms.

The causes of the formation of one or several polyps lie in the violation of metabolic processes and abnormalities in the structure of the mucous membrane of the gallbladder. Blood relatives of a patient with polyps automatically fall into a risk group.

Polyps in the gallbladder are most likely to be affected by persons with:

pathologies of the endocrine system;
impaired fat metabolism;
hypercholesterolemia caused by the abuse of harmful food;
cirrhosis of the liver;
hepatitis;
urolithiasis;
cholecystitis;
LCD.

In some cases, the formation of polyps can occur after the transferred infectious diseases.

Symptoms of polyps in the gallbladder

Symptoms of the pathological process depend on the site of polyps. The most unfavorable case is when polyposis proliferations are localized on the neck of the gallbladder or in its ducts. Such an anomaly creates a serious barrier to the movement of bile to the intestines, because of which the patient can develop a dangerous and unpleasant pathology, such as mechanical jaundice.

If the location of polyps are other areas of the gallbladder, then no specific clinical picture does not arise. However, it is possible to suspect the disease. For this you need to pay attention to the presence of the following signs:

Painful sensations in the right hypochondrium, which arise due to stretching of the walls of the HP due to stagnation of bile. Pain has a dull, aching character. Occur periodically, they are given to the right hypochondrium, so patients often complain that they have "a liver ache". Pain syndrome can occur when drinking alcohol or fatty, fried. For this reason, most patients are unaware of the presence of polyps, linking the ailment with stress or malnutrition.
Yellowing of the epidermis and mucous membranes of the eyes, oral cavity, etc.. In the presence of polyp in the bile duct, mechanical jaundice develops, accompanied by the aforementioned deviations. Due to blockage of the bile duct, bile can not go out naturally, therefore it seeps through the walls of the bladder and enters the bloodstream. The patient suffers from skin itching, bouts of nausea, vomiting of gallstones may open. A characteristic feature of mechanical jaundice is a darkening of urine.
Hepatic Colic. If the neoplasm has a long leg and is localized in the region of the cervix of the gallbladder, then when it twists, an attack of hepatic colic develops. Often, this symptom occurs with a significant reduction in the patient's body. If there is a torsion of the polyposis stalk, the patient has a sharp attack of acute, cramping pain. He suffers from symptoms of hypertension and increased heart rate. At the same time, anxiety symptoms do not disappear when a person takes a comfortable pose, which indicates the development of hepatic colic.
Symptoms of dyspepsia. It is due to its presence that it is possible to judge polyps in the gallbladder. The degree of its expression can vary in each individual case. Typical manifestations of dyspeptic symptoms are bitterness in the mouth, attacks of nausea in the morning, the emergence of vomiting during overeating. All these anomalies are the result of stagnant processes in the body. This also adversely affects digestion, which can lead to a sharp weight loss.

Despite this, patients rarely treat such symptoms with medical help. But the timely conduct of ultrasound helps identify the polyp and determine its exact location.

What is a dangerous polyp of the gallbladder?

Polyps in the gallbladder represent a danger from the point of view of their ability to degenerate into a cancerous tumor. This probability varies between 10-30%.

In addition, polypous lesions can cause suppuration in the diseased organ. Against the background of an increased level of bilirubin, intoxication of the brain can develop. Avoid these dangerous complications can only be provided in a timely manner for seeking qualified medical care.

Diagnostics

The presence of polyps can be determined by carrying out ultrasound diagnosis of the liver and gallbladder. On the monitor of the ultrasound machine, a specialist can clearly see the formation of a rounded shape that is attached to the wall of the HP and does not have an acoustic shadow.

To date, one of the most informative diagnostic methods is endoscopic ultrasonography. The procedure is carried out on the principle of EGF. In the DPC of the patient, a flexible endoscopic tube with an ultrasonic probe at the end is inserted. Since the duodenum is located in the immediate vicinity of the gallbladder, the picture during ultrasonography is much clearer.

Surgery

Operation is the only effective way to treat polyps. However, to cope with the pathological process, removing only the growths, it will not be possible - it is necessary to remove the entire organ.

There are situations when surgical intervention can not be postponed. These include:

The size of the polyp is 1 cm or more;
parallel flow in the gallbladder of other pathological processes: cholelithiasis or cholecystitis, which has passed into the phase of chronization;
Rapid growth of build-up;
the multiplicity of polyps;
high risk of malignancy neoplasm.

Laparoscopic cholecystectomy

In this case, removal of the gallbladder is carried out using endoscopic medical equipment. When performing manipulation on the anterior abdominal wall, several punctures are made, through which special instruments are introduced into the abdominal cavity - trocar. They are equipped with hollow tubes with valve devices at the ends. They are necessary for the safe expansion of tissues. Only after placing the trocar in the punctures is introduced a laparoscope and a special eyepiece with a video camera.

Before the operation, the patient undergoes repeated ultrasound diagnosis, UAC and coagulogram. The procedure is carried out in several stages:

The doctor makes 4 incisions, after which he introduces trocar.
Through the trocar in the abdominal cavity are placed working medical instruments.
A preliminary examination of the peritoneum organs is carried out.
The hepatic-duodenal ligament with the arterial cavity and duct is determined, which then undergoes clipping (the procedure in which the ligation and crossing of the artery and duct take place).
With the help of an electrocoagulator, the doctor separates the gallbladder and excises it.
Through the punctures, the gallbladder is carefully removed from the abdominal cavity.

The advantages of laparoscopic cholecystectomy include:

minor and short pain during the rehabilitation period;
absence of a long stay in the hospital (as a rule, the patient is hospitalized no more than for 5 days);
low risk of complications (formation of adhesions, attachment of bacterial infection, etc.);
the patient's ability to self-service after the procedure.

Open cholecystectomy

In this case, in the abdominal cavity of the patient do not punctures, but cuts. Manipulation is carried out through laparotomy - cutting the abdominal wall to gain access to the diseased organ. In polyps in the gallbladder, as a rule, an oblique laparotomy is performed. To gain access to the liver and HP, produce an oblique incision along the edge of the costal arch.

The operation is carried out in stages:

The place where the preliminary section was made is treated with antiseptic preparations.
Using a scalpel, an incision of 10-15 cm is made.
Fabrics are cut in layers.
As with laparoscopic cholecystectomy, the doctor finds a hepatic-duodenal ligament and clips the artery and duct.
The gallbladder is separated from the liver bed and bandaged, after which it is excised.
Together with the organs, regional lymph nodes are resected.
Fabrics in the region of the cut are sewn layer by layer, but in the reverse order.

Laparotomic cholecystectomy is performed if the polyps have reached a size of 15 to 18 mm. Doctors say that such polyposis sprouting is prone to malignancy, therefore during surgery it is necessary to remove the bladder along with the regional lymph nodes. Simultaneously, a small piece of liver tissue is excised for examination under a microscope.

Open cholecystectomy is performed exclusively under general anesthesia, and only with the use of an IVL apparatus. Postoperative sutures are removed for 6-7 days. On the first day after the intervention, the patient is only allowed to drink still water, the next day - to eat in limited quantities. You can get up after the operation for 3-4 days. The length of the rehabilitation period is about 14 days.

Nutrition rules

To avoid stagnation of bile and disruption of the digestive tract, it is necessary to adhere to a rigid diet. Table No. 5 implies the following activities:

fractional nutrition (4-5 times a day at regular intervals);
use only digestible food (liquid, "broken" on a blender or grated over a sieve);
full refusal of confectionery and bakery products, baking;
the use of unsaturated and non-acidic juices, fruit drinks, herbal decoctions, phyto-tea;
complete elimination of products containing caffeine and ethyl alcohol;
refusal of carbonated drinks;
consumption up to 2 liters of liquid per day;
the use of semi-solid low-fat cheese, vegetable soups, purees, boiled or baked in the oven vegetables and fruits.

You can include in the diet a small amount of sweets and cookies. It is necessary to control the level of consumed fats, protein and carbohydrates.

This diet is designed for six months, but sometimes it has to be respected and longer. On its length the patient is forbidden to drink alcohol and smoke.

Forecast

If the polyps in the gallbladder are small and not prone to proliferation, the prognosis for their treatment is considered favorable. Smoking symptoms and reduce the risk of the spread of the pathological process can be due to the periodic holding courses of conservative therapy.

However, the complexity of the situation is that the disease does not manifest itself at the initial stages of development. Consequently, the symptoms are manifested even when the polyposis enlargement reaches a large size. And this is fraught with their degeneration into malignant neoplasms.

To avoid such consequences, you do not need to wait for the symptomatology to pass by itself. You should immediately consult a doctor and get tested. The earlier the disease is detected, the more favorable the outcome of the treatment will be.