Polyps in the gallbladder: causes. How dangerous are polyps in the gallbladder? Features of the treatment of polyps in the gallbladder Removal of polyps in the gallbladder with a laser

A gallbladder polyp is a neoplasm that is benign. Localized in the inner wall of the gallbladder (GB). They have a round or oval appearance, some of them have a leg, with which they are attached to the wall of the organ.

According to statistics, 6% of the population has a polyp of this localization. Women over 35 are most often affected. Among patients, their number, according to statistics, reaches 80%. The nature of polyps differs in men and women. In men, cholesterol types of polyps are more common, in women - hyperplastic ones.

According to ICD-10, the gallbladder polyp is marked under the code K82.

A bit of history

In 1857, this pathology was described in the writings of the German pathologist Rudolf Virchow. Later, with a detailed study of these neoplasms, scientists found that the cause of their formation is a violation of lipid metabolism. Doctors accidentally discovered polyps during operations on other organs. X-rays were used as diagnostic equipment.

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Types of polyps and their causes

Consider what types of gallbladder polyps exist today, why they are formed, is it dangerous and what to do when they are detected.

Specialists divide polyps into true polyps and pseudopolyps. True polyps grow from epithelial tissue. Polyps of this type include adenomatous polyps and. These types of polyps can become malignant. Polyps are localized in a wide part of the organ or on its neck.

Pseudopolyps are formed from accumulations of cholesterol, as well as due to inflammatory processes. The true reason why polyps appear has not been established. Consider the factors affecting the formation of polyps:

1. genetic predisposition. If someone in the family suffered from this disease, their appearance in any of the family members is not excluded. But only one hereditary factor cannot provoke the disease. Inflammation that has not been fully cured, such as that resulting in bile stasis, and genetic predisposition can play a role in the formation of polyps. From this we can conclude that the formation of polyps can be influenced by several factors. It is believed that the occurrence of adenomatous polyps and papillomas is associated with a genetic predisposition;
2. Inflammatory processes in the gallbladder. Most often, acute and chronic cholecystitis, gallstones, pancreatitis, biliary dyskinesia are the impetus for the development of polyps. With inflammation, the outflow of bile is disturbed, as a result of which the walls of the organ are injured, inflamed and deformed. In these places, pseudopolyps are formed;
3. Metabolic disease. Bile contains cholesterol. Its excess settles on the walls of the gallbladder and growths are formed, which later form polyps. But not always the cause of polyps is excess cholesterol in bile. Most often, as mentioned above, several reasons can contribute to this process. Bile, stagnating for a long time in the gallbladder, can provoke the deposition of cholesterol. And we considered the reasons for the stagnation. Polyps formed by cholesterol are called cholesterosis and, in most cases, do not exceed 5 mm.
4. Biliary dyskinesia when the cause of the formation of polyps are physiological changes in the gallbladder. With an excessive or insufficient number of contractions of this organ, bile does not enter the duodenum in the norm that is necessary, as a result of which digestive disorders occur and metabolism is disturbed.

Separately, we note adenomatous polyps, since polyps of this type can become malignant. Adenomatous polyps consist of epithelial cells, fibrous fibers, with cystic implants. Polyps of this type have vessels and nerves. Polyps of an inflammatory nature and cholesterol types of polyps do not have them. The blood supply is clearly visualized with Doppler. Most often, polyps of this etiology are removed, since such polyps cannot resolve even when taking potent drugs. One type of adenomatous polyp is considered hyperplastic cholecystopathy. More common in women than in men, due to hormonal disorders, namely with high levels of estrogen.

Symptoms of the disease

The disease may not make itself felt for a long time. Manifestations of signs of the disease depend on the location of the polyps and their size. A person experiences pain in the form of biliary colic, accompanied by nausea and vomiting, in cases where the polyp is located in the bile duct and its growth blocks the outflow of bile. With these causes of pain, discomfort is felt on the right side in the hypochondrium. The pain is dull and paroxysmal.

If the cause of the formation of polyps is cholecystitis and any other types of cholelithiasis, then the signs of the presence of polyps are similar to the symptoms of these diseases, namely bitterness in the mouth, nausea in the morning, dry mouth.

With an impressive size of polyps, the outflow of bile worsens. Bile stagnates in the bile ducts. Due to the fact that bilirubin occurs in excess in the bloodstream, due to which the color of the skin and sclera take on an icteric tint.

Diagnosis of the disease

Despite the seeming harmlessness of the disease, a visit to the doctor is a necessary procedure in order to protect yourself from complications. Usually this doctor is a gastroenterologist, if necessary, an oncologist. Before being referred for diagnosis using modern technologies, the doctor will examine the patient, make a survey on key points, then palpate the gallbladder and liver to assess the condition of the organs and the presence of pain in a particular area.

There are several types of diagnostics - ultrasound and endoscopic methods, computed tomography and cholangiography.

Ultrasound examination (ultrasound) is the standard of medicine and is very effectively used in the diagnosis of gallbladder polyps. What type of polyp belongs to, its structure is determined by the so-called echo signs. A white spot on ultrasound is characteristic of a cholesterol or inflammatory type of polyps. With an adenomatous polyp, the spot has a darker appearance.

Endoscopic ultrasonography in the diagnosis of polyposis of the gallbladder, in combination with ultrasound and an endoscope, is able to reveal the structure and location of polyps by inserting into the lumen of the duodenum.

Computed tomography and magnetic resonance cholangiography, as additional diagnostic methods, can detect the smallest neoplasms, and even determine the type of tumor, its malignancy or benignity, as well as what disorders they led to. The only drawback of these research methods is the high cost.

In addition to the above diagnostic methods, laboratory tests are also used as:

• Blood biochemistry, to determine the content of bilirubin, cholesterol levels, as well as the level of alkaline phosphatase;
• Urinalysis for the presence of bilirubin;
• Analysis of feces for the presence of stercobilin.

Treatment

Since polyps are capable of malignancy (k), doctors will most likely suggest that the patient remove the gallbladder along with polyps.

Many people are afraid of the operation, and they begin to resort to all kinds of alternative medicine methods, without listening to the opinions of specialists. According to statistics, in 33% of cases, polyps turn into a malignant tumor. These are considerable numbers and should alert people who have this disease.

It is necessary to remove the gallbladder along with polyps or not, and how to treat, the doctor decides. With polypous cholesterosis, conservative treatment without surgery is possible if the size of the polyp is not more than 1 cm and their number does not exceed five pieces.

Surgical intervention is an absolute indicator in the following situations:

• The size of the polyp exceeds 1 cm;
• With multiple polyposis;
• Damage to the walls of the gallbladder to one degree or another;
• Diffuse spread of polyps throughout the wall of the gallbladder;
• The desire of the polyp to grow at least 2 mm per year;
• Suspicion of malignant transformation of the neoplasm.

Surgery to remove polyps in the gallbladder is called a cholecystectomy. There are two methods: open cholecystectomy, and the most modern method is laparoscopy. The laparoscopic method of extracting the gallbladder is characterized by minimal trauma. In the case of an overweight patient or an abundance of gallstones, doctors may resort to the usual method of surgery through an incision.

Endoscopic polypectomy is a promising surgical technique. Its essence is that the integrity of the organ is preserved by introducing special instruments into the organ. But its use is not yet widespread.

When choosing a conservative method of treatment, the patient must follow certain rules. First, you need to get checked regularly. Usually, the first two years after the discovery of the disease, you need to undergo an ultrasound check every 6 months, then once a year. If the polyps are of an adenomatous type, a visit to the doctor is required 4 times a year with the same interval of time.

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The formation of polyps is mainly associated with lifestyle and nutritional quality. For patients of this category, a certain diet for polyps is provided, limiting fatty and flour foods. Food should be fractional. Preference should be given to products containing fiber and rich in vitamins and minerals. In specially designed diets for this category of patients, it is considered in detail what to eat, in what quantities and volumes. Dr. Malysheva repeatedly in her articles and programs does not get tired of repeating the importance of the quality of nutrition in the pathologies of the gastrointestinal tract.

With polyps of the gallbladder, aggravated by inflammatory diseases, cholecystitis, the appointment of certain drugs (antispasmodics, anti-inflammatory drugs, etc.) is allowed. Medicines do not destroy polyps, but they eliminate inflammation and pain. Some medications can dissolve small gallstones. With a cholesteroid polyp, drugs are prescribed, such as Ursosan, Ursofalk, Henofalk, which can reduce their size and even dissolve. Hofitol, which has a choleretic property, may be recommended.

If polyps are found during pregnancy, the doctor determines the tactics of treatment. If the size of the polyps is small and does not pose any danger to the body, the doctor recommends only periodically being observed by a gastroentrologist in order to prevent any complications. But if the patient is in pain, an ultrasound scan reveals that the bile duct is blocked, doctors are forced to remove the organ by cholecystectomy. Since ignoring this condition threatens to intoxicate the body and cause great harm to the health of the unborn child and mother.

Ideally, a woman planning a pregnancy should exclude all diseases, including gallbladder polyposis, since pregnancy exacerbates the course of many diseases.

Treatment with folk remedies and homeopathy is not forbidden, but it should be noted that it is impossible to completely get rid of polyps or cure them in this way.

People are often interested in whether they take the army with this disease. It all depends on the course of the disease. Only a doctor decides this issue. This disease belongs to article 10, point "b" of the Schedule of Diseases.

This condition should never be ignored, at best they will lead to pathologies in nearby organs, namely the pancreas and liver. At worst - to the malignant degeneration of polyps.

A polyp is a benign neoplasm of the mucous membrane of hollow organs, has a spherical shape and a leg, which is attached to the inner wall. The most likely cause of their occurrence is considered to be genetic changes. Since polyps are much more common in women, this suggests a connection between their appearance and the hormone estrogen.

Types of polyps

There are four types of polyps:

• Inflammatory, formed at the site of the inflammatory process.
• Cholesterol, when cells containing a large amount of cholesterol grow.
• Papilloma is a tumor with growths of a benign nature and appears as a manifestation of the human papillomavirus.
• An adenomatous polyp is formed from the glandular tissue of the organ.

Diagnosis and symptoms of polyps

As a rule, the ultrasound method of research and x-ray cholecystography allows to identify polyps. The latter method is effective when large polyps appear. A blood test is also required.

The main signs of polyps are similar to the general symptoms of damage to the liver and gallbladder. These are nausea, vomiting, bitter taste, yellowing of the skin, constipation and bloating, belching. The first symptoms must be differentiated from other liver diseases. If necessary, the doctor conducting the diagnosis will prescribe an effective treatment for hepatitis C or other identified disorder.

The danger of polyps

Polyps block bile flow, which can lead to a buildup of bilirubin (hence the yellow color of the skin), which poses a threat to brain cells.

Since bile gradually accumulates in the organ, this causes its pathological expansion, which cannot but lead to the occurrence of inflammatory processes. In some cases, polyps can turn into a malignant tumor.

Polyp treatment

Therapy of this disorder must be carried out under the supervision of a physician. The use of any traditional medicine should be agreed with a specialist and accompanied by conservative drug treatment. Medicines are designed to facilitate the work of the liver, which contributes to the relief of the patient's condition. Drugs that relieve unpleasant symptoms may also be prescribed.

Surgical intervention is required only in cases where the size of the polyps exceeds 1 cm, as well as in cases where there is rapid growth in a short time (by 2 mm during the year). Only a doctor can determine whether an operation is necessary on the basis of detailed studies.

It is important for women to remember that polyps in the gallbladder are an obstacle to pregnancy. A rapid increase in the number of sex hormones can cause an increase in the size of the polyp. If conception is planned, then polyps must be removed without fail.

The operation to remove polyps is carried out with the most gentle methods. As a rule, an endoscope (the thinnest probe with a video camera) is used. This allows the surgeon to accurately control the course of the operation and avoid complications.

After removal, the condition of the organ is subject to medical supervision at least once a year.

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Polyposis of the gallbladder is called a multiple benign growth of the epithelial layer of the mucosa of the organ with formations - polyps, the size of which averages 3-10 mm.

Diagnosis of the disease is difficult, and effective treatment is possible with surgical removal of the formations. At an early stage, polyposis can be treated with folk methods.

The prevalence of the disease is quite high - from 2.5 to 4% of people have polyps in the gallbladder, and 80% of patients are women.

Causes

The occurrence of polyps is a polyetiological disease that occurs against the background of several causes at the same time:

• Hereditary predisposition, genetic abnormalities are considered aggravating factors that, under certain conditions, cause the development of the disease;
• The presence of inflammatory diseases causes thickening and deformation of the walls of the organ, stagnation of bile, which contributes to the formation of polyps;
• Violation of metabolic processes leads to the formation of cholesterol deposits on the walls of the mucosa of the organ. Over time, deposits calcify over time (deposition of calcium salts occurs in them), which contributes to the formation of polyps;
• The development of biliary dyskinesia, which is characterized by excessive or insufficient contractions of the gallbladder and, accordingly, an imbalance in the flow of bile into the intestine.

General symptoms of the disease

The clinical picture of gallbladder polyposis is associated with the area of ​​localization of polyps. The most dangerous is the location of the formations in the neck of the organ or its duct due to the difficulty in the movement of bile into the intestines. Often this leads to the development of a secondary disease - obstructive jaundice.

In the case of the location of formations in other parts of the body, the symptoms are often not expressed.

There are a number of main manifestations of gallbladder polyposis:

Types of polyposis

The classification of varieties of gallbladder polyps is based on their division into pseudopolyps and true forms of polyps:

True polyps often take a malignant form.

Diagnosis of the disease

The presence of gallbladder polyposis is analyzed using instrumental methods - ultrasound and endoscopic.

In addition to instrumental diagnostics, which allows to determine the presence of polyps, traditional laboratory tests are carried out.

• Blood chemistry allows you to identify the main symptoms of cholestasis (the occurrence of stagnation of bile): high levels of bilirubin, alkaline phosphatase enzyme and cholesterol (liver lipid);
• Analysis of urine helps to determine the appearance of bilirubin, which is absent in the norm and a decrease in the concentration of urobilinogen (a product of bilirubin recovery);
• Examination of feces to analyze the reduction or complete disappearance of the bile pigment stercobilin.

Polyposis treatment

Treatment of the disease is based on the surgical removal of formations due to the ineffectiveness of medical methods.

Preparations

The use of drugs is carried out only for the treatment of concomitant diseases - the causes of the appearance of polyps. Also, drugs (antispasmodics, choleretic drugs) are used to relieve unpleasant manifestations of polyposis.

• No-shpa, which has antispasmodic properties, is used 1-2 capsules for pain attacks;
• Application Gepabene allows you to normalize the secretion of bile and eliminate spasms of the gallbladder. The recommended dose is 1 capsule 3 times a day;
• A drug Holiver eliminates the symptoms of cholestasis, stimulates the formation of bile and peristalsis of the gallbladder. The dosage is 2 tablets 3 times a day. It is impossible to use the medicine with complete blockage of the biliary tract by a polyp.

In the treatment of cholesterol polyps, drugs that dissolve deposits are used. This drug has such an effect. Ursolfak which increases the solubility of cholesterol. The dosage of the drug is 10 mg/kg body and is determined based on the patient's weight.

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Surgical treatments

In the absence of the effect of therapeutic treatment within six months, surgical methods are used.

There are certain indications for the removal of gallbladder polyps.:

• The size of the formations is more than 1 centimeter;
• The presence of concomitant chronic pathologies;
• An increase in the size and number of polyps;
• The presence of stones in the gallbladder;
• Deterioration of the outflow of bile;
• Cancer risk.

The operation to remove polyps (cholecystectomy) is performed endoscopically (through punctures) or in the classical way and involves cutting out the entire gallbladder.

Folk methods of treatment

If the disease is detected at an early stage, treatment can be started with folk remedies.

Complications

In the absence of treatment of polyposis, a number of significant complications can occur:

• Cirrhosis of the liver- pathological changes in tissue structure;
• Jaundice is a yellowish discoloration of the skin and mucous membranes;
• Osteoporosis - low bone density;
• Insufficiency (decrease in functionality) of the liver and kidneys.

Diet for sickness

With polyposis of the gallbladder, a meal should be observed, based on some rules.

It must be remembered that in the treatment of polyposis, it is important to conduct timely diagnosis and follow the recommendations of the attending physician. Constant monitoring of the gallbladder will help to avoid the development of polyposis and all its possible complications.

The gallbladder is a tumor-like formation of various etiologies ( causes), which is localized on the inner wall of the gallbladder and grows into its lumen.

According to the summary data of various authors, 6 percent of the total population suffers from gallbladder polyps. Among patients with this pathology, 80 percent are women whose age exceeds 35 years. The sex of a person affects not only the prevalence of polyps, but also the nature of polyposis formations. So, in men, cholesterol polyps are most often diagnosed, while hyperplastic formations of the gallbladder predominate in the female.

Interesting Facts

The first to discover pathological deposits in the gallbladder mucosa was the German pathologist Rudolf Virchow in 1857. In the same year, this phenomenon was studied in detail by a microscopic method and described by another scientist. An important point in the study of gallbladder polyps was the assumption that there was a link between gallbladder polyposis and impaired fat metabolism. In 1937, the first medical work on this topic was published.

The author of the article identified the pathology of lipid metabolism as the main factor provoking the formation of one of the types of polyps. After 19 years at the World Gastroenterological Congress, impaired fat metabolism was identified as the underlying cause of one of the categories of gallbladder polyps.
All the works of that period on the study of this pathology were more descriptive. The basis for the study of polyposis proliferation of the mucosa was mainly accidental findings during operations or autopsies. X-rays were also used to identify gallbladder polyps.

The introduction of ultrasound scanning into medical practice has expanded the possibilities of diagnosing gallbladder polyps.

Anatomy of the gallbladder

The gallbladder is a hollow, sac-like organ of the hepatobiliary system that acts as a reservoir of bile. The bile produced from the liver flows through the bile ducts and accumulates in the gallbladder.

The gallbladder is located in the fossa or bed) of the gallbladder, which is located between the right and left lobes of the liver. The fibrous membrane covering the liver in this place fuses directly with the gallbladder. Thus, the bladder turns out to be, as it were, completely covered by the liver, leaving only a small extrahepatic segment. This segment is projected onto the anterior abdominal wall at the point of intersection of the 10th rib and the outer edge of the rectus abdominis muscle.

The gallbladder is pear-shaped and dark green in color. The length of this organ varies from 9 to 15 centimeters, and the volume is from 40 to 60 cubic centimeters. In the structure of the gallbladder, several departments are distinguished.

The divisions of the gallbladder are:

• bottom- the widest part, which is projected onto the anterior abdominal wall;
• body of the gallbladder, which narrows to the neck of the gallbladder;
• gallbladder neck, which gradually narrows, passes into the cystic duct, subsequently connecting with the common hepatic duct.

After the connection of the cystic duct and the common hepatic duct, the common bile duct is formed. Its length varies from 5 to 7 centimeters, and its width from 2 to 4. Further, the common bile duct merges with the pancreatic duct and opens into the lumen of the duodenum. The opening and closing of this duct is regulated by the sphincter of Oddi. This sphincter is a valve device, which is located in the papilla of Vater on the inner wall of the duodenum. It controls the secretion of bile and pancreatic juice into the duodenum. Also, this sphincter prevents the intestinal contents that are in the pancreas from being thrown into the bile duct.

The structure of the walls of the gallbladder

The walls of the gallbladder are relatively thin, consisting of three layers - serous, muscular and mucous membranes.

Outer serosa
The serous membrane of the gallbladder is formed by loose connective tissue.

muscle layer
The muscular coat is formed by smooth muscle tissue, which, unlike skeletal muscles, does not contract voluntarily. The bundles of muscle fibers are located in a circular, oblique and longitudinal layer. This layer is developed differently in different parts of the gallbladder. So, in the region of the bottom of the gallbladder, muscle fibers are poorly developed, and in the region of its neck, the muscle layer is developed most intensively. The muscular layer of the cystic duct is similarly well developed. Thanks to this developed layer of the gallbladder wall, the bile duct itself is able to contract, thereby ensuring the promotion of bile.

mucous membrane
The mucous layer of the gallbladder forms numerous folds. It is lined with a single-layered epithelium, in the thickness of which there are glands.

Blood supply and innervation of the gallbladder

The gallbladder receives arterial blood from a branch of the right hepatic artery, which is called the cystic artery. The outflow of venous blood departs into the branches of the portal vein. The lymphatic system is represented by lymph nodes and ducts, which are localized along the portal vein. The accumulated fluid is drained into the lymphatic ducts.

Innervation is carried out by nerve fibers extending from the celiac plexus. These fibers are located along the hepatic artery. Also, the gallbladder receives innervation from the vagus nerve. It controls the contractility of the gallbladder.

Physiology of the gallbladder

Bile enters the gallbladder from the liver through the bile ducts. Bile is the fluid secreted by the liver cells ( hepatocytes). This liquid contains numerous enzymes and acids necessary for digestion. The bile produced by hepatocytes accumulates in the gallbladder, from where it subsequently enters the duodenum. In the gallbladder, not only the accumulation of this fluid occurs, but also its concentration.
Previously, it was believed that bile accumulates in the gallbladder between meals, while the flow of bile into the intestine occurs during meals. However, today, numerous studies have shown that both the accumulation of bile and its entry into the intestines is a continuous process. It is regulated under the influence of the hormone cholecystokinin and a mechanical factor ( degree of fullness of the gallbladder).

So, the intake of food and its digestion in the duodenum leads to the secretion of the hormone cholecystokinin. Receptors for this hormone are located in the thickness of the walls of the gallbladder. When cholecystokinin is released, it stimulates the receptors, causing the gallbladder to contract. Contracting, the gallbladder causes the passage of bile through the cystic duct into the common bile duct, and from there into the duodenum. The flow of bile is regulated by contraction or relaxation of the sphincter of Oddi. When the sphincter relaxes, bile flows into the duodenum. When it is reduced under the influence of cholecystokinin and other humoral factors, the flow of bile stops.

The composition of bile and its functions

Bile is composed of water, organic lipids ( fat) and electrolytes. Organic lipids include bile salts and acids, cholesterol, phospholipids. Of particular importance in the digestive process are bile acids - cholic and chenodeoxycholic. These acids are involved in the process of emulsifying fats, thereby ensuring their absorption. The emulsification process means that large fat molecules are broken down into smaller particles. Phospholipids include lecithin and taurine.

Other functions of bile are:

• fat absorption;
• activation of pancreatic juice enzymes;
• absorption of fat-soluble vitamins ( A, E, D, K) and calcium salts;
• stimulation of intestinal motility.

Causes of a polyp

Before finding out the causes of polyp formation, it is necessary to understand what polyps are. So, distinguish between true polyps and pseudopolyps. True polyps are those that are growths of epithelial tissue. These include adenomatous polyps and papillomas of the gallbladder. Pseudopolyps include the so-called cholesterol polyps, which are nothing more than deposits of cholesterol on the mucous membrane of the gallbladder. Pseudopolyps also include polyps of inflammatory etiology.


The causes of a gallbladder polyp are:

• genetic abnormalities and hereditary factor;
• inflammatory diseases of the gallbladder;
• violations of metabolic processes;
• biliary dyskinesia and other diseases of the hepatobiliary system.

Genetic anomalies and hereditary factor

It has been established that the hereditary factor plays an important role in the occurrence of gallbladder polyps. First of all, this applies to adenomatous polyps and papillomas of the gallbladder. Since both adenomatous polyps and papillomas are considered benign tumors, the hereditary factor in this case plays the maximum role. Even if among relatives there were tumor-like formations of other organs, the risk of formation of gallbladder polyps increases.

The hereditary factor also plays a large role in diseases against which polyps can develop. Thus, a genetic predisposition to the development of biliary dyskinesia was noted.

However, today polyps are considered a polyetiological disease, which means that several factors are simultaneously involved in their formation. So, against the background of a burdened family history in terms of polyps under the influence of other incoming factors ( e.g. bile stasis) polyps may form.

Inflammatory diseases of the gallbladder

First of all, these diseases include acute and chronic cholecystitis. These conditions are accompanied by stagnation of bile in the gallbladder and are a risk factor for the development of polyps. Pain is the main symptom of this pathology. The pain is localized in the right hypochondrium and can radiate to different parts of the body ( for example, in a shoulder blade). The nature of the pain syndrome is dull and paroxysmal. As a rule, pain appears after eating especially fatty foods. Sometimes the pain can be very intense and take on the character of hepatic colic. At the height of such pain, a single vomiting may occur.

In the period between pains, patients are worried about belching with bitter contents, morning sickness on an empty stomach due to stagnation of bile. During the inflammatory process in the gallbladder, its wall thickens and deforms. As a result of this, stagnation of bile occurs, which is the cause of the above symptoms.
As a reaction to the inflammatory process, granulation tissue grows on the walls of the gallbladder. Thus, inflammatory pseudopolyps are formed.

Metabolic disorders

This reason is the main one in the occurrence of cholesterol polyps ( more specifically, pseudopolyps). In the case of these types of polyps, cholesterol deposits are noted in the gallbladder mucosa. Over time, these deposits grow and calcify ( calcium salts are deposited). The reason for all this is a violation of lipid metabolism, in which there is an increased content of cholesterol in the blood. Cholesterol is an organic compound made up of lipids. In human blood, cholesterol is bound to proteins. These complexes of cholesterol and protein are called lipoproteins. The increased content of cholesterol leads to its deposition in the form of plaques on the walls of blood vessels and the gallbladder. Since cholesterol is present in bile, its stagnation may be accompanied by its deposition on the walls of the bladder, even without its increased concentration. If the patient already has high cholesterol ( more than 5.0 millimoles per liter), then stagnation of bile, only accelerates the formation of cholesterol pseudopolyps.

This type of polyp is the most common. For a long time, they do not bother the patient in any way, which is the reason for the long-term failure to see a doctor. This, in turn, leads to extensive cholesterol deposits.

Biliary dyskinesia and other diseases of the hepatobiliary system

With biliary dyskinesia, functional disorders are noted against the background of the absence of structural changes. With dyskinesia, there is either excessive contraction of the gallbladder, or insufficient. It is known that normally adequate contractility ensures the flow of bile into the duodenum. If, for some reason, the contraction of the gallbladder is disturbed, then there is an imbalance between the flow of bile and its need in the process of digestion. Most often, hypokinesia is observed, in which there is insufficient contraction of the gallbladder and, as a result, a deficiency of bile in the intestine. Since bile is mainly involved in the digestion and absorption of fats, a patient with such a problem has complaints such as nausea and vomiting after fatty foods, severe pain, and weight loss.

Excessive contractions of the gallbladder are observed with its increased tone. The pains are sharper and more cramping and are caused by strong contractions. The outflow of bile is also impaired, which provokes symptoms such as belching with bitter contents, heaviness after eating.
Most often, gallbladder polyps are the result of several causes. This is the interaction of both hereditary factors and all kinds of metabolic disorders.

Symptoms of a gallbladder polyp

The clinical picture of gallbladder polyps depends on their location. The most dangerous situation is when the polyp ( or polyps) is located in the neck of the gallbladder or in its duct. In this case, this formation makes it difficult for the outflow of bile from the bladder into the intestine, causing the development of obstructive jaundice.
If the polyp is located in other parts of the gallbladder, then its symptoms are often erased and unexpressed.

Symptoms of a gallbladder polyp are:

• pain syndrome;
• jaundice;
• hepatic colic;
• dyspeptic manifestations - bitter taste in the mouth, nausea, periodic vomiting.

Pain syndrome

Pain in polyps of the gallbladder is the result of overstretching of the walls of the bladder with stagnant bile or a consequence of its frequent contractions. Most often, a growing polyp blocks the outflow of bile, which leads to its accumulation in the gallbladder. Congestion provokes overstretching of the bladder and irritation of numerous receptors in its serous membrane. Also, pain can occur due to frequent and intense contractions of the gallbladder.

The pains are located on the right in the hypochondrium and are dull in nature. They are rarely constant and are more often cramping in nature. Pain is provoked by fatty and plentiful food, alcoholic beverages, sometimes stressful situations.

Jaundice

Jaundice is called icteric staining of the skin and visible mucous membranes, namely the sclera. This syndrome is a consequence of elevated levels of bile pigment ( bilirubin) in blood. So, normally, its content should not exceed a concentration of 17 micromoles per liter of blood. However, when bile stagnates in the gallbladder, its components begin to seep into the blood. As a result of this, bilirubin and bile acids are at elevated concentrations in the blood plasma.
First of all, the color of the skin and sclera changes - they acquire an icteric hue, the severity of which depends on the initial color of the patient's skin. So, if the patient has a dark skin tone, then it becomes dark orange, if it is light, then bright yellow. If the patient is the owner of very dark skin, then jaundice can be determined only by the color of the sclera.

Also, jaundice is accompanied by symptoms such as itching, nausea and vomiting. Skin itching appears as a result of the release of bile acids into the blood. Since the outflow of bile from the gallbladder is blocked, the bile begins to build up in it. Accumulating up to a certain time ( based on the initial size of the gallbladder), bile begins to look for a way out. It is soaked through the walls of the gallbladder and enters directly into the blood ( where normally it shouldn't be). Circulating in the vessels of the skin, bile acids irritate the nerve endings, thus causing itching. Often, scratching from severe itching is visible on the skin of patients. The skin is very dry and tight. Skin itching with jaundice is generalized and does not have a clear localization. Nausea and vomiting with jaundice is a consequence of stagnation of bile.
Also, with jaundice, urine becomes dark in color, pain in the joints and muscles appears. An unfavorable symptom is fever.

hepatic colic

Hepatic colic is a syndrome that is characterized by the appearance of sudden, sharp and cramping pains in the right hypochondrium. As a rule, colic is a manifestation of cholelithiasis and appears when the outflow of bile is completely impaired. With a polyp of the gallbladder, hepatic colic appears in exceptional cases. It can appear when a polyp on a very long stalk is diagnosed. Being in the region of the neck of the gallbladder, the leg of the polyp can be infringed and provoke hepatic colic.

A pedunculated polyp is a type of polyp that is shaped like a mushroom. In its structure, a leg and the hat itself are distinguished. The leg of the polyp can be very long and thin. Therefore, it can easily twist and pinch if the polyp is located in the neck of the bladder. When the bubble contracts, it can pinch either the entire poly or its movable leg. This moment provokes sharp, sharp and cramping pains like hepatic colic.
Very intense pains appear sharply and suddenly. The patient at the same time can not sit in one place and is constantly rushing about. An increase in heart rate ( pulse), and blood pressure may also rise. The skin becomes pale and covered with sweat.

A distinctive feature of hepatic colic from a pain syndrome of another etiology is that the patient in this condition cannot find a suitable position. As a rule, with pain of a different etiology, the patient finds himself a position in which the pain subsides a little. For example, with pleurisy, a person lies on the affected side in order to weaken the excursion of the chest and, thereby, reduce pain. With hepatic colic, this is not observed.

Dyspeptic manifestations

This symptomatology is manifested most often with polyps of the gallbladder. It can be very intense or, on the contrary, erased.

Manifestations of dyspeptic syndrome with a gallbladder polyp are:

• bitter taste in the mouth;
• nausea, especially in the morning;
• occasional vomiting, especially after eating large meals.

The above symptoms are the result of stagnation of bile in the gallbladder and impaired outflow. When bile does not reach the intestines, it stagnates in the gallbladder. At the same time, its secretion is disturbed depending on the meal. The absence of bile acids in the intestine leads to the fact that food ( predominantly oily) is not digested or assimilated. If bile is not involved in digestion for a long time, a person begins to rapidly lose weight. This is because bile is essential for the digestion and absorption of fats.
The bitter taste in the mouth, in turn, can be explained by the reflux of bile from the duodenum ( ) into the stomach. This is due to a violation of the contractility of the gallbladder, which is also observed in polyps. As a rule, the bitter taste in the mouth is explained by hyperkinesia ( increased physical activity) gallbladder.

Classification of polyps in the gallbladder

Cholesterol polyp	Inflammatory polyp	adenomatous polyp	Papilloma
It is not a true polyp, but is a pseudo-formation. It is formed by deposits of cholesterol on the mucous membrane of the gallbladder.	It also belongs to the category of pseudotumors. It is an overgrowth of the mucosal epithelium in response to an inflammatory reaction.	It develops from the glands of the epithelium, which covers the mucous membrane of the gallbladder. More often than other polyps, it becomes malignant.	Benign formation with numerous papillary growths. Also inclined to move into oncology.

Diagnosis of a polyp of the gallbladder

Diagnosis of a gallbladder polyp is reduced to an ultrasound and endoscopic examination.

Ultrasound diagnosis of a polyp

This diagnostic is based on the use of sound waves with a frequency above 20,000 Hertz. These waves are capable of changing their characteristics when passing through various media, including those of the body. Reflecting from some obstacle ( body), the wave returns and is captured by the same source that generated it. Thus, the difference is calculated ( or the ratio) between the wave that came out initially and the one that was reflected. This reflectance is captured by a special sensor and converted into a graphic image.

On ultrasound, the gallbladder looks like a dark oval formation surrounded by a light thin wall. The wall is normally thin and even. The bladder cavity is normally uniform in color. With a polyp on a dark background, a light formation is diagnosed, growing from the wall into the cavity. The shape of this light formation is determined by the shape of the polyp - if it is a polyp on a stalk, then a stalk and a cap stand out in it. If there are many polyps, then several light formations growing from the wall into the dark cavity are determined at once. The color of polyps on ultrasound is heterogeneous. If it is a cholesterol or inflammatory polyp, then on ultrasound the formation is completely white. If it is an adenomatous polyp, then there are blackouts on a light background.

Carrying out ultrasound diagnostics
Preliminary preparation before the ultrasound is not required. However, if the patient suffers from severe gas formation ( swelling), then it is recommended to exclude gas-forming products 2-3 days before the diagnosis. Directly on the day of the study, a light breakfast or lunch is recommended so as not to overload the digestive system.

The place to which the sensor will be attached is treated with gel. This prevents air from penetrating between the sensor and the skin. For better visualization, the doctor may ask the patient to lie on the right side. The difference between a gallbladder polyp and its other formations is that the polyp does not give an acoustic track, for example, as with a gallbladder stone. Another feature is that it does not move when changing the position of the body.

Endoscopic ultrasonography method

This method combines both the endoscopic method and ultrasound. It consists in conducting an ultrasonic transducer with the help of an endoscope into the cavity of the duodenum. Being in the intestinal cavity, the sensor scans the surrounding tissues at a distance of 12 centimeters. Since the gallbladder and duodenum are in close proximity, being in the intestinal cavity, the ultrasonic sensor visualizes the bladder. The advantage of this method is the use of high frequency ultrasound. Thus, a high image quality is achieved, in which it is possible to examine and study the polyp in detail.

For this diagnostic method, miniature ultrasound probes are used, which are first inserted into the stomach, and from there into the duodenum.

Performing endoscopic ultrasonography
The procedure is performed on an empty stomach. The night before, dinner should also be light so as not to overload the stomach. On the day of the procedure, the patient if he is very nervous) intramuscular injection of diazepam. The cavity of the oropharynx is treated with a solution of lidocaine, which is injected as a spray.
The patient is asked to open his mouth, and when the endoscope is inserted into the oropharynx, he makes a swallowing movement. At the moment of swallowing, the endoscope tube is pushed into the esophagus, and from there into the stomach cavity. From the cavity of the stomach, the endoscope, at the end of which an ultrasonic sensor is attached, enters the cavity of the duodenum, from where the surrounding tissues are scanned. Due to the high frequency of the ultrasound wave, the picture of the gallbladder is obtained with high resolution. This makes it possible to diagnose even very small polyps.

CT scan

Computed tomography is an additional diagnostic method. The advantage of this method is the high resolution ( allows you to see even very small polyps), non-invasiveness ( no tissue damage), there is no need for special training. A significant disadvantage is the cost of the method.
Using this diagnostic method, the structure and localization of the polyp, as well as associated anomalies of the biliary tract, are determined. If computed tomography is performed using a contrast agent, then the accumulation of this substance by the polyp can also be assessed. The tomography method often helps to determine the cause of the formation of polyps. So, it can be pathologies of the biliary tract and their various anomalies.

In addition to instrumental diagnostic methods that allow you to identify the polyp itself, standard laboratory tests are carried out.

Laboratory diagnostic methods that are used for gallbladder polyps

Method name	What reveals
Blood chemistry	The following signs of cholestasis are determined(bile stasis): increased content of bilirubin, more than 17 micromoles per liter of blood; increased content of alkaline phosphatase, more than 120 units per liter of blood; elevated cholesterol, more than 5.6 millimoles per liter of blood.
Analysis of urine	appearance of bilirubin normally absent); the concentration of urobilinogen is reduced, less than 5 mg per liter.
Fecal analysis	Fecal stercobilin is reduced or absent.

Treatment of a polyp of the gallbladder

Treatment of the gallbladder polyp is reduced to its surgical removal. Medical treatment of polyps is not effective. It is used only for the treatment of background diseases, that is, those against which polyps have formed. Symptomatic treatment is also used, which is aimed at eliminating the symptoms of polyps in the gallbladder. For example, with a pronounced pain syndrome, antispasmodics are prescribed, with stagnation of bile - choleretic drugs. In the case of cholesterol polyps, drugs are used to help dissolve cholesterol deposits.

Drugs prescribed to eliminate the symptoms of a gallbladder polyp

Name of the drug	Mechanism of action	Mode of application
Holiver	Stimulates the secretion of bile and peristalsis of the gallbladder. Eliminates the symptoms of cholestasis ( violation of bile secretion). Contraindicated in complete obstruction ( overlap) gallbladder polyp.	Before meals, 2 tablets three times a day.
Gepabene	Normalizes the secretion of bile by hepatocytes, and also eliminates spasm of the gallbladder. Thus, it facilitates the flow of bile into the intestines, where it takes part in digestion.	It is recommended to take the drug during meals with a small amount of food, one capsule three times a day.
No-shpa	It has a relaxing effect on the smooth muscles of the internal organs, including the muscles of the gallbladder. As a result, spasm of the gallbladder is eliminated.	One - two capsules for pain attacks.
Simvastatin	Reduces cholesterol and lipoprotein levels.	It is taken once a day. In the evening, one capsule daily, the course of treatment is determined individually.
Ursofalk	It is used to destroy cholesterol deposits. The drug increases the solubility of cholesterol in the biliary system, which leads to the dissolution of cholesterol polyps.	The dose of the drug is determined based on the body weight of the person. So, on average, the daily dose is 10 mg per 1 kg of weight. If the patient weighs 60 kg, then he needs 2 capsules per day. The drug is taken daily in the evening, for 3 to 6 months.

If a patient with gallbladder polyps is treated with ursofalk or other drugs from this group, then periodic ultrasound examinations are recommended. So, once every three months, an ultrasound is performed, during which the size of cholesterol polyps is visualized. If they decrease that is, the drug is effective), the treatment continues. If after 6 months or more no result is visible, then surgical removal of the gallbladder is undertaken.

Surgery
It is the main treatment for gallbladder polyps. As a rule, a polyp in the gallbladder is removed endoscopically. In this case, the entire gallbladder is removed, and this version of the operation is called cholecystectomy.

Indications for surgical treatment of gallbladder polyps are:

• the size of the polyp exceeds one centimeter;
• if the polyp develops against the background of another chronic pathology, for example, against the background of cholecystitis;
• if the polyp is constantly growing and increasing;
• if there are multiple polyps of the gallbladder;
• if there are additional gallbladder stones;
• if there is a burdened family history in terms of oncology.

Is surgery necessary for a gallbladder polyp?

Surgery for a polyp of the gallbladder is performed when there is a possibility of transformation of the neoplasm into a cancerous tumor. The propensity to transition to oncological education is indicated by such factors as the size of the polyp ( over 10 mm in diameter), intensive growth ( magnification up to 20 mm), number ( more than one polyp).

Another indication for surgery is the presence in the gallbladder, in addition to polyps, stones and other neoplasms. Those polyps that cause discomfort and adversely affect the patient's health are also removed. A timely operation allows you to avoid serious complications. The method of surgical treatment is established by the physician, based on data on the general condition of the patient and the nature of the polyps.

The reasons why it is necessary to remove a gallbladder polyp are:

• transformation of a polyp into cancer;
• attacks of hepatic colic;
• inflammation of the walls of the gallbladder;
• purulent cholecystitis;
• deterioration of the outflow of bile;
• increased levels of bilirubin.

Transformation of a polyp into cancer

The frequency of malignancy ( rebirth into cancer) polyps of the gallbladder varies from 10 to 35 percent. The size of the neoplasm greatly influences the probability of degeneration into a malignant tumor. So, polyps, whose diameter exceeds 20 millimeters, are transformed into cancer in half of the patients.
At the initial stage of the disease, the patient does not observe any symptoms, which greatly complicates the diagnosis and treatment. Increasing, a malignant tumor begins to manifest itself with such symptoms as general physical weakness, loss of appetite, dull pain in the right hypochondrium. As the pathological process progresses, patients begin to complain of itching, vomiting, nausea, and yellowness of the skin. Often, the presence of a cancerous tumor in the gallbladder is accompanied by a lightening of the shade of feces and darkening of the urine.
The prognosis for gallbladder cancer is poor. After diagnosis, the average life expectancy of the patient is 3 months. Up to one year, no more than 15 percent of patients survive. Therefore, if polyps are found with a high probability of malignancy, an operation is prescribed.

Attacks of hepatic colic

Growing, the polyp can block the lumen of the gallbladder, causing attacks of acute hepatic colic. This condition is characterized by severe pain, which is localized under the right row of ribs. Pain may radiate spread) in the right shoulder or shoulder blade, back, neck. Sometimes the pain covers the entire abdomen. Such attacks develop in most cases at night suddenly and can last from one to several hours. In rare cases, hepatic colic does not go away within a day. Pain reaches its peak on inspiration and when the patient lies on his left side.

Other manifestations of a gallbladder polyp are:

• severe nausea;
• frequent vomiting, not leading to relief;
• pallor and moisture of the skin;
• yellowness of the skin and mucous membranes of the eyes;
• soreness and bloating;
• increase in temperature;
• dark urine.

In this condition, an immediate operation is indicated, the implementation of which is hampered by the unsatisfactory condition of the patient. To prevent such a complex surgical intervention, it is necessary to remove polyps in a timely manner as they are detected.

Inflammation of the gallbladder

Gallbladder polyps are often accompanied by inflammatory processes that affect the walls of this organ. With the growth or increase in the number of polyposis formations, the inflammation becomes more pronounced and begins to cause severe discomfort to the patient. Common symptoms of activation of the inflammatory process are pain in the area of ​​the right hypochondrium, constipation or diarrhea, bloating, vomiting, nausea. Discomfort and pain of the patient increase after eating fatty and fried foods.

Purulent cholecystitis

As inflammation of the gallbladder progresses, it can turn into purulent cholecystitis. This form of inflammation is characterized by a more severe course, constant pain and a sharp deterioration in the patient's condition. Purulent lesions of the gallbladder can lead to serious complications, many of which have an unfavorable prognosis and lead to death.

The consequences of untimely removal of the gallbladder polyp are:

• Gangrenous cholecystitis- represents the next stage of purulent cholecystitis and is accompanied by necrosis ( deadness) walls of the gallbladder. The consequence of this condition may be the rupture of this organ.
• liver abscess- the formation of a cavity in the tissues of the liver, which is filled with purulent contents. An abscess can break into the abdominal cavity and cause a general infection of the body.
• Peritonitis- an inflammatory process in the peritoneal cavity, which develops as a result of a breakthrough of purulent contents into the peritoneum. This complication is characterized by a high mortality rate.
• Cholangitis- inflammation of the bile ducts, which can lead to sepsis ( blood poisoning).

Decreased flow of bile

Large polyps can cause obstructed flow of bile. This leads to stagnation of bile, which is accompanied by numerous pathological changes in the patient's health status. cholestasis ( violation of the outflow of bile and its stagnation) is manifested by bitterness and unpleasant odor in the mouth, poor appetite, constipation. In the region of the right hypochondrium, the patient feels acute pain, heaviness and general discomfort. Patients experience persistent weakness, decreased physical and mental activity, and dizziness. The volume of excreted urine increases, which, together with malnutrition, leads to a deficiency of vitamins. An insufficient amount of vitamins causes visual impairment, dryness of the mucous membranes and skin, and muscle weakness. One of the signs of a violation of the outflow of bile is a yellow tint of the mucous membranes of the eyes and skin. In this case, age spots may appear on the chest, elbows and back. Severe itching is also a common symptom of this disorder. Poor bile flow leads to increased fat content in the feces. Because of this, the stool acquires a mushy structure, and its shade brightens. With a long course of this disease, the development of serious negative consequences is possible.

Complications of gallbladder polyps are:

• cirrhosis of the liver ( pathological changes in the structure of the liver tissue);
• jaundice ( staining of the eye sclera and skin in a yellow tint);
• osteoporosis ( decrease in bone density);
• liver failure ( decrease in the functions of these organs).

Increasing bilirubin levels

Stagnation of bile due to polyps in the gallbladder leads to an increase in the amount of bilirubin in the blood. This substance is formed during the breakdown of hemoglobin and has a toxic effect. Bilirubin is excreted along with bile, therefore, with a decrease in the outflow of bile, it begins to accumulate in the blood. With an excessive amount, this compound provokes intoxication of the body and a deterioration in the functionality of all vital organs. The most sensitive to the effects of bilirubin are brain cells. The initial signs of an excess of this substance are icteric coloration of the skin, a dark shade of urine, and general weakness. In the future, such symptoms as memory impairment, sleep disturbances, and a decrease in mental activity join. One of the complications of this condition is irreversible changes in the structure of the brain.

Types of surgery for a polyp of the gallbladder

Surgery for a polyp of the gallbladder is called cholecystectomy. This means that the gallbladder itself is removed along with the polyps. This type of surgical intervention can be performed endoscopically or in the usual classical way. In 90 percent of cases, this intervention is performed using endoscopic techniques.

Laparoscopic cholecystectomy

The purpose of this operation is to remove the gallbladder using endoscopic technique. To do this, punctures are made on the anterior abdominal wall, through which instruments are inserted into the abdominal cavity. These instruments, also called trocars, are hollow tubes with valve devices at the end. Trocars do not make additional incisions, but only push the tissues apart. Further, through the introduced trocars, working instruments, such as a laparoscope, an eyepiece with a video camera, are inserted into the abdominal cavity.

Before the operation, the patient undergoes all the necessary clinical examinations. A repeated ultrasound examination, a complete blood count and a coagulogram ( includes testing for platelets, prothrombin, fibrinogen).

Anesthesia
Laparoscopic cholecystectomy is performed under general anesthesia with the use of muscle relaxants.

• four small incisions are made through which trocars are inserted;
• surgical instruments are inserted through the trocars into the abdominal cavity;
• being audited ( inspection) abdominal organs;
• there is a hepatoduodenal ligament, from which the cystic artery and cystic duct stand out;
• artery and duct are ligated and divided ( clipping occurs in medical language);
• from the liver bed is released and the gallbladder is separated. Most often, an electrocoagulator is used, which cuts and coagulates tissues;
• the gallbladder is removed from the abdominal cavity through the punctures made.

The advantages of laparoscopic cholecystectomy are:

• short and moderate pain intensity in the postoperative period;
• minimal hospital stay in the postoperative period ( up to 5 days);
• a low percentage of complications such as adhesions, postoperative hernia, infection of postoperative wounds;
• immediately after the operation, the patient can serve himself.

Open cholecystectomy

This operation involves the removal of the gallbladder not through punctures, but through full-fledged incisions. A laparotomy is performed - cutting the abdominal wall, which gives access to the liver and gallbladder. There are several options for laparotomy, but for gallbladder polyps, an oblique laparotomy is performed. In this case, an oblique incision is made along the edge of the costal arch, which provides access to the liver and gallbladder.

The operation consists of the following steps:

• the field of the preliminary incision is treated with antiseptics;
• then an incision of 10 - 15 centimeters is made with a scalpel;
• tissue incision is carried out layer by layer;
• next is the hepatoduodenal ligament, after which the artery and duct are clipped;
• the gallbladder is removed from the bed, bandaged and removed;
• regional lymph nodes are removed;
• the incision is also sutured in layers, but in reverse order.

Laparotomic cholecystectomy is performed when gallbladder polyps exceed 15 to 18 millimeters. It is believed that polyps of this size turn into a malignant tumor. Therefore, when the gallbladder is removed, lymph node dissection is performed ( removal of regional nodes) and resection of a fragment of the liver.

With open cholecystectomy, general anesthesia is performed with tracheal intubation and the use of muscle relaxants. The sutures are removed on the 6th - 7th day. On the first day after the operation, the patient can drink water, on the second - to eat. Getting up after an open laparotomy is allowed from 3 to 4 days. The duration of the rehabilitation period lasts about two weeks.

Rehabilitation after surgery for a gallbladder polyp

Rehabilitation after surgical treatment of a gallbladder polyp consists of a number of measures aimed at restoring body functions and preventing postoperative complications. The duration of the stage from the moment of the operation to the return to a normal lifestyle depends on the age and condition of the patient. Also, the duration of rehabilitation is influenced by the nature of the operation performed. During laparoscopic cholecystectomy ( operations through punctures in the wall of the peritoneum) the patient's ability to work is restored within 2-3 weeks. In the case of an open operation, a period of 1 to 2 months is required for a complete recovery. The rehabilitation process includes 3 stages.

The first stage of rehabilitation ( early stationary stage)

This stage lasts 2-3 days from the moment of the operation and requires careful monitoring of the patient's condition. Observation is necessary, since in this period the changes caused by surgery are most pronounced.
After laparoscopic cholecystectomy, the patient is transferred to the intensive care unit for 2 hours, where the necessary measures are taken to bring the patient out of anesthesia. During an open operation or in the presence of complications, the period of stay in this department increases. The patient is then transferred to the general ward. Rehabilitation at this stage is diet and exercise. In the absence of complications, the first stage of rehabilitation ends with the discharge of the patient from the hospital.

Nutrition for the first stage of rehabilitation
During the first 4-6 hours, the operated person is forbidden to eat or drink. Further, within 10 - 15 hours, you need to drink only still water in small portions. After a day, you can begin to introduce liquid and semi-liquid food into the patient's diet.

Allowed dishes in the first stage of rehabilitation are:

• kefir, yogurt;
• oatmeal and buckwheat porridge;
• potato, squash, pumpkin puree;
• vegetable soups;
• banana puree;
• baked apples;
• lean meat soufflé.

Physical exercises of the first stage of rehabilitation
The first 5-6 hours after recovery from anesthesia, the patient should be in a horizontal position. Attempts to get out of bed can only be made with the permission of a doctor and in the presence of medical personnel. This is necessary in order to avoid fainting, which can develop due to prolonged lying and the action of medications.

An important stage of this rehabilitation stage is the implementation of a series of exercises. The task of physical activity is to activate breathing to remove the anesthetic from the respiratory tract. Also, exercises are necessary to normalize the circulation of blood and lymph. In the absence of complications, the exercises should be started immediately after the effect of anesthesia ends. You should start with breathing exercises, which consists of a slow deep breath and a sharp exhalation. It is necessary to repeat the alternation of inhalation and exhalation for 2-3 minutes, while holding the postoperative wound with your hand.

Then, within 2-3 minutes, flexion and extension of the limbs should be carried out, as well as their dilution to the sides and bringing them to their original position. After the patient is allowed to get up, gymnastics should be supplemented with a number of exercises.

Physical exercises of the first stage of rehabilitation are:

• breeding legs bent at the knees in a prone position;
• torso to the side, sitting on a chair;
• walking in place with alternately raising the right and left knee;
• rolling from heels to toes and back.

All exercises are performed slowly, without holding the breath, 5-6 times.

The second stage of rehabilitation after removal of the gallbladder polyp

The second stage lasts 30-40 days, and its goal is to return all functions to normal and normalize the general condition of the body.

The directions of rehabilitation of the second stage are:

• compliance with the regime of physical activity;
• diet therapy;
• hygiene of postoperative wounds;
• tracking complications.

Compliance with the regime of physical activity
During laparoscopic surgery for gallbladder polyps, the condition of patients in most cases is satisfactory as early as 3-4 days after surgery. Despite this, patients are advised not to visit the street for a week and to observe bed rest. Further, throughout the entire stage, any physical activity and exercises that require tension in the abdominal press should be excluded. You should also refuse to lift objects whose weight exceeds 3 - 4 kilograms. This is necessary so that the abdominal wall injured during the operation heals faster.

diet therapy
Compliance with certain principles in the selection and preparation of dishes is an important stage in the rehabilitation of surgical treatment of gallbladder polyps.

The rules for the preparation and use of products are:

• the diet should be fractional and meals should be carried out every 3 hours;
• after eating, there should not be a feeling of overeating;
• during the cooking process, the products must be crushed or wiped;
• as a heat treatment, it is recommended to use boiling, steaming or baking in the oven;
• ready-made dishes are seasoned with butter and vegetable oil;
• the temperature of the food consumed should be medium;
• within 1.5 - 2 hours after eating, it is necessary to abandon physical activity;
• the introduction of new products should be carried out gradually, controlling the reaction of the body.

Name	Allowed meals	Unauthorized meals
flour products	Rye bread ( yesterday or dried); bran bread; whole grain bread; unsweetened bagels; dry unsweetened cookies; durum pasta; products from unleavened non-yeast dough.	wheat bread; cornbread; kalach; fried donuts, pies; pasta is not hard varieties; any products from sweet dough.
First meal	vegetarian soup; milk soup; cereal soup; secondary meat broth ( 1 - 2 times a week); vegetable puree soups; ear on lean fish; lean borscht.	hodgepodge ( spicy first course of fatty meat or fish); kharcho ( spicy lamb soup); pickle ( pickled cucumber soup); mushroom soup; cheese soup.
Meat dishes	hen ( brisket); rabbit ( fillet); Turkey ( All parts); veal ( tenderloin); beef ( fillet, entrecote); pork ( fillet without fat). fillet in boiled or baked form; broths for first courses; boiled meatballs; steam cutlets; souffle.	chicken drumsticks and thighs; duck, goose ( any fragments of the carcass); pork ( all parts that contain fat); mutton ( any part of the carcass); beef ( all parts with fat or a lot of tendons); meat of wild birds or animals.
Fish products	river and sea bass; zander; mackerel; Amur; pollock; roach; burbot. Cooking recommendations: baked carcasses in foil; broths for first courses; fish casseroles; cutlets cooked in the oven.	pink salmon; carp; oily fish; sea ​​and river bream; capelin; herring; horse mackerel; tuna; smelt; mackerel; halibut; saury; Atlantic herring.
cereals	buckwheat; wild rice; oatmeal; simple rice.	lentils; semolina; millet; rye.
Snacks, sauces	low-fat boiled sausage ( limited); mild cheese; soy cheese; dairy or sour cream sauces without fried flour; natural yogurt dressings.	ketchup; mayonnaise; raw smoked meat products; dried meat products; soy sauce; vinegar dressings.
Fruits and berries	bananas; apples; blueberry; cranberry; avocado; grape.	kiwi; gooseberry; dates; raspberries; blackberry; persimmon.
Vegetables	carrot; pumpkin; zucchini; squash; cauliflower; Brussels sprouts; green pea; beet; potato.	sorrel; spinach; radish; turnip; garlic; tomatoes ( limited); beans; White cabbage; cucumbers.
Milk products	milk ( if tolerated); yogurt; fermented baked milk; kefir; low-fat cottage cheese; curdled milk.	salted cheese; spicy cheese; fat sour cream; sweet glazed curds; yoghurts with dyes and preservatives.
Beverages	rosehip decoction; tea with milk; weak coffee ( preferably natural); herbal teas ( linden, chamomile); fruit juices.	any carbonated drinks; alcohol; cocoa; drinks from dry concentrates; unnatural drinks.
desserts	fruit jelly; milk puddings; sweet milk porridge; sweetened curd; meringues ( whipped and baked protein dessert).	chocolate ( in any form); pastries, cakes; sand dough products; biscuits; pancakes.

Hygiene of postoperative wounds
After the operation, special plasters are applied to the wounds. Depending on the type of stickers, they can be removed or not removed before taking water procedures. If the patch needs to be removed, after showering, the wound should be treated with an antiseptic and a new sticker should be fixed. Bathing, swimming in a pool, lake or other body of water is prohibited until the removal of the stitches and for 5 days after they are removed.

Complication tracking
Any type of surgery for gallbladder polyps can be accompanied by complications. To take timely measures to eliminate negative consequences, the patient must monitor the state of the body. If you notice any changes in your health, you should consult a doctor.

Symptoms of complications after gallbladder polyp surgery are:

• redness, suppuration of postoperative wounds;
• the appearance of painful seals in the wound area;
• rash, redness of the skin;
• bloating, abdominal pain;
• nausea, vomiting;
• muscle, joint pain.

Also, in order to prevent complications, the patient must undergo medical supervision 2-3 days after discharge from the hospital. The next examination is carried out in 2-3 weeks.

The third stage of rehabilitation after removal of the gallbladder polyp

Rehabilitation in the long term consists in the dynamic observation of the patient in order to prevent relapse ( recurrence of the disease). A month after the operation, it is necessary to pass a general urine test and a general and biochemical blood test. Also, in some cases, it is recommended to undergo an ultrasound examination. In the future, during the year after the operation, the patient needs to be examined every 3 months.

Prevention of gallbladder polyps

Prevention of polyposis formations of the gallbladder consists in reducing the influence of factors that provoke the formation of polyps. The main causes of this pathology include hereditary predisposition, impaired fat metabolism, cholestasis ( deterioration of outflow and stagnation of bile). Also, the development of polyps is influenced by the patient's lifestyle.

Directions for the prevention of polyposis overgrowth of the gallbladder mucosa are:

• dynamic observation by a doctor with hereditary predisposition;
• prevention of bile stasis cholestasis);
• timely treatment of inflammation of the gallbladder;
• normalization of fat metabolism.

Dynamic observation by a doctor with hereditary predisposition

Heredity is one of the key factors that increases the likelihood of the formation of gallbladder polyps. Scientists explain this by the fact that close relatives have a similar metabolism and mucosal structure. Therefore, people whose parents suffered from this disease should be systematically examined. The leading method for diagnosing polyposis formations today is an ultrasound examination of the abdominal cavity. An ultrasound scan detects 90 to 95 percent of all polyps. Magnetic resonance imaging is also used.

Timely treatment of inflammation of the gallbladder

Inflammatory process ( cholecystitis) in the gallbladder leads to pathological changes in the parameters and structure of this organ. The consequence of this condition is the formation of polypoid formations on the mucosa. The cause of cholecystitis is most often various pathogenic microorganisms of the intestine, which provoke an infectious process. Infection from the intestines into the gallbladder penetrates along with blood or lymph.

Signs of the development of the inflammatory process in the gallbladder are:

• dull pain under right row of ribs;
• swollen belly;
• dysfunction of the digestive system;
• nausea, vomiting;
• staining of the skin and eye sclera in a yellow tint.

In acute inflammation, there are symptoms of intoxication of the body ( high fever, headaches, general weakness).
If you find these manifestations of inflammation, you should consult a doctor. The physician will prescribe treatment, which will prevent the formation of inflammatory polyps in the gallbladder.

Prevention of bile stasis ( cholestasis)

Violations of the outflow of bile leads to the fact that this substance begins to have a toxic effect on the mucous membrane of the gallbladder. As a result, polyposis formations begin to develop on the walls of this organ. In the role of circumstances that contribute to the stagnation of bile, various internal and external factors can act. One of the common reasons is the lack of food culture ( frequent snacking, long breaks between meals, dry food). The quality of the foods consumed can also provoke cholestasis. Contributes to this disease fatty foods with a minimum amount of fiber. Dysfunction of the endocrine system and chronic diseases of the digestive tract also cause bile stasis and, as a result, the formation of polyps in the gallbladder. Disorders of the nervous system and a sedentary lifestyle can also cause a violation of the outflow of bile and the formation of gallbladder polyps.

Measures that will help prevent gallbladder polyps are:

• compliance with the regimen when eating;
• inclusion in the diet of plant products with fiber;
• control of consumption of animal fats;
• maintaining an active lifestyle;
• timely treatment of gastritis, ulcers, pancreatitis;
• adequate therapy of infectious diseases of the intestine;
• timely access to a doctor with dysfunctions of the nervous system.

Normalization of fat metabolism

In violation of fat metabolism ( lipids) cholesterol begins to accumulate on the walls of the gallbladder ( fat breakdown product), which causes the formation of polyps. The main factor that causes an imbalance in the lipid metabolism system is malnutrition. In addition, hypodynamia contributes to the deterioration of fat metabolism ( decreased muscle tone due to a sedentary lifestyle), bad habits. to endogenous ( internal) causes of lipid metabolism disorders include a number of diseases of the gastrointestinal tract, which cause a deterioration in the absorption of fats.
In order to prevent gallbladder polyps, it is necessary to adhere to a certain diet and quality of nutrition and adjust the lifestyle. It is also necessary to treat diseases of the digestive system in a timely manner, preventing their transition into a chronic form.

Measures to normalize fat metabolism are:

• quality control and quantity of consumed fats;
• increase in the rate of dietary fiber consumed;
• control of the balance of carbohydrates in the diet;
• fight against hypodynamia;
• timely detection and treatment of diseases.

Controlling the quality and quantity of fats consumed
Excess intake of fats in the body leads to the fact that the liver ceases to cope with their processing, which leads to a deterioration in lipid metabolism. The likelihood of developing this disorder is affected by both the amount and quality of fat consumed. All fats consumed by a person can be divided into two groups - good and bad. Healthy fats include unsaturated fats, which are found mainly in plant foods. Saturated and modified fats are harmful. The main difference between one category and another is the fact that at room temperature, unhealthy fats retain a solid consistency. In order to prevent gallbladder polyps, people over 40 should consume no more than 70 ( women) – 100 (men) grams of fat per day. In this case, the proportion of harmful fats should not exceed 10 percent.

Good and bad fats and the foods they contain

Name	Products
monounsaturated (useful)fats	rapeseed oil; olive oil; hazelnuts; pistachios almond; avocado.
Polyunsaturated (useful)fats	linseed oil; corn oil; walnuts; pumpkin seeds; sesame.
Saturated (harmful)fats	interior fat of birds and animals; Salo ( melted and hard); mutton; pork; hard-billed poultry.
Modified (harmful)fats	fast food ( fast food); confectionery; puff pastry; chips, french fries; frozen semi-finished products.

Increasing dietary fiber intake
Alimentary fiber ( cellulose) contribute to better absorption of fats, and also favorably affects the metabolism. Fiber is found only in plant foods.

Foods that are rich in dietary fiber are:

• fruit- raspberries, blackberries, bananas, pears, apples, kiwi;
• vegetables- green peas, beets, broccoli, cabbage, carrots;
• cereals- pearl barley, buckwheat, bulgur ( whole wheat cereal), oatmeal;
• legumes- lentils, beans, chickpeas, soybeans, peas;
• nuts- walnuts, forest, almonds, cashews, peanuts.

Controlling the balance of carbohydrates in the diet
Depending on the structure and effect on the body, carbohydrates are divided into fast and slow. Fast carbohydrates are transformed in the body into fats. Such substances are contained in sugar, wheat flour, chocolate, potatoes. Slow carbohydrates act as a source of energy, improve metabolism and maintain a feeling of satiety. They are found in whole grains bran, durum pasta), vegetables, unsweetened fruits.
To improve lipid metabolism and prevent the formation of gallbladder polyps, the amount of carbohydrates per day should be 3-4 grams per kilogram of weight. In this case, the rate of fast carbohydrates should not exceed 30 percent.

The fight against hypodynamia
A sedentary lifestyle has a negative effect on metabolism, increasing the risk of the formation of gallbladder polypous formations. In addition, physical inactivity contributes to a decrease in immunity, which also contributes to the occurrence of polyps. In order to prevent this pathology, it is necessary to increase physical activity. It can be morning exercises, sports dancing, walking, active sports. Regardless of the type of lesson chosen, a number of rules must be observed when performing them.

The rules for dealing with hypodynamia are:

• gradual increase in load;
• control of one's own state;
• the regularity of the exercises.

The first 2 months of training at the peak of the load, the pulse should not exceed 120 beats per minute. In the future, the optimal pulse is determined by the formula 180 minus the person's age. If shortness of breath, excessive sweating or deterioration of well-being occurs, the exercise must be stopped, and subsequently the volume and intensity of the exercises performed should be reduced.

Timely detection and treatment of diseases
Violation of fat metabolism can be triggered by some diseases. Prevention of gallbladder polyps implies timely treatment of these disorders.

Diseases that cause lipid metabolism disorders are:

• pancreatitis ( inflammatory disease of the pancreas);
• enteritis ( inflammation in the small intestine);
• hypothyroidism ( decreased thyroid function);
• hypovitaminosis ( vitamin deficiency).

What are the consequences of polyps in the gallbladder?

Gallbladder polyps are dangerous primarily for their complications.

The consequences of polyps in the gallbladder are:

• transition to gallbladder cancer;
• infringement of the legs of the polyp;
• complete obstruction ( overlap) gallbladder polyp.

Transition to gallbladder cancer
This consequence is the most dangerous, since the prognosis for gallbladder cancer is extremely unfavorable. A cancerous tumor in this place is most often inoperable. Life expectancy after diagnosis ranges from three months to a year ( in 10 percent of patients).

The greatest risk of malignancy is in sessile adenomatous polyps. Percentage of malignancy ( transition of a polyp to a malignant tumor) according to various data varies from 10 to 35 percent. An increased risk of malignancy is also observed in the case of large polyps - more than 10 millimeters in diameter.
The symptoms of gallbladder cancer are similar to those of gallbladder polyps. Pain, nausea, vomiting are also observed. However, with cancer, they are the most pronounced - vomiting is observed much more often, pain is constantly disturbing. A common symptom is jaundice and icteric staining of the sclera. Sometimes there may be a fever that appears on the background of jaundice.

Infringement of the polyp leg
Infringement of the polyp's leg provokes a sharp, burning pain in the right hypochondrium, which is similar in intensity to hepatic colic. This complication is observed when a pedunculated polyp is detected in the gallbladder, and it is localized in the neck of the gallbladder. This type of polyp resembles a mushroom in shape, in the structure of which a leg and a hat are distinguished. The stem can be short, wide or very long. When the stalk is long, it can twist, bend, and be pinched by the neck of the gallbladder. Since the neck is very narrow, when the gallbladder contracts, the polyp can be squeezed by its walls.

In this case, the patient feels sharp, cramping pains in the right hypochondrium. The heart rate increases ( over 90 beats per minute), the skin becomes pale and moist.

Complete obstruction of the gallbladder by a polyp
This complication occurs when the polyp is very large and closes the lumen of the neck of the gallbladder. Also, complete obstruction can be observed when there are several polyps, and they similarly fill the lumen of the gallbladder.

With complete obstruction, there is no outflow of bile from the gallbladder into the duodenum. First, bile begins to accumulate in the gallbladder. Due to its absence in the intestines, food fats are not digested and absorbed. The patient suffers from nausea and vomiting even after a small meal. He begins to lose weight, because the fats that he absorbs are not completely absorbed and are excreted from the body.

Further, bile begins to soak through the walls of the gallbladder and enter the bloodstream. Jaundice develops, which is accompanied by icteric staining of the skin and sclera. Unbearable skin itching occurs on the patient's body. There are also changes in the urine, which becomes dark in color.

Should a gallbladder polyp be removed?

The gallbladder polyp must be removed when it is true and there is a risk of its malignancy. A true polyp is one that develops from epithelial tissue. Such polyps include adenomatous polyp and papilloma of the gallbladder. These polyps have the highest risk of malignancy and therefore need to be removed.

Pseudopolyps include cholesterol and inflammatory polyps. A cholesterol polyp is a deposit of cholesterol plaques on the bladder mucosa, while an inflammatory polyp is a reaction of the gallbladder mucosa to an inflammatory process. With regard to these polyps, expectant management is adopted. They are under the supervision of an uzist and if they do not regress for a long time ( do not shrink in size) are removed.


A gallbladder polyp must be removed if:

• the diameter of the gallbladder polyp exceeds one centimeter;
• if it is an adenomatous polyp more than 5 millimeters in diameter;
• many polyps are revealed;
• there are destructive changes in the gallbladder;
• polyps are accompanied by stones in the gallbladder;
• The patient has a relative with cancer.

If there are the above indications, then an operation is performed - cholecystectomy. It involves the removal of the entire gallbladder along with polyps. If the patient does not have a burdened family history in terms of oncology, and the size of the polyp does not exceed 18 millimeters, then endoscopic surgery is performed. This operation is minimally invasive and is performed without a complete opening of the abdominal cavity. Instruments for surgery are inserted through small incisions in the abdominal wall. There are 4 such incisions, and their length ranges from 3 to 5 centimeters. The advantage of this type of operation is a short rehabilitation period and a low incidence of postoperative complications.

However, if the polyp exceeds the size of 18 millimeters, and the patient has relatives with cancer, then an open abdominal operation is performed. It involves a full incision of the abdominal wall to gain access to the gallbladder. Along with the gallbladder, the lymph nodes and parts of the liver are removed.

How to get rid of a polyp in the gallbladder?

You can get rid of a polyp in the gallbladder with medication and surgery.

Medical way to get rid of a polyp
This method is effective only in the case of cholesterol polyps. These polyps are cholesterol deposits on the lining of the gallbladder and are not true polyps. Therefore, to eliminate them, drug treatment can be used, which involves taking drugs that dissolve these deposits. These are preparations of chenodeoxycholic acid and ursodeoxycholic acid. These include ursosan and henofalk. These drugs help to reduce the concentration of cholesterol and dissolve cholesterol deposits.

Their dosage is strictly individual and is determined by the weight of the patient and the size of cholesterol deposits. So, the average daily dose for drugs containing ursodeoxycholic acid is 10 milligrams per kilogram of patient weight. For drugs with chenodeoxycholic acid, this dose is 15 milligrams per kilogram of body weight.

Approximate doses of drugs for cholesterol polyps

The duration of taking these drugs depends on the size of the cholesterol polyps. At least these drugs are taken for 3 to 6 months, maximum - 2 years. If against the background of this therapy there is a dissolution of cholesterol deposits, then surgical removal of polyps is not required. However, if therapy is ineffective, then the polyps are removed along with the gallbladder.

Surgical removal of polyps
The operation to remove a polyp of the gallbladder is called a cholecystectomy. This method of surgical intervention can be carried out endoscopically or in the usual classical way.

Most often, the removal is carried out using endoscopic techniques, that is, laparoscopic cholecystectomy takes place. If the size of the polyp exceeds 18 millimeters in diameter, and the patient has a burdened oncological history, then an open laparotomy operation is performed. During this operation, the gallbladder, part of the liver and regional lymph nodes are removed.

How to take ursosan with polyps in the gallbladder?

Ursosan is a preparation of ursodeoxycholic acid, which is able to dissolve cholesterol pseudopolyps. It is prescribed exclusively for cholesterol polyps and is not effective for other types. Analogues of ursosan are preparations ursofalk, grinterol, ursodez, urdox.

Mechanism of action
The drug has a hypocholesterolemic and hypolipidemic effect, which means a decrease in the concentration of both cholesterol and lipids ( fat). By stimulating the secretion of bile by hepatocytes, it contributes to the resolution of cholestasis ( bile stasis). Since bile stasis is one of the main factors in the formation of cholesterol deposits, its prevention stimulates their resorption. Also, the drug increases the solubility of cholesterol, forming liquid crystals with it. Thus, already formed cholesterol deposits are dissolved.

How to use?
Ursosan capsules are taken orally with a small amount of water. The course of treatment is from six months to a year. Ultrasound examinations are periodically performed to track the dynamics of growth or reduction of polyps.

The daily dosage is 10 milligrams per kilogram of the patient's weight. So, if a patient weighs 70 - 75 kilograms, then he needs 700 - 750 milligrams of the drug per day. Based on the fact that one capsule contains 250 milligrams, the daily dose will be contained in three capsules ( 250 x 3 = 750 milligrams for a 75 kilogram person). In the first three months of treatment, it is recommended to take one capsule in the morning, afternoon and evening. Further, the daily dosage can be taken once in the evening.

The drug is taken only with a well-functioning gallbladder. There should be no destructive changes in the bladder, the patency of the duct should be maintained, and the size of cholesterol polyps should not exceed 20 millimeters. Control ultrasound examination is carried out every six months.

What does adenomatous polyp of the gallbladder mean?

An adenomatous polyp is a polyp that develops from the epithelial glands of the gallbladder. This type of polyp has a high risk of malignancy, according to various sources - from 10 to 30 percent. It is considered a benign neoplasm, the treatment of which involves an exclusively surgical method.

These polyps tend to grow extensively and invasively. Most often, one to three adenomatous polyps are diagnosed. An adenomatous polyp manifests itself most often with symptoms of cholestasis ( bile stasis).


Symptoms of an adenomatous polyp of the gallbladder are:

• bitter taste in the mouth
• nausea, occasional vomiting;
• pain syndrome;
• jaundice;
• hepatic colic.

The pain syndrome is the result of congestion, which provokes overdistension of the bladder and irritation of numerous receptors in its shell. The pains are located on the right in the hypochondrium and are dull in nature. They are rarely constant and are more often cramping in nature. Exacerbated after taking fatty and plentiful food, as well as alcoholic beverages.
With jaundice, the color of the patient's skin and sclera becomes icteric, and the urine becomes dark in color ( strong tea colors). The bitter taste in the mouth, in turn, is due to the reflux of bile from the duodenum ( where does it go from the gallbladder) into the stomach. Nausea and vomiting are the result of stagnation of bile in the gallbladder and its disturbed outflow.

The situation is aggravated by the fact that with this disease there are no specific symptoms. Some doctors say that a mandatory operation is required, others are less categorical. They argue that if you have gallbladder polyps, treatment without surgery is possible. Who is right in this situation? Let's try to figure it out.

Symptoms of gallbladder polyps

What is a gallbladder polyp? These are growths on the inner wall of the organ. When they are in the plural, it is polyposis. It is dangerous that these benign formations can develop into cancer. Unfortunately, they do not have pronounced symptoms. The appearance of pain on the right, in the hypochondrium, heaviness when eating, nausea - all the same is manifested in diseases of the liver, cholelithiasis. Diagnostics, except for ultrasound, does not exist, and formations are detected by chance.

It is important!

Tired of papillomas and warts? Time to get rid of them! - More.

Distribution have cholesterol polyps of the gallbladder. Their reason is simple - cholesterol is deposited on the inner walls of the organ. In inflammatory formations, diseased tissue grows. Papillomas look like papillae. The most dangerous - adenomas - the growth of cancer cells. There are several reasons for this:

• accumulation of cholesterol;
• obesity;
• taking hormones;
• stagnation of bile;
• eating fatty, fried foods.

Treatment without surgery

How to treat a polyp in the gallbladder? A single growth up to 5 millimeters is not dangerous. When their dimensions are from 5 to 10 millimeters, constant medical supervision is required. Therapy is needed in order to exclude an increase in growths. Prescribe medications: "Allochola", "Holenzima", bear bile. At the same time, a strict diet, treatment with folk remedies is recommended. See what the growth looks like in the photo.

When the formations increase in size, become more than 10 millimeters, an endoscopic gallbladder polypectomy is performed. During this operation, only the growth is removed, and the organ itself remains intact, continues to work normally. Only when the size of the formations is more than two centimeters, it is recommended to remove the diseased organ, because the likelihood of cancer is high. The operation is fast, after 2 days the patient continues outpatient treatment at home. According to the international ICD-10 classification, diseases with such neoplasms have the code K80-K86.

diet

In addition to taking medications, a diet is prescribed. With polyposis, she is very strict. The diet eliminates fatty and smoked foods, limits the use of sweets and honey, and reduces the amount of salt. The following products are completely excluded:

The diet for polyps in the gallbladder involves fractional meals - five times a day. It is necessary to drink plenty of water, up to two liters, so that the bile becomes less thick. It is recommended to add bran rich in fiber to food. Allowed:

Folk remedies

If you have a polyp in the gallbladder, treatment with folk remedies will stop its increase. Excellent results are obtained by using a decoction of celandine. The course of treatment lasts one month, a break is made for 10 days, then the process continues, and so on for three months. To prepare the composition, a spoonful of celandine grass is poured into a thermos, a liter of boiling water is added. An hour lasts. It should be taken before meals, three times a day. Dosage - one hundred grams.

Can a gallbladder polyp be cured?

This disease cannot be completely cured. Growths do not disappear without a trace. They can only stop their growth. For this, early diagnosis is important. Only when you have captured the disease at the very beginning, and the formations are small, treatment is not excluded. Prescribe medications, diet, treatment with folk remedies. In this case, periodic monitoring of ultrasound is mandatory.

Video: what to do with a gallbladder polyp

Some experts tell you that surgery is required if there are neoplasms, while others say that it is possible to get by with treatment. Watch the video and you will get acquainted with the risk factors and causes of the disease. It will become clear to you in which case, under what conditions, surgical intervention is mandatory. When is treatment without surgery acceptable for polyps in the gallbladder?

Feedback on the results of treatment

She was examined, the doctor accidentally discovered a growth on the wall of the gallbladder. Advised a strict diet. The most difficult thing in all this is to give up sweets, pies. It is especially difficult to drink water often. Six months later, she came for an ultrasound scan, but the growth did not increase in size, and she also lost 6 kilograms. Very healthy diet, I advise you to follow.

Came to the hospital with pain in the hypochondrium on the right. I thought that the liver hurts, it turned out that the reason for this was a small growth in the gallbladder. Advised to drink infusion of celandine. I won't say it's nice. But the doctor said that if not treated, the polyp will grow, and you will have to operate. I took it for three months, went for an ultrasound - there is no increase. Great recipe. I advise.

There was aching pain in the side, on the right. I went for an ultrasound, and small papillomas were found in the gallbladder. The doctor said that at this stage, treatment without surgery is acceptable for polyps in the gallbladder. Herbal collection will stop their growth. I drank immortelle and yarrow with rhubarb. Six months later, ultrasound showed no changes. I highly recommend drinking herbs.

The information presented in the article is for informational purposes only. The materials of the article do not call for self-treatment. Only a qualified doctor can make a diagnosis and give recommendations for treatment based on the individual characteristics of a particular patient.

Polyps in the gallbladder: symptoms and treatment without surgery

Polyps in the gallbladder are a common ailment. Approximately 10 percent of Russians find polyps in a particular organ. In the gallbladder, formations are detected during a preventive examination. The likelihood of suffering from the disease is much greater than the statistics say. Some people live with such neoplasms all their lives, completely unaware of their existence. For some, insidious polyps develop into oncology.

The main symptoms and signs of polyps in the gallbladder

The insidiousness of polyps is that they do not declare themselves for many years. Or they cause symptoms that are similar to gastritis, indigestion, stomach ulcers, liver disease, cholelithiasis.

For example, here are the symptoms of polyposis:

• nausea, and sometimes vomiting, after which it becomes easier;
• pain in the hypochondrium;
• hepatic colic;
• jaundice;
• bloating;
• elevated temperature;
• poor sleep, memory problems;
• dark urine;
• feeling of heaviness after eating.

What are polyps anyway? Peculiar neoplasms on the mucous membrane inside the gallbladder. These neoplasms can be large, small, single or multiple. They can only be detected by ultrasound.

Causes

An interesting fact: polyps are more common in women, and over the age of 35. And only in 20 percent of cases in men. Perhaps it depends on the fact that men are less likely than women to go to clinics for medical examinations. And neoplasms are detected more often during medical examinations. Be that as it may, the fact remains that women suffer from this disease 4 times more often.

And the causes of pathology are considered:

• inflamed gallbladder;
• stagnant bile;
• impaired metabolic functions;
• obesity;
• biliary dyskinesia.

There is an opinion that the hereditary factor and genetic predisposition are most affected. If someone in the family had cancerous tumors, then the risk of neoplasms in the gallbladder increases significantly. And yet, experts say that several reasons play a role in polyposis at once: for example, heredity and at the same time stagnation of bile acquired due to strict diets or other reasons.

Types and diagnosis of polyps in the gallbladder

Polyps are divided into:

• cholesterol (these are pseudopolyps). They are cholesterol deposits on the mucous membrane of the organ. Most often detected in men;
• real, consisting of epithelial tissue. They also differ in papillomas and adenomatous papillomas - one of the most dangerous in terms of the risk of developing into an oncological disease.

Recognizing the disease only by the symptoms will not work. We need such studies as ultrasound and endoscopy. As well as methods of laboratory tests.

Ultrasound examination shows the gall sac as a dark oval mass. If there is a polyp in it, then it looks like a light formation starting from the wall and growing into the cavity. Endoscopic ultrasonography allows you to see the polyp in detail, since high-frequency ultrasound is used, the picture of the image is clearer.

Another examination may be computed tomography. It gives a clear picture, determines the nature and location of polyps, the causes of their occurrence.

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What is the danger of a gallbladder polyp?

Many people live their entire lives with a polyp in their gallbladder and die for other reasons. However, this is not a reason to calm down and not take action if nothing disturbs. A preventive examination at least once every two years is necessary. And if there are severe symptoms, it is necessary to check. After all, what is the danger of a gallbladder polyp? In 35 percent of cases, polyps turn into cancer. But even if you are lucky to avoid cancer, other consequences are also dangerous.

Among them:

• inflammation of the gallbladder;
• gangrenous cholecystitis;
• liver abscess;
• peritonitis (pus enters the peritoneum, often ends in death);
• cholangitis (leads to sepsis).

The growths interfere with the normal outflow of bile. And this leads to cirrhosis of the liver, to osteoporosis.

How to treat polyps in the gallbladder without surgery?

Treatment of polyps without surgery is possible when it comes to pseudopolyps. That is, those that were formed as a result of the deposition of cholesterol. There are medications that can dissolve polyps. But it still depends on the size of the neoplasms. Large ones, those that exceed one centimeter, are removed with the help of an operation.

Medical treatment of polyps in the gallbladder

As soon as it is precisely established that the polyps are of a cholesterol nature, the doctor prescribes medication. Such therapy allows you to reduce cholesterol and dissolve the formed growths in the gallbladder. For this, ursosan and henofalk are used. There are other similar drugs, for example, ursofalk. It also effectively destroys cholesterol deposits.

The dosage and duration of treatment depend on the degree of neglect of the disease, the age of the patient, his body weight and other factors. For example, for patients weighing from 60 to 70 kilograms, three ursosan capsules per day are enough. Those who weigh more may be given another extra capsule.

Noshpu is taken as a pain reliever. It eliminates spasms of the gallbladder, and the pain disappears. One tablet is enough for severe pain.

Such therapy lasts from three months to two years, it all depends on the size of the neoplasms. As a rule, during this period, with the help of dissolving medications, you can completely get rid of the disease without surgery. But, alas, sometimes the results are not what we would like. In this case, you still have to resort to surgical intervention.

Folk remedies

Ancient recipes are good as an additional remedy. They allow you to stop the growth of neoplasms. A decoction of celandine is good in this regard. A tablespoon of grass is poured into a thermos and 1000 g of boiling water is poured. After an hour of infusion, they drink one hundred grams in the morning, at lunchtime and in the evening before a meal. Such a course is carried out for a month, then a ten-day break is taken, and the course is repeated again. And so 90 days. Doctors call the treatment of polyps in the gallbladder folk remedies quite effective. But in any case, you should consult with your doctor.

Diet for polyps in the gallbladder

When confirming the diagnosis, nutrition should be completely reconsidered. It should be rich in fiber. Coarse fibers of vegetables, fruits, grains and legumes restore metabolism well, promote the rapid absorption of fats.

The intake and type of fats should be monitored, as well as the balance of carbohydrates. Uncontrolled eating of fats leads to a situation where the gallbladder is not able to qualitatively process food. Fats are useful and harmful. Healthy are unsaturated fats, and harmful are saturated and modified (margarine, refined butter). These bad products are ideally banned altogether.

Eat a little and don't overeat before bed. Two-thirds of the meal should be non-starchy vegetables.

This diet must be followed for life. Polyps can even form again after removal.

The diet on the first day after the removal of neoplasms is even more strict. In the first 6 hours you can not eat or drink. Then, during the day, only drink mineral water without gas in small portions. In the next two weeks - only mashed vegetables cooked with steam - as a puree or soup.

When is it impossible to treat polyps in the gallbladder without surgery?

Surgery is more common. In some situations, there is even no other alternative.

It is when:

• a polyp larger than a centimeter;
• when the polyp was the result of another disease - cholecystitis, gastritis;
• when growth of neoplasm is observed;
• when a lot of polyps formed;
• if plus to the polyp there is also cholelithiasis;
• when someone in the family had cancer.

That is, the operation is indicated when there is a high risk of the polyp degenerating into an oncological disease, or into another dangerous condition.

A dangerous condition can also be considered the fact if the polyp creates significant discomfort, a violation of health. It means:

• the transition of an ordinary polyp to an onco;
• hepatic colic;
• inflammation of the gallbladder;
• purulent cholecystitis;
• obstructed outflow of bile;
• excess bilirubin.

Cancer of the gallbladder is a very dangerous condition in which only 15 percent of patients live up to a year. Thus, in case of suspicious neoplasms, the operation is carried out without delay.

Surgical interventions are most often laparoscopic, that is, with the least surgical interventions and rapid recovery after surgery. But sometimes you have to remove the gallbladder through a full incision. The operation is called an open cholecystectomy. They resort to this method of removing neoplasms when they reach large sizes - about two centimeters.

Prevention of polyps

Although polyposis is considered mainly a hereditary disease, a lot depends on the lifestyle of the patient.

Negative factors:

• sedentary work, too few walks;
• passion for too fatty, fried, spicy food;
• alcohol abuse;
• untreated diseases of the gastrointestinal tract;
• dry food, in a hurry, a long break between meals;
• overweight.

It is important to change eating habits, in the nature of rest. Be more in the fresh air, move, take daily walks, fix health problems in time, be sure to undergo an annual preventive examination.

Removal of stones from the gallbladder without removal of the gallbladder

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Removal of stones and polyps from the gallbladder without removing the gallbladder itself

Removal of polyps from the gallbladder

The operation to remove polyps from the gallbladder takes place under general anesthesia. A trocar with a diameter of 0.5 cm is inserted through a micro-incision in the navel area, through which a mini-laparoscope is inserted. With the help of a laparoscope, you can examine the abdominal cavity, find out if there are any pathological changes in combination with other organs and choose the most suitable place for making the smallest incision of 1-2 cm to enter the abdominal cavity. Under video surveillance for 1 minute, the gallbladder is accurately captured and moved into the abdominal cavity.

Through a small incision at the base of the gallbladder, they enter the cavity of the gallbladder, then a rigid laparoscope is inserted. The advantages of a rigid laparoscope over a soft one are image clarity and larger scale. With a rigid laparoscope, smaller polyps in the gallbladder can be located and then grasped with forceps. A special protective device at the end of the laparoscope allows you to safely examine the cavity of the gallbladder. In a number of studies, it has been observed that most of the gallbladder polyps are supplied with blood from arterioles. After removal of the polyps, the blood is stopped using a solid choledochoscope complete with an electrocoagulator. Thus, the amount of blood released is negligible, which reduces the time of surgery to remove polyps in the gallbladder and avoids that polyps in the gallbladder may go unnoticed due to blood clots. Polyps in the gallbladder are removed one at a time to ensure the patency of the gallbladder duct.

The polyps extracted from the gallbladder are sent for examination in order to perform an operation if malignant lesions are found.

A day after the operation, the patient can get up and walk. Discharge from the hospital usually occurs 4-5 days after the operation.

gallbladder polyps, gallbladder polyposis, gallbladder

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What to do with polyps in the gallbladder: the right treatment

Polyps are called abnormally arisen benign outgrowths that have an irregular, teardrop-shaped or rounded shape and are localized on the walls of organs with a hollow structure. Usually, polyposis formations are located on a wide base or are fastened to the wall of the organ with a kind of leg.

Polyps can be localized on the mucous membrane of any organ, however, most often such outgrowths are found in the gall or bladder, intestines, uterus, stomach or nasal cavity. Sometimes polyposis formations are detected on the walls of the gallbladder.

The concept of illness

Polyps of gallbladder localization are tumor-like neoplasms of a predominantly benign nature that form on the inner mucous layer of the organ and grow into its lumen.

Photo of a polyp in the gallbladder

According to the international classification of diseases, gallbladder polyps belong to the code K82 (other gallbladder pathologies). Polyps with a similar location are difficult to diagnose, because they have symptoms similar to other gallbladder pathologies.

Varieties

The following types of polyps can be found in the gallbladder:

More often than others, cholesterol polyps are found, which are amenable to conservative therapy.

Causes

Most often, the causes of the formation of polyps in the gallbladder lie in the following factors:

1. material exchange violations;
2. Gallbladder pathologies of inflammatory origin;
3. hereditary tendency;
4. Anomalies of genetic origin;
5. Biliary dyskinesia and other hepatobiliary pathologies.

Most often, it is cholesterol polyps that form against the background of various kinds of metabolic disorders of fats, as a result of which a large amount of cholesterol circulates in the bloodstream. As a result, cholesterol excesses are deposited on the vascular walls and in the gallbladder, which provokes the formation of cholesterol pseudopolyps.

Chronic forms of cholecystitis are considered the most common factors causing polypous formations.

Against the background of the inflammatory process in the gallbladder tissues, bile stasis occurs, which leads to thickening of the walls of the organ and their deformation. As a result, granulation tissue cells proliferate and pseudopolyps form.

If the family history is aggravated by genetic abnormalities, then this is an additional provoking factor for the occurrence of clinical manifestations of the pathology.

Hepatobiliary pathologies or diseases of the biliary tract provoke an imbalance in relation to the excreted bile and its actually required volumes.

Due to excessive or deficient secretion of bile, digestive processes are disturbed, which further leads to the formation of gallbladder polyposis.

Symptoms

The symptomatic picture of polyposis of biliary localization is determined by the specific location of the outgrowth in the organ.

The most dangerous from a clinical point of view is the location of the polyp in the neck or duct of the bladder.

In such a situation, the polyp will interfere with normal bile flow, which will lead to the development of mechanical jaundice.

With the location of the polyposis formation in another part of the bladder, the clinical picture of the pathology acquires an erased and unexpressed character. Most often, the presence of a gallbladder polyp is indicated by such manifestations.

• Jaundice. The skin becomes icteric, like the sclera, which indicates an exorbitant content of bilirubin in the blood. A similar picture is observed when bile stasis occurs in the bladder, leading to leakage of bile into the bloodstream. The yellowness of the skin is complemented by symptoms such as darkening of urine, myalgia and arthralgia, hyperthermia, nausea and vomiting, and skin itching.
• Soreness. Painful manifestations in gallbladder polyps occur due to overstretching of the walls of the organ. This happens when bile stagnates in the bladder. In addition, pain can also occur against the background of frequent bladder contractions. Such pains are localized in the region of the right hypochondrium and have a dull character. They occur cramping, aggravated after fatty foods or overeating, alcohol, stress, etc.
• Dyspepsia. It is characterized by the occurrence of a nausea syndrome, more often in the morning, after a heavy meal, vomiting occurs, and there is a taste of bitterness in the mouth. Similar signs are also caused by bile stasis, which provokes a violation of digestion processes. Bitterness in the mouth is due to the reflux of bile into the stomach due to motor gallbladder hyperactivity.
• Colic in the liver. It is manifested by sudden cramping and acute pain in the hypochondrium on the right. A similar symptom usually occurs quite rarely, mainly with polyps that have a long stalk. The pain in colic is so severe that the patient is unable to stay in one place, so he rushes about, looking in vain for a more painless position of the body.

Accompanying illnesses

Quite often, polyps cause pathological processes in neighboring organs - the pancreas and liver. Since polyposis can act as an infectious source that causes the development of an inflammatory process, biliary spasms, cholecystitis, pancreatitis, etc., often develop against the background of gallbladder polyps.

In general, among the pathologies associated with polyposis, spasms of the gallbladder ducts or dyskinesia, various forms of pancreatitis and cholecystitis, or cholelithiasis can be distinguished.

Is this neoplasm dangerous?

Gallbladder polyps are dangerous because, if left untreated, they can easily degenerate into malignant tumors, the percentage of such a probability is about 10-30%.

In addition, polyps can be complicated by purulent inflammation of the gallbladder, etc. Against the background of constantly elevated bilirubin, cerebral intoxication may develop.

Therefore, it is necessary to contact specialists for help and treatment in a timely manner.

Diagnostics of education

Typically, patients turn to specialists when they have the appropriate symptoms associated with right subcostal soreness. But it is impossible to determine the presence of polyps in the gallbladder only by this symptom.

Pathology can be detected only with the help of a more thorough diagnosis using appropriate equipment.

First, patients are sent for an ultrasound examination, which is considered leading in the detection of gallbladder polyposis.

Computed tomography and magnetic resonance cholangiography are also shown. These techniques make it possible to determine with maximum accuracy the location, nature and good quality of polyposis formations, as well as to detect the presence of concomitant disorders.

As part of a diagnostic study, endoscopic endosonography is often present, which reveals the location and structure of the polyposis growth.

How to treat polyps in the gallbladder?

Usually, after the detection of polypous gallbladder formations, conservative therapy is prescribed. It often happens that with cholesterol polyposis, after adjusting the diet and taking certain drugs, cholesterol polyps disappear on their own.

If the formations belong to other varieties and have a diameter of no more than a centimeter, then they are observed for some time just observed. The patient periodically goes for an ultrasound examination, CT or MRI. If the polyps do not show a tendency to grow, then they will not be touched.

Polyp treatment without surgery

As specified above, non-surgical treatment of polyposis in the gallbladder is possible only with the cholesterol nature of the formations. In the treatment of such polyps, drugs like Ursofalk, Simvastatin, Holiver, Ursosan are most often indicated, and No-shpu and Gepabene are recommended for adjuvant therapy.

Conservative therapy of cholesterol polyps is justified if they do not exceed a centimeter size.

Polyposis may actually not be cell growths, but loose cholesterol calculi, which in the future will cause severe pain attacks.

Operation

An operative approach is shown only in cases where polyps are characterized by constant growth and multiple character.

Preservation of the gallbladder is a priority for doctors, because with its ectomy, digestion will be severely disturbed, and fatty foods will not be digested at all.

If polyps are found in the gallbladder cavity, then the doctor must take the patient under special control in order to exclude the likely risks of the formation degenerating into a malignant tumor process.

In the case when the course of traditional treatment did not give the expected effect or the polyps grew to large sizes, a prompt solution to the issue is shown.

Indications

Absolute indications for surgical removal of polyps are factors such as:

• Large sizes of polyposis overgrowth of more than one centimeter;
• The tendency of polyps to grow rapidly, manifested by an increase in formations by 2 mm per year;
• The multiple nature of polyposis with a predominance of growths that have a wide base, but do not have a leg;
• If polyposis is supplemented by the presence of gallstone disease;
• With the development of polyposis against the background of chronic inflammation of the gallbladder;
• With a burdened family history.

Also, the operation is necessary in case of a transformational change in the structure of the polyp into a malignant formation, with pronounced hepatic colic, purulent cholecystitis, disorders of bile flow, elevated bilirubin levels.

When can you do without surgery?

If the polyps do not grow in size to centimeter parameters, then there is no need to remove them, however, for prevention, a woman must undergo medical examinations and ultrasound examinations monthly for six months.

If, after six months of drug exposure, there are no signs of positive dynamics, then proceed to surgical treatment.

Training

The most common operation to remove polyps is cholecystectomy. Such a procedure involves the removal of not only polyposis growths, but also gallbladder tissues. Such an operation is performed in a conventional or endoscopic way. The latter option is more preferable and is used in 90% of cases.

Before surgery, the patient undergoes the necessary diagnostic tests, laboratory tests, and ultrasound diagnostics. Before the operation, the patient is given general anesthesia using muscle relaxants to relax muscle tissue.

The operation itself is carried out through 4 punctures for the introduction of instruments into the abdominal cavity and further extraction of the gallbladder.

As a result of such an operation, there is minimal rehabilitation, slight severity of postoperative pain, a low percentage of various complications such as adhesive or hernial process, infectious lesions.

Lifestyle after polyp removal

After the operation, the patient will have to change the usual diet.

When the gallbladder is absent, enzymatic activity is seriously impaired, gastric juice is secreted in much lower concentrations, and instead of the gallbladder, it is immediately sent to the intestines.

In order for the body to more or less learn to live without a gallbladder, it takes at least two years.

The first six months are especially important, requiring compliance with the smallest and most insignificant requirements regarding the diet:

• Consumed food should be cooked only by boiling or steaming;
• Food should be chewed for a long time and thoroughly so that large pieces do not get into the stomach, which will provide the liver with more opportunities for enzymatic activity;
• At one meal, you need to eat a small amount of food so as not to overload the digestive system.

Diet

Both before and after surgery, the diet for gallbladder polyps involves following a fractional diet, when the patient should eat a little bit, but every 3 hours. Moreover:

• After eating there should not be a feeling of overeating;
• Food should be eaten in a grated or heavily crushed form;
• Eliminate any load for one and a half hours after eating;
• Products to cook only by baking or boiling;
• Dishes should not be eaten hot.

You can’t eat mushroom and fatty soups, muffins and fried pies, fatty fish and meat, smoked meats, various mayonnaises and sauces, sour vegetables like tomato, radish, sorrel, etc. Fatty dairy products, alcohol and soda, chocolate, etc. are also prohibited.

Folk remedies

But if the doctor has chosen observation tactics and prescribed conservative therapy, then the main treatment can be supplemented with herbal preparations, but only with the agreement of the doctor.

For additional conservative treatment, you can take an infusion of celandine herbs or with the addition of chamomile flowers. Grass is poured with boiling water and kept in a thermos for a couple of hours, after which they drink a large spoonful before meals.