Polyps are abnormally formed benign outgrowths that have an irregular, drop-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 bile or, or. Sometimes polyposis formations are detected on the walls of the gallbladder.
The concept of the disease
Biliary polyps are tumor-like neoplasms predominantly benign, which are formed on the inner mucous layer of the organ and grow into its lumen.
Most often, biliary polyps are found in women (in 80% of cases) over 35 years of age. In general, polyps are found in the gallbladder in 6% of the world population.
Photo of a polyp in the gallbladder
According to international classification diseases of gallbladder polyps belongs to the code K82 (other biliary pathologies). Polyps with a similar location are difficult to diagnose, because they have symptoms similar to other biliary 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 of occurrence
Most often, the reasons for the formation of polyps in the gallbladder lie in the following factors:
- Substance exchange disturbances;
- Biliary pathologies of inflammatory origin;
- Hereditary tendency;
- Anomalies of genetic origin;
- and other hepatobiliary pathologies.
Most often, it is cholesterol polyps that form against the background of various kinds of fat metabolism disorders, as a result of which circulates in the bloodstream a large number of cholesterol. 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 polyposis formations.
Against the background of the inflammatory process in the biliary tissues, biliary stasis occurs, which leads to a thickening of the walls of the organ and their deformation. As a result, the cells of the granulation tissue grow, and the formation of pseudopolyps occurs.
With regard to heredity and genetic abnormalities, scientists have proven that papillomas and adenomatous polyps can be inherited. Even if other tumors were detected in blood relatives, the risk of biliary polyposis increases significantly.
If the family history is burdened with genetic abnormalities, then this is an additional provoking factor for the onset of clinical manifestations of pathology.
Hepatobiliary pathologies or diseases of the biliary tract provoke an imbalance in relation to the secreted bile and its really necessary volumes.
Due to excessive or deficient bile secretion, digestive processes are disturbed, which further leads to the formation of biliary polyposis.
Symptoms
The symptomatic picture of biliary polyposis 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 outflow, which will lead to the development of mechanical jaundice.
When the polyposis formation is located in another part of the bladder, the clinical picture of the pathology becomes blurred and unexpressed. Most often, such manifestations indicate the presence of a biliary polyp.
- Jaundice. The skin acquires an icteric tint, like the sclera, which indicates the prohibitive content of bilirubin in the blood. A similar picture is observed when bile stasis occurs in the bladder, leading to the leakage of bile into the bloodstream. Symptoms such as darkening of urine, myalgia and arthralgia, hyperthermia, nausea-vomiting syndrome and skin itching complement the yellowness of the skin.
- Soreness. Painful manifestations with gallbladder polyps occur as a result of 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 contractions of the bladder. Such pains are localized in the area of the right hypochondrium and are dull in nature. They arise in a cramping manner, exacerbate after fatty foods or overeating, alcoholic beverages, stress, etc.
- ... It is characterized by the occurrence, more often in the morning hours, after a plentiful meal, vomiting occurs, and there is a taste of bitterness in the mouth. Similar signs are also caused by provoking a violation of the digestion processes. Bitterness in the mouth is due to the throwing of bile into the stomach due to motor biliary hyperactivity.
- Colic in the liver. It is manifested by a sudden cramping and acute soreness in the hypochondrium on the right. A similar symptom usually occurs quite rarely, mainly with polyps with a long stem. The colic pain is so severe that the patient is unable to stay in one place, so he rushes about, in vain looking 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 biliary polyps.
In general, among the pathologies associated with polyposis, spasms of the bile ducts or dyskinesia, various forms of pancreatitis and cholecystitis, or.
Is this neoplasm dangerous?
Biliary polyps are dangerous in that, if untreated, they can easily degenerate into, the percentage of such a probability is about 10-30%.
In addition, polyps can get complicated. purulent inflammation gallbladder, etc. Against the background of constantly increased bilirubin cerebral intoxication may develop.
Therefore, it is necessary to promptly contact specialists for help and treatment.
Diagnostics of education
Usually, patients turn to specialists when they have the corresponding symptoms associated with right subcostal pain. But only by this symptom it is impossible to determine the presence of polyps in the bile.
It is possible to identify pathology only with the help of a more thorough diagnosis using the appropriate equipment.
First, patients are sent for an ultrasound examination, which is considered leading in the detection of biliary polyposis.
Also shown is magnetic resonance cholangiography. These techniques make it possible to determine with maximum accuracy the location, nature and benignity of polyposis formations, as well as to detect the presence of concomitant disorders.
As part of the diagnostic study, endoscopic endosonography is often present, which reveals the location and structure of polyposis growth.
How are polyps in the gallbladder treated?
Usually, after the detection of polyposis biliary formations, conservative therapy is prescribed. It often happens that with cholesterol polyposis, after adjusting the diet and taking certain medications, 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, they are simply observed. The patient periodically goes for an ultrasound examination, CT or MRI. If 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, the administration of drugs like Ursofalk, Simvastatin, Holiver, Ursosan is most often indicated, and No-shpa and Gepabene are recommended for auxiliary therapy.
Conservative therapy for cholesterol polyps is justified if they do not exceed a centimeter in size.
Polyposis may actually turn out to be not cellular growths, but loose cholesterol stones, which in the future will cause severe pain attacks.
Operation
The operative approach is shown only in cases where polyps are characterized by constant growth and multiple character.
The priority for doctors is the preservation of the gallbladder, because during its ectomy, digestion will be severely impaired, and fatty foods will not be absorbed at all.
If polyps are found in the biliary cavity, then the doctor must take the patient under special control in order to exclude the possible risks of degeneration of the formation 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 a large size, a prompt solution to the issue is shown.
Indications
Absolute indications for surgical removal of polyps are factors such as:
- Large sizes of polyposis growth of more than one centimeter;
- The tendency of polyps to rapid growth, 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 the polyposis is complemented by the presence of gallstone disease;
- With the development of polyposis against the background of chronic inflammation of the gallbladder;
- In the presence of a burdened family history.
Also, the operation is necessary in the case of a transformational change in the structure of the polyp in malignant formation, with pronounced hepatic colic, purulent cholecystitis, impaired bile outflow, increased bilirubin level.
When can you do without surgery?
If 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 conservative therapy has led to a decrease in polyposis size, then it is continued until the formations are completely resorbed.
If, after six months of drug exposure, there are no signs of positive dynamics, then surgical treatment is started.
Training
The most common surgery to remove polyps is cholecystectomy. Such a procedure involves the removal of not only polypous growths, but also biliary tissues. Such an operation is performed in a conventional or endoscopic manner. 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 injected 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, an insignificant severity of postoperative pain, a low percentage of various complications such as or, infectious lesions.
Lifestyle after polyp removal
After the operation, the patient will have to change his usual diet.
When the gallbladder is absent, enzymatic activity is seriously impaired, gastric juice excreted in much lower concentrations, and instead of the gallbladder, it is immediately sent to the intestines.
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 dietary requirements:
- The food consumed should be prepared only by boiling or steaming;
- Food must 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;
- In one meal, you need to eat a small amount of food so as not to overload the digestive system.
Diet
Both before and after the operation, the diet for gallbladder polyps involves adherence to a fractional diet, when the patient must eat a little bit, but every 3 hours. Moreover:
- After eating, there should be no feeling of overeating;
- Food should be eaten in a grated or highly crushed form;
- Eliminate any stress for an hour and a half after eating;
- Prepare products only by baking or boiling;
- Dishes should not be eaten hot.
You cannot eat mushroom and fatty soups, pastries and fried pies, fatty fish and meat, smoked meats, various mayonnaises and sauces, sour vegetables like tomatoes, radishes, sorrel, etc. Fatty dairy products, alcohol and soda, chocolate, etc. are also prohibited.
Folk remedies
But if the doctor chose the tactics of observation and prescribed conservative therapy, then the main treatment can be supplemented with the intake of herbal preparations, but only with the agreement of the doctor.
For additional conservative treatment, you can take an infusion of celandine herb or with the addition of chamomile flowers. The herb is poured with boiling water and kept in a thermos for a couple of hours, after which they drink a large spoon before eating.
A polyp in the gallbladder is a benign neoplasm growing from the mucous membrane of an organ. The disease develops in about 6% of people, more often in middle-aged women. The first description of a gallbladder polyp was made by the German scientist Virchow in 1857. A thorough study of the disease began only in 1937. The main cause of polyps is considered to be a violation of fat metabolism and inflammatory processes in the bladder.
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The essence of pathology and types of polyps
The gallbladder is an organ of the digestive system that is part of the hepatobiliary system. It performs the function of accumulating and distributing bile. The gallbladder has a three-layer wall. Under the influence of certain reasons, polyps are formed on the inner mucous membrane. Depending on the mechanism of formation, several forms of neoplasms are distinguished:
- adenomatous - represent the growth of glandular tissue;
- papillomas - warty growths of the mucous membrane;
- inflammatory - occur against the background of inflammation of the mucous membrane;
- cholesterol - are deposits of cholesterol on the mucous membrane.
The first two forms are called true polyps, the last two are called false. True polypous growths are prone to malignancy.
Reasons for development
The reasons for the formation of polyps in the gallbladder include:
- genetic predisposition;
- inflammatory processes;
- metabolic disorders;
- dyskinesia of the biliary tract.
The hereditary factor is of great importance in the development of adenomatous polyps and papillomas. However, genetic predisposition alone is not enough. Polyposis is a polyetiological disease, that is, to a certain extent, both inflammatory processes and metabolic disorders are present.
The main inflammatory disease, against the background of which polyps are formed, is cholecystitis. Inflammation of the mucous membrane leads to stagnation of bile, which irritates the tissues. This causes a compensatory appearance of granulation tissue.
Violation of fat metabolism leads to the formation of cholesterol polyps. Cholesterol is a combination of fats and proteins that are easily deposited on the mucous membrane. Over time, the cholesterol plaques become saturated with calcium and become very durable. Such polyps are quite common, they practically do not cause discomfort, therefore they can reach large sizes.
Biliary dyskinesia can be hypomotor or hypermotor type. The impaired contractile function of the gallbladder contributes to the stagnation of bile, constant irritation of the mucous membrane.
Clinical manifestations
The symptoms of polyps depend on their location and size. When polyposis growths are found in the body or the bottom of the bladder, the clinical picture is usually erased. Severe symptoms are observed if the polyp is located in the neck of the organ. This leads to a violation of the outflow of bile, obstructive jaundice develops with pain.
Main manifestations:
- pain in the right hypochondrium;
- obstructive jaundice;
- dyspeptic symptoms;
- hepatic colic.
Symptoms have varying degrees severity.
Pain syndrome develops as a result of stretching the walls of the organ with a large volume of bile. Less commonly, pain is caused by intense contraction of the bladder. She has a dull character, moderate intensity. Occurs after exercise or dieting.
Jaundice is a staining syndrome skin and mucous membranes in yellow color, darkening of urine, lightening of feces. Jaundice develops due to an increase in the level of bilirubin in the blood. First, the sclera are stained, then the skin. The intensity of the color depends on the level of bilirubin. The same pigment causes discoloration of urine and feces. Jaundice is accompanied by itching, nausea, and vomiting.
Yellowing of the sclera
Dyspepsia is almost always present with polyps. It is characterized by persistent nausea. unpleasant aftertaste in the mouth, occasional vomiting. Dyspeptic phenomena are caused by stagnation of bile, which leads to impaired digestion of fatty foods.
An acute attack of pain is called hepatic colic. It occurs when the polyp completely blocks the outflow of bile. Colic is characterized by extremely intense, cramping pains. They are accompanied by pallor of the skin, palpitations, sweating. The pain reaches such intensity that a person rushes about, cannot find suitable posture to alleviate the condition. Hepatic colic is dangerous by the development of pain shock.
Diagnostics
To identify a polyp in the bile, an endoscopic and ultrasound examination... Additional diagnostic methods are laboratory research, CT scan.
Table. Methods for diagnosing polyposis growths.
Diagnostic method Method essence Research result Ultrasound Ultrasound, when passing through tissues with different densities, is reflected at different speeds. After reflection, ultrasound waves are captured by a sensor and converted into an image on a computer. The gallbladder looks like a dark oval with a light wall. The polyp is represented by the outgrowth of this light wall into a dark cavity. Endoscopic ultrasonography method With the help of a fiber-optic system, you can go into the cavity of the gallbladder, and a miniature camera transmits the image to the screen The polyp looks like a round growth of the mucous membrane. May have a leg or sit on a wide base CT scan A high-precision diagnostic method that allows you to obtain layer-by-layer images of an organ. Reveals even the smallest neoplasms Growths are represented by light spots on a dark background. With the help of tomography, it is possible to determine the provoking disease. Laboratory research Reveals changes in the level of bilirubin, cholesterol, liver enzymes In a biochemical blood test, it is determined elevated level bilirubin, cholesterol, alkaline phosphatase. The level of urobilin rises in the urine. In feces, a reduced amount of stercobilin is determined In most cases, an ultrasound examination is sufficient to make a diagnosis.
Complications
Lack of treatment can lead to the development of a number of complications:
- transition to a malignant tumor;
- hepatic colic;
- purulent cholecystitis;
- obstruction of the biliary tract.
The probability of a malignant polyp is 10-30%. Most often, polypous growths with a diameter of more than 20 mm are reborn. Gallbladder cancer is one of the most aggressive, with an average life expectancy of no more than 3 months.
Treatment
Treat polyps with conservative and surgical methods... Treatment without surgery is only symptomatic and is used in the absence of indications for surgery. It includes adherence to a diet, taking medications, using traditional medicine recipes, physiotherapy and exercise therapy. Radical treatment of polyps is an operation.
Diet
Compliance with a healthy diet with polyposis formations in the gallbladder is necessary to prevent pain attacks and hepatic colic. It is recommended to limit the calorie content of the diet to 2000 kcal per day. Shown fractional meals - often in small portions. You need to consume at least 1.5 liters of fluid throughout the day. The menu should be composed in accordance with the list of permitted and prohibited foods.
Table. Useful and harmful foods for gallbladder polyposis.
Product group Can It is forbidden Flour products - dried bread;
- bran bread;
- whole wheat bread;
- cracker;
- durum wheat pasta
- White bread;
- baking;
- fried pies;
- soft wheat pasta
Soups - vegetable;
- lactic;
- lean broths
- hodgepodge;
- mushroom picker;
- kharcho;
- pickle
Meat - chicken breast;
- Turkey;
- veal;
- beef and pork tenderloin
- chicken legs;
- duck and goose;
- pork;
- mutton;
A fish - perch;
- pollock;
- burbot;
- zander
- pink salmon;
- oily fish;
- mackerel;
- halibut;
- tuna;
- capelin;
- herring
Cereals - buckwheat;
- rice;
- oatmeal
- semolina;
- millet;
- lentil
Fruits, berries - bananas;
- apples;
- avocado;
- grape;
- cranberry
- kiwi;
- persimmon;
- raspberries;
- blackberry
Vegetables - carrot;
- pumpkin;
- zucchini, squash;
- cauliflower, Brussels sprouts;
- potato
- greenery;
- radish;
- onion garlic;
- tomatoes;
- White cabbage
Milk products - low-fat cheese, cottage cheese;
- milk;
- kefir;
- curdled milk
- salty, fatty cheese;
- sour cream;
- yoghurts
Beverages - fruit drink;
- herbal tea;
- weak regular tea;
- compote;
- jelly
- strong tea, coffee;
- cocoa;
- alcohol;
- carbonated drinks
It is preferable to steam, boil, bake, stew food. You should limit the consumption of salt, spices, preservatives.
Medications
Medical treatment is carried out according to the prevailing symptomatology. Appoint medications eliminating pain and preventing the accumulation of bile. Drug therapy can temporarily stop the growth of polyps.
Table. Drugs to relieve symptoms of polyposis.
Group of drugs Therapeutic action Photo Choleretics: Allochol, Gepabene They stimulate the outflow of bile, improve cystic peristalsis. Eliminate dyspeptic symptoms 
Antispasmodics: No-shpa, Drotaverin Eliminate muscle spasm, improve bile outflow, relieve pain 
Statins: Simvastatin, Atorvastatin Contributes to the normalization of blood cholesterol levels 
Derivatives of ursodeoxycholic acid: Ursofalk, Urdoksa Destroy cholesterol deposits, normalize blood bilirubin levels 
Treatment is carried out by a course, after which a control ultrasonography... Based on the data obtained, further treatment tactics are decided.
Folk remedies
The use of folk remedies is possible only as a symptomatic treatment. They can not replace either the operation, if there are indications for it, or drug treatment.
When using folk remedies, you must consult a doctor and use only proven recipes:
- 1. Choleretic collection. Take 1 tablespoon of chamomile flowers and celandine, pour 200 ml of boiling water. Let it brew and filter. Take a 20 ml infusion before meals.
- 2. Decoction of burdock roots. Rinse 2 kg of burdock roots, peel and chop finely. Pour in five liters of water, bring to a boil and boil for another 10 minutes. Then strain and drink throughout the day instead of water and tea. Continue treatment for 2 weeks.
- 3. Chaga tincture. Take 100 grams of birch mushroom, grind and pour 400 ml of vodka. Insist for two weeks, take 10 ml before meals.
It is useful to drink rosehip decoctions, eat garlic.
Physiotherapy
They are used for single polypous growths in the absence of acute pain syndrome. The following types of physiotherapy are used:
- electrophoresis;
- paraffin and ozokerite applications;
- magnetotherapy.
Physiotherapy is carried out in courses that include 10-15 procedures. They need to be repeated every six months.
Exercise therapy
Therapeutic gymnastics for polyps allows you to get rid of unpleasant symptoms, improve the outflow of bile. The following exercises are recommended on a daily basis:
- lying on your back, clasp your bent knees with your hands, roll forward and backward;
- while lying down, draw in and inflate the stomach;
- while standing, bend your knees and pull them to your chest as much as possible;
- while standing, spread your legs shoulder-width apart, perform turns to the sides.
Exercise should be done regularly.
Operative treatment
You can completely get rid of polyps only with the help of an operation. Surgical intervention for polyposis is indicated in the following situations:
- the size of the neoplasm is more than 15 mm;
- the presence of another cystic pathology in the exacerbation stage;
- rapid growth of neoplasms;
- the presence of multiple polyps;
- hereditary burden of gallbladder cancer.
The operation is performed in an open or endoscopic manner. If the polyp is single, only it is removed, and the operation is called polypectomy. If there are many neoplasms, there are other gallbladder diseases, the entire gallbladder is removed. The operation in this case is called cholecystectomy.
Table. Types of surgical interventions for polyps in the gallbladder.
Operation type and description Stages Peculiarities Laparoscopic. Removal of the polyp is performed using endoscopic equipment. Three small incisions are made on the abdominal wall through which the instruments are inserted. Before the operation, a standard examination is required. An operation is performed under general anesthesia - 1. making cuts;
- 2. examination of the abdominal cavity;
- 3. ligation of blood vessels and bile ducts;
- 4. dissection of the bladder;
- 5. excision of the neoplasm;
- 6. moxibustion of blood vessels;
- 7. suturing the bladder;
- 8.suturing of wounds
Laparoscopic surgery is characterized by minimal trauma, the risk of infection is reduced, and the postoperative period is shortened Open. Dissection is performed abdominal wall, remove the entire bladder and nearby lymph nodes, if necessary, a section of the liver. An operation of such a plan is carried out if there is a suspicion of malignancy of polyposis growth - 1. processing of the surgical field;
- 2. making an incision up to 10 cm;
- 3. ligation of arteries and ducts;
- 4. selection and removal of the bubble;
- 5. removal of lymph nodes;
- 6.wound closure
At open surgery a longer recovery period is required, the period of bed rest is lengthened, the risk of infection is higher The goal of the postoperative period is to improve well-being and restore a person's ability to work. With endoscopic surgery, it lasts for 2-3 weeks, after open surgery - up to 1.5 months. The postoperative period consists of several stages:
- 1. Early - the first three days. Compliance with a strict diet, breathing exercises. If the condition of the seams is satisfactory, the patient is discharged for outpatient follow-up care.
- 2. The second stage - up to 30 days. Recovery of the body. A strict diet, treatment of seams, and therapeutic exercises are prescribed. On the 7-10th day, it is allowed to remove the stitches.
- 3. Late - up to 3 months. Observation by a doctor, control of blood and urine parameters, ultrasound examination.
Subsequently, a person is examined by a doctor annually. Diet # 5 is recommended throughout your life.
Forecast and prevention
The prognosis with timely treatment is favorable. Most dangerous complication is the malignancy of polyposis growth.
Prevention of the formation of polyps is to reduce the influence of provoking factors:
- adherence to the principles of healthy eating;
- regular medical examination;
- timely treatment of inflammatory diseases;
- adequate physical activity.
The conscription into the army in the presence of a gallbladder polyp is made in most cases. The only exceptions are large neoplasms, leading to a pronounced dysfunction of digestion.
It is believed that according to ultrasound data, 6% of the population are diagnosed with polyps in the gallbladder. And in 80% of cases, they are found in women after 35 years. However, everyone knows that ultrasound diagnostics can not always accurately determine the nature of the neoplasm tissue and there are a lot of cases when such a diagnosis is mistakenly made, when in fact the patient has not polyps in the gallbladder, but loose cholesterol stones, the growth dynamics of which must be monitored.
How are biliary polyps diagnosed?
The most accessible and cheapest diagnostic method is ultrasound. In this case, the doctor discovers single or multiple rounded formations that are associated with the wall of the gallbladder and there is no acoustic shadow. Another method, the most promising and interesting, is endoscopic ultrasonography.
This is a flexible endoscope with an ultrasound probe at the end; for examination, the patient must swallow the device, which enters the duodenum, which is located near the gallbladder. This device uses frequencies 2 times higher than with conventional ultrasound Therefore, endoscopic ultrasonography shows a higher quality image, distinguishing the walls of the gallbladder in layers.
What are polyps?
The causes of biliary polyps are still not known and are only theoretical guesses. According to many experts, polyps are asymptomatic, and in the presence of symptoms, the diagnosis should be revised in favor of gallstone disease, concomitant diseases of the digestive system, such as, for example, reactive pancreatitis, etc. Today, these neoplasms are divided into the following groups:
- Cholesterol polyps - pseudotumors
It is cholesterol neoplasms that are taken on an ultrasound scan for polyps. They represent the deposition of cholesterol as an elevation of the mucous membrane of the bladder. The accumulation of cholesterol occurs against the background of lipid metabolism disorders and often contain calcified inclusions, so they give the impression of gallbladder stones fixed to the walls.
- Inflammatory polyps are also pseudotumors
These neoplasms are inflammatory response mucous membrane of the bile, manifested by the proliferation of the internal tissue of the affected bladder.
- Adenoma of the gallbladder, as well as papillomas and papillary neoplasms are true polyps
These are benign neoplasms, however, in 10-30% of patients, their malignancy is observed, and often the development of such polyps is asymptomatic or a combination of gallstone disease with chronic cholecystitis is possible (see also). The reasons for the development of oncology against the background of such neoplasms remain largely unclear.
The most common polyps are cholesterol, which can be treated conservatively.
There are two opinions of specialists as to what is considered cholesterol biliary polyps. Some argue that they can be in the form of inclusions that create a diffuse mesh, usually they are 1-2 mm, or be larger 2-4 mm and look like outgrowths from the submucous layer of the bladder, while its ultrasonographic features are smooth outlines and wide base. Larger cholesterol neoplasms from 3-4 mm to 5-7 mm can also be found, they are located on a thin leg, with an even contour, do not give an acoustic shadow during examination, even larger - over 10 mm have a scalloped contour and this cholesterol polyp hypoechoic.
Another opinion of doctors is that 95% of the polyps described on ultrasound are not really, but are considered loose cholesterol stones. Indeed, on ultrasound, they look like polyps, even as multiple, but they almost never give any pain, and if the patient complains of symptoms of cholecystitis, gallstone disease, it is the stones that cause severe pain and ailments.
If there is the slightest chance of preserving the organ, they should always be used; in the presence of a polyp in the gallbladder, treatment should not be directed at 100% removal of the bladder. There are no useless organs in the body. By removing the storage of bile, from which bile flows through the duct to participate in digestion, significant changes occur in the entire process of digestion.
Therefore, if cholesterol polyps are found on the basis of ultrasound, the doctor may recommend starting drug therapy, dissolving stones with ursodeoxycholic or chenodeoxycholic acids (ursofalk, ursosan), that is, with special drugs for 2-3 months and make a control ultrasound. Based on the result in dynamics, conclusions can be drawn if positive effect takes place - then the dissolution of stones should be continued, if there are no positive dynamics, the issue of surgical treatment should be resolved.
These conclusions are made by surgeons when, after surgical treatment of gallbladder polyps, the described polyps according to the results of ultrasound in 95% of cases were loose parietal cholesterol stones, which can give symptoms of gallstone disease.
Therefore, in agreement with the attending physician, it is possible to conduct courses of drugs that improve the rheology of bile and thin bile (ursosan, ursosan, ursofalk). The course and dosage is determined by the doctor depending on the patient's weight, and the treatment can be supplemented with choleretic herbs such as agrimony. In addition, you should follow the diet number 5, 4 meals a day.
However, of course, one should also remember about the possible malignancy of the adenomatous polyp, papilloma or papillary neoplasm. To do this, a control ultrasound should be performed every six months, preferably with the same specialist and on the same apparatus. If the neoplasm grows by 2 mm per year, surgery is indicated, since the risk of malignancy is high, in the absence of growth, continue monitoring. In each specific clinical case, only a doctor or a council of doctors determines the feasibility of surgical removal of the gallbladder in the presence of polyps.
Symptoms of gallbladder polyps
As we wrote above, polyps are asymptomatic, patients have no specific complaints. Very rarely, there may be pain in the epigastric region or discomfort in the right hypochondrium, intolerance to certain types of food, and often they are found by chance on an ultrasound scan.
Treatment of polyps
The opinion of most specialists when polyps are found in the bile is an operation, that is, only a surgical intervention, 100% of the indications for which are: 
- A polyp less than 10 mm in size on a pedicle is monitored every six months for 2 years and once a year for life; if it grows, removal is indicated. However, some doctors insist on the need for surgery immediately after a large neoplasm is detected.
- With the development of clinical symptoms of polyps, removal is indicated regardless of their size and type.
- It is recommended to remove any polyps larger than 10 mm due to the high risk of its degeneration into cancer.
Given the oncological tension, there is also such a tactic for managing dubious clinical cases - it is based on constant monitoring of the size of even small polyps. If it is less than 1 mm, there is no indication for removal, but most doctors insist on monthly ultrasound control for 6 months, then every 3 months, then six months and then annually. We remind you that the rapid growth of a polyp is considered 2 mm during the year.
Among modern methods surgical intervention for the removal of a polyp or gallbladder, the following methods are distinguished:
- LCE - Video laparoscopic cholecystectomy - modern endoscopic technologies, the most sparing operations, but performed only in certain cases (see)
- OLCHE - open laparoscopic cholecystectomy, performed from a mini-access, using the "Mini-Assistant" instruments
- Traditional cholecystectomy, TCE, is performed from oblique or midline laparotomic access
- Endoscopic polypectomy - the long-term results and consequences of such an operation are not deeply understood and so far it is not often used.
For reference:
- The incidence of gallbladder cancer is 0.27-0.41% among all cancers
- It occurs in women 2 times more often than in men
- Among oncology of the gastrointestinal tract, gallbladder cancer ranks 5th (after cancer of the stomach, pancreas, colon and rectum)
- Among oncology of the hepato-pancreato-duodenal zone organs - 2nd place after pancreatic cancer
- The risk of development increases after 45-50 years, the peak incidence is 56-70 years
- In operations on the biliary tract, it occurs in 1-5% of cases.
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 suffer from gallbladder polyps. Among patients with this pathology, 80 percent are women over 35 years old. The sex of a person influences not only the prevalence of polyps, but also the nature of polyposis formations. So, in men, cholesterol polyps are most often diagnosed, while in the female, hyperplastic formations of the gallbladder predominate.
Interesting Facts
The first to find pathological deposits in the mucous membrane of the gallbladder 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 polyps of the gallbladder, there was an assumption about the existence of a connection between polyposis formations of the gallbladder and a violation of fat metabolism. The first medical work on this topic was published in 1937.
The author of the article identified the pathology as the main factor provoking the formation of one of the types of polyps lipid metabolism... 19 years later, at the World Gastroenterology Congress, impaired fat metabolism was identified as the underlying cause of one of the categories of gallbladder polyps.
All works of that period on the study of this pathology were of a more descriptive nature. The basis for the study of polyposis proliferation of the mucosa was mainly random finds during operations or autopsies. X-rays were also used to detect gallbladder polyps.
Implementation in medical practice ultrasound scanning made it possible to expand the possibilities of diagnosing gallbladder polyps.
Gallbladder anatomy
The gallbladder is a hollow, sac-like organ in the hepatobiliary system that acts as a reservoir of bile. From the liver, the bile produced flows through the bile ducts and accumulates in the gallbladder.The gallbladder is located in the fossa ( or bed) the gallbladder, which is located between the right and left lobes of the liver. The fibrous membrane covering the liver in this place grows directly with the gallbladder. Thus, the bladder is, 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 greenish in color. The length of this organ varies from 9 to 15 centimeters, and the volume from 40 to 60 cubic centimeters. There are several divisions in the structure of the gallbladder.
The sections of the gallbladder are:
- bottom- the most wide part, which is projected onto the anterior abdominal wall;
- gallbladder body which tapers to the neck of the gallbladder;
- gallbladder neck, which gradually narrowing, passes into the cystic duct, which subsequently connects to the common hepatic duct.
The structure of the walls of the gallbladder
The walls of the gallbladder are relatively thin and consist of three layers - serous, muscular and mucous membranes.Outer serous membrane
The serous membrane of the gallbladder is formed by loose connective tissue.
Muscle layer
The muscular layer is formed by smooth muscle tissue, which, unlike skeletal muscles, does not contract arbitrarily. Muscle fiber bundles are arranged in a circular, oblique and longitudinal layer. This layer is developed unevenly in different parts of the gallbladder. So, in the area of the bottom of the gallbladder, muscle fibers are poorly developed, and in the area of its neck, the muscle layer is most intensively developed. Similarly, the muscular layer of the cystic duct is well developed. Thanks to the developed layer of this layer, the walls of the gallbladder and the bile duct itself are able to contract, thereby ensuring the advancement of bile.
Mucous membrane
The mucous layer of the gallbladder forms numerous folds. It is lined with a single-layer 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 flows into the branches of the portal vein. The lymphatic system is represented by lymph nodes and ducts, which are located 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. He exercises control over the contractility of the gallbladder.
Physiology of the gallbladder
Bile enters the gallbladder from the liver through the bile ducts. Bile is a fluid that is secreted by liver cells ( hepatocytes). This liquid contains numerous enzymes and acids necessary for digestion. 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.It was previously thought that bile accumulates in the gallbladder between meals, while bile enters the intestines during meals. However, today, numerous studies have revealed 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 ( the 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 embedded in the thickness of the walls of the gallbladder. When cholecystokinin is released, it stimulates receptors, which causes the gallbladder to contract. By contracting, the gallbladder causes the movement of bile along 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, a stream of bile enters 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 consists of water, organic lipids ( fat) and electrolytes. Organic lipids include bile salts and acids, cholesterol, phospholipids. Bile acids - cholic and chenodeoxycholic - play a special role in the digestive process. These acids are involved in the emulsification of fats, thereby ensuring their assimilation. The emulsification process means that large fat molecules are broken down into smaller particles. Phospholipids include lecithin and taurine.Other functions of bile are:
- absorption of fats;
- activation of pancreatic juice enzymes;
- assimilation of fat-soluble vitamins ( A, E, D, K) and calcium salts;
- stimulation of intestinal motility.
The causes of the polyp
Before you find out the reasons for the formation of polyps, you need 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. Also polyps of inflammatory etiology belong to pseudopolyps. The causes of a gallbladder polyp are:
- genetic abnormalities and hereditary factors;
- inflammatory diseases of the gallbladder;
- metabolic disorders;
- biliary dyskinesia and other diseases of the hepatobiliary system.
Genetic abnormalities and hereditary factors
It has been established that a hereditary factor plays an important role in the occurrence of gallbladder polyps. First of all, this concerns adenomatous polyps and papillomas of the gallbladder. Since both adenomatous polyps and papillomas are considered benign tumors, the hereditary factor in this case plays a maximum role. Even if among the relatives there were tumor-like formations of other organs, the risk of the 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 ( for example, stagnation of bile) polyps can form.
Inflammatory diseases of the gallbladder
First of all, such 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. The main symptom of this pathology is pain syndrome. The pain is localized in the hypochondrium on the right and can be given to different parts of the body ( for example, in the 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 pains, a single vomiting may occur.In the period between pains, patients are worried about eructation of 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, bile stagnation occurs, which is the cause of the above symptoms.
As a reaction to the inflammatory process, the growth of granulation tissue occurs 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 ( or rather, pseudopolyps). In the case of these types of polyps, cholesterol deposits are noted in the gallbladder mucosa. Over time, such deposits grow and calcify ( calcium salts are deposited in them). The reason for all this is lipid metabolism disorders, in which there is increased content cholesterol. Cholesterol is called organic compound composed 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 can be accompanied by its deposition on the walls of the bladder, even without its increased concentration. If the patient already has a high cholesterol content ( more than 5.0 millimoles per liter), then stagnation of bile only accelerates the formation of cholesterol pseudopolyps.This type of polyps is most common. For a long time, they do not bother the patient in any way, which is the reason for a long non-consultation with a doctor. This, in turn, leads to extensive cholesterol deposits.
Biliary dyskinesia and other diseases of the hepatobiliary system
With dyskinesia of the biliary tract, functional disorders are noted against the background of the absence of structural changes. With dyskinesia, either excessive contraction of the gallbladder is observed, or insufficient. It is known that normally adequate contractile ability ensures the flow of bile into the duodenum. If, for some reason, the contraction of the gallbladder is disturbed, then an imbalance occurs between the flow of bile and its need for digestion. Most often, hypokinesia is observed, in which there is an 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 assimilation of fats, a patient with such a problem develops complaints such as nausea and vomiting after fatty foods, severe pain syndrome, 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 reasons. This is the interaction of both hereditary factors and all kinds of metabolic disorders.
Gallbladder polyp symptoms
Clinical picture gallbladder polyps depend on their location. The most dangerous situation is when a polyp ( or polyps) is located in the neck of the gallbladder or in its duct. In this case, this formation complicates the outflow of bile from the bladder into the intestines, 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.
The symptoms of a gallbladder polyp are:
- pain syndrome;
- jaundice;
- hepatic colic;
- dyspeptic manifestations - a bitter taste in the mouth, nausea, periodic vomiting.
Pain syndrome
Pain with polyps of the gallbladder is the result of overstretching of the walls of the bladder with stagnant bile or as a result of its frequent contractions. Most often, a growing polyp blocks the outflow of bile, which leads to its accumulation in the gallbladder. Congestion provokes hyperextension 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 permanent and are more often cramping in nature. Pain is provoked by fatty and plentiful food, alcoholic beverages, and sometimes stressful situations.
Jaundice
Jaundice is the icteric coloration of the skin and visible mucous membranes, namely the sclera. This syndrome is a consequence of an increased level 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 bloodstream. As a result, bilirubin and bile acids are found in increased concentrations in the blood plasma.First of all, the color of the skin and sclera changes - they acquire an icteric tint, 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 light - then bright yellow. If the patient is very dark skin, then jaundice can only be identified by the color of the sclera.
Also, jaundice is accompanied by symptoms such as itching, nausea and vomiting. Itching occurs as a result of the release of bile acids into the blood. Since the outflow of bile from the gallbladder is blocked, bile begins to heat up in it. Accumulating until 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 goes 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. At the same time, the skin is very dry and tight. 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, pains in the joints and muscles appear. An unfavorable symptom is a rise in temperature.
Hepatic colic
Hepatic colic is a syndrome characterized by the appearance of sudden, sharp and cramping pains in the right hypochondrium. As a rule, colic is a manifestation of gallstone disease and appears when the outflow of bile is completely disturbed. With a polyp of the gallbladder, hepatic colic appears in exceptional cases... It can appear when a polyp with a very long stem is diagnosed. Being in the area of the gallbladder neck, the leg of the polyp can be pinched and provoke hepatic colic.A pedunculated polyp is a type of polyp that is shaped like a fungus. In its structure, a leg and the cap itself are distinguished. At the same time, 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 clamp either the entire poly or its movable leg. This moment provokes sharp, sharp and cramping pains as hepatic colic.
Very intense pains appear abruptly and suddenly. At the same time, the patient cannot sit in one place and constantly rushes about. The heart rate rises ( pulse), blood pressure can also rise. The skin becomes pale and covered with sweat.
A distinctive feature of hepatic colic from pain syndrome of a different etiology is that the patient is this state can't find a suitable pose. As a rule, with pains 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 sore 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 manifests itself most often with gallbladder polyps. It can be very intense or, on the contrary, worn out.The manifestations of dyspeptic syndrome with a gallbladder polyp are:
- bitter taste in the mouth;
- nausea, especially in the morning;
- intermittent vomiting, especially after eating a rich meal.
A 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 with polyps. Typically, the bitter taste in the mouth is due to hyperkinesia ( increased motor activity) gallbladder.
Classification of polyps in the gallbladder
| Cholesterol polyp | Inflammatory polyp | Adenomatous polyp | Papilloma |
| It is not a true polyp, but a pseudo-formation. It is formed by deposits of cholesterol on the mucous membrane of the gallbladder. | Also belongs to the category of pseudotumors. It is an excessive proliferation of mucosal epithelium in response to an inflammatory response. | It develops from the glands of the epithelium, which covers the mucous membrane of the gallbladder. More often than other polyps, it turns into a malignant form. | Benign lesion with numerous papillary growths. Also inclined to switch to oncology. |
Diagnostics of the gallbladder polyp
Diagnosis of a gallbladder polyp is reduced to an ultrasound and endoscopic examination. Ultrasound diagnostics of a polyp
This diagnosis is based on the use of sound waves with a frequency higher than 20,000 Hertz. These waves are capable of changing their characteristics when passing through various media, including those of the body. Reflecting from any obstacle ( organ), the wave returns and is captured by the same source that generated it. Thus, the difference is calculated ( or the coefficient) between the wave that came out initially and the one that was reflected. This reflectivity 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-colored formation is determined by the shape of the polyp - if it is a pedunculated polyp, then the leg and 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 the 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.
Ultrasound diagnostics
Preliminary preparation before the ultrasound scan is not required. However, if the patient suffers from severe gas production ( bloating), then it is recommended to exclude gas-forming products 2 - 3 days before the diagnosis. A light breakfast or lunch is recommended on the day of the study, so as not to overload the digestive system.
The place to which the sensor will be applied is treated with gel. This eliminates the penetration of air between the sensor and the skin. For better visualization, the doctor may ask the patient to lie on the right side. The difference between the gallbladder polyp and its other formations is that the polyp does not give an acoustic path, for example, as with a gallbladder stone. Another feature is that it does not shift when the position of the body changes.
Endoscopic ultrasonography method
This method combines both the endoscopic method and ultrasound. It consists in the introduction of an ultrasound probe with an endoscope into the duodenal cavity. Being in the intestinal cavity, the sensor scans the surrounding tissue at a distance of 12 centimeters. Since the gallbladder and the duodenum are in close proximity, the ultrasonic sensor visualizes the bladder while in the intestinal cavity. The advantage of this method is the use of high frequency ultrasound. Thus, a high image quality is achieved, at which it is possible to examine and study the polyp in detail.For this diagnostic method, miniature ultrasound probes are used, which are inserted first into the stomach, and from there into the duodenum.
Endoscopic ultrasonography
The procedure is carried out on empty stomach... The evening 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) diazepam is injected intramuscularly. The oropharyngeal cavity 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 motion. At the time of swallowing, the endoscope tube is pushed into the esophagus, and from there into the stomach cavity. From the stomach cavity, the endoscope, at the end of which an ultrasonic sensor is attached, enters the duodenal cavity, from where the surrounding tissues are scanned. Thanks to high frequency ultrasound wave picture of the gallbladder is obtained with high resolution. This allows even very small polyps to be diagnosed.
CT scan
Computed tomography is an additional diagnostic method. The advantages of this method are 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.With the help of this diagnostic method, the structure and localization of the polyp, as well as concomitant anomalies of the biliary tract, are determined. If computed tomography is performed using contrast agent, then it is also possible to assess the accumulation of this substance by the polyp. 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 used for gallbladder polyp
| Method name | What reveals |
| Blood chemistry | Determined following signs cholestasis(stagnation of bile):
|
| Analysis of urine |
|
| Stool analysis | Stool stercobilin is reduced or absent. |
Treatment of a polyp of the gallbladder
Treatment of a gallbladder polyp is reduced to its surgical removal. Medication for polyps is not effective. It is used only for the treatment of background diseases, that is, those against which polyps have formed. Also applies symptomatic treatment, which is aimed at eliminating the symptoms of polyps in the gallbladder. For example, with severe 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
| Drug name | 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 ( overlapping) gallbladder polyp. | Before meals, 2 tablets three times a day. |
| Hepabene | 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, the 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 a person. So, on average daily dose equal to 10 mg per 1 kg of body weight. If the patient weighs 60 kg, then he needs 2 capsules per day. The drug is taken daily in the evening for 3-6 months. |
If a patient with gallbladder polyps is being treated with Ursofalk or other drugs from this group, then periodic ultrasound examinations are recommended. So, once every three months, an ultrasound scan 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 the result is not visible, then surgical removal of the gallbladder is undertaken.
Surgery
It is the main treatment for gallbladder polyps. Typically, a polyp in the gallbladder is removed endoscopically. In this case, the entire gallbladder is removed, and this type of 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 enlarging;
- if there are multiple polyps of the gallbladder;
- if there are additionally gallbladder stones;
- if there is a burdened family history of cancer.
Is surgery necessary for a gallbladder polyp?
Operation for a gallbladder polyp is performed when there is a possibility of transformation of the neoplasm into a cancerous tumor. Factors such as the size of the polyp ( more than 10 millimeters in diameter), intensive growth ( increase up to 20 millimeters), number ( more than one polyp).Another indication for surgery is the presence of stones and other neoplasms in the gallbladder, in addition to polyps. It also removes those polyps that cause discomfort and adversely affect the patient's health. A timely operation allows you to avoid serious complications. The method of surgical treatment is established by a 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 the polyp of the gallbladder are:
- transformation of a polyp into cancer;
- attacks of hepatic colic;
- inflammation of the walls of the gallbladder;
- purulent cholecystitis;
- deterioration in the outflow of bile;
- increased bilirubin levels.
Transformation of a polyp into cancer
The frequency of malignancy ( rebirth into cancer) of gallbladder polyps varies from 10 to 35 percent. The likelihood of degeneration into a malignant tumor is greatly influenced by the size of the neoplasm. So, polyps, whose diameter exceeds 20 millimeters, transform 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, the malignant tumor begins to manifest itself with symptoms such as general physical weakness, impaired appetite, dull pain in the right hypochondrium. As it progresses pathological process patients begin to complain of itching, vomiting, nausea, 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 urine.
The prognosis for gallbladder cancer is poor. After diagnosis, the patient's average life expectancy is 3 months. Up to one year, no more than 15 percent of patients survive. Therefore, when polyps are found with a high probability of malignancy, an operation is prescribed.
Hepatic colic attacks
Growing, the polyp can block the lumen of the gallbladder, causing attacks of acute hepatic colic. This condition is characterized by severe pain that is localized under the right row of ribs. Pain can radiate ( spread) in the right shoulder or shoulder blade, back, neck. Sometimes painful sensations cover 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 24 hours. The pain reaches its peak on inhalation and when the patient lies on his left side.Other manifestations of a gallbladder polyp are:
- severe nausea;
- frequent vomiting that does not lead to relief;
- pallor and moisture of the skin;
- yellowness of the skin and mucous membranes of the eyes;
- soreness and bloating;
- an increase in temperature;
- darkening of urine.
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 the patient severe discomfort... Common symptoms of the activation of the inflammatory process are pain in the right hypochondrium, constipation or diarrhea, bloating, vomiting, and nausea. The patient's discomfort and pain increase after eating fatty and fried foods.Purulent cholecystitis
As the 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 sharp deterioration the patient's condition. A purulent lesion of the gallbladder can lead to serious complications, many of which have a poor prognosis and are fatal.The consequences of untimely removal of the gallbladder polyp are:
- Gangrenous cholecystitis- represents the next stage of purulent cholecystitis and is accompanied by necrosis ( mortification) the walls of the gallbladder. The consequence of this condition may be a 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 burst 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 the breakthrough of purulent contents into the peritoneum. This complication characterized by high level deaths.
- Cholangitis- inflammation of the bile streams, which can lead to sepsis ( blood poisoning).
Deterioration of bile outflow
Large polyps can cause bile to become difficult to move. This leads to stagnation of bile, which is accompanied by numerous pathological changes in the patient's health. Cholestasis ( violation of the outflow of bile and its stagnation) manifests itself as bitterness and an unpleasant odor in the mouth, poor appetite, constipation. In the area 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 urine excreted increases, which, together with inadequate nutrition, leads to a vitamin deficiency. An insufficient amount of vitamins causes visual impairment, dry mucous membranes and skin, muscle weakness. One of the signs of a violation of the outflow of bile is a yellow tint of the mucous membrane of the eyes and skin. In this case, on the chest, elbows and back may occur dark spots... Severe itching of the skin is also a common symptom of this disorder. Poor bile flow leads to an increased fat content in the stool. Because of this, the stool acquires a mushy structure, and its shade brightens. With a long course this disease development of serious negative consequences.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 ( decreased bone density);
- hepatic renal failure ( decrease in the functions of these organs).
Increased 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 excess amount, this compound provokes intoxication of the body and deterioration of the functionality of all vital important organs... Brain cells are the most sensitive to the effects of bilirubin. Initial signs an excess of this substance is an icteric color of the skin, a dark shade of urine, general weakness... In the future, symptoms such as memory impairment, sleep disturbances, and decreased mental activity are added. One of the complications of this condition is irreversible changes in the structure of the brain.Types of surgery for gallbladder polyp
The operation for a gallbladder polyp is called cholecystectomy. This means that the gallbladder itself is removed along with the polyps. This type of surgery can be carried out endoscopically or in the usual classical way. In 90 percent of cases, this intervention is carried out using endoscopic techniques. Laparoscopic cholecystectomy
The purpose of this operation is to remove the gallbladder using endoscopic techniques. For 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 at the end of which valve devices are located. Trocars do not make additional incisions, but only move the tissue apart. Further, through the inserted trocars into abdominal cavity working instruments are introduced, such as a laparoscope, an eyepiece with a video camera.Before the operation, the patient undergoes all the necessary clinical examinations. A repeated ultrasound examination, a general blood test and a coagulogram ( includes a study for platelets, prothrombin, fibrinogen).
Anesthesia
Laparoscopic cholecystectomy is performed under general anesthesia using muscle relaxants.
- four small incisions are made through which trocars are inserted;
- operating instrumentation is inserted through trocars into the abdominal cavity;
- an audit is underway ( inspection) organs of the abdominal cavity;
- there is the hepato-duodenal ligament, from which the cystic artery and the cystic duct stand out;
- the artery and duct are ligated and crossed ( in medical language, they are clipped);
- from the bed of the liver, the gallbladder is secreted and separated. Most often, an electrocoagulator is used, which both cuts and coagulates tissues;
- The gallbladder is removed from the abdominal cavity through punctures made.
- short and moderate in intensity of pain in postoperative period;
- minimum hospital stay in the postoperative period ( up to 5 days);
- a low percentage of complications such as adhesions, incisional hernias, infection of postoperative wounds;
- immediately after the operation, the patient can take care of himself.
Open cholecystectomy
This operation involves removing the gallbladder not through punctures, but through full 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 stages:
- the preliminary incision field is treated with antiseptics;
- then an incision of 10 - 15 centimeters is made with a scalpel;
- tissue incision is carried out layer by layer;
- then the hepato-duodenal ligament is located, after which the artery and duct are clipped;
- the gallbladder is removed from the bed, tied and removed;
- regional lymph nodes are removed;
- the incision is also sutured in layers, but in the reverse order.
With open cholecystectomy, general anesthesia is performed with tracheal intubation and the use of muscle relaxants. The stitches are removed on days 6-7. On the first day after the operation, the patient can drink water, on the second day, eat. It is allowed to get up after an open laparotomy from 3 to 4 days. The duration of the rehabilitation period lasts about two weeks.
Rehabilitation after surgery for a biliary 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 normal life depends on the age and condition of the patient. Also, the duration of rehabilitation is influenced by the nature of the operation. When performing 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 - 2 months is required for full 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 department for 2 hours intensive care, where the necessary measures are taken to remove the patient from anesthesia. When conducting an open operation or in the presence of complications, the period of stay in this department increases. Then the patient is transferred to the general ward. Rehabilitation at this stage consists of diet and exercise. In the absence of complications, the first stage of rehabilitation ends with the patient's discharge from the hospital.
Nutrition for the first stage of rehabilitation
During the first 4 - 6 hours, the operated person is prohibited from eating or drinking. Then, within 10 - 15 hours, it is necessary to drink only non-carbonated water in small portions. A day later, you can begin to introduce liquid and semi-liquid food into the patient's diet.
Allowed meals in the first stage of rehabilitation are:
- kefir, yogurt;
- oatmeal and buckwheat porridge;
- potato, squash, pumpkin puree;
- vegetable soups;
- banana puree;
- baked apples;
- soufflé from lean meat.
Physical exercises of the first stage of rehabilitation
The first 5 - 6 hours after coming out of anesthesia, the patient should stay in a horizontal position. Attempts to get out of bed may only be carried out 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 step in this rehabilitation phase is the performance of a series of exercises. The task of physical activity is to activate breathing to remove the anesthetic from the airways. Also, exercise is necessary to normalize the circulation of blood and lymph. In the absence of complications, the exercises should be started immediately after the effect of the anesthesia ends. You should start with breathing exercises, which consists of 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.
This is followed by flexion and extension of the limbs, as well as their dilution to the sides and bringing them to their original position, within 2 - 3 minutes. 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;
- tilting the body 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.
The second stage of rehabilitation after removal of the gallbladder polyp
The second stage lasts 30-40 days, and its purpose is to return all functions to normal and normalize the general state 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.
When carrying out 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 stay in bed. Further, throughout the entire stage, any physical activity and exercise that require tension of the abdominal press should be excluded. You should also refuse to lift objects weighing more than 3 - 4 kilograms. This is necessary in order for the abdominal wall injured during the operation to heal faster.
Diet therapy
Compliance with certain principles when choosing and preparing dishes is an important milestone rehabilitation of surgical treatment of polyposis formations of the gallbladder.
The rules for the preparation and use of products are:
- the diet should be fractional and meals should be taken every 3 hours;
- after eating, there should be no feeling of overeating;
- during the cooking process, products must be chopped or wiped;
- it is recommended to use cooking, steaming or baking in the oven as a heat treatment;
- creamy and vegetable oil ready-made dishes are refueled;
- the temperature of the foods consumed should be medium;
- within 1.5 - 2 hours after eating it is necessary to give up 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 |
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| First meal |
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| Meat Dishes |
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| Fish products |
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| Cereals |
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| Snacks, sauces |
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| Fruits and berries |
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| Vegetables |
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| Milk products |
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| Beverages |
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| desserts |
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Hygiene of postoperative wounds
After the operation, special plasters are applied to the wounds. Depending on the type of stickers, they may or may not be removed before taking water treatments. If the patch needs to be removed, after showering, the wound should be treated with an antiseptic and a new patch attached. Bathing, bathing in a pool, lake or other body of water is prohibited until the seams are removed and for 5 days after they are removed.
Tracking complications
Any type of surgery for gallbladder polyps can be accompanied by complications. In order to take timely measures to eliminate negative consequences, the patient must monitor the state of the body. If you find any changes in the state of health, you should consult a doctor.
Symptoms of complications after gallbladder polyp surgery are:
- redness, suppuration of postoperative wounds;
- appearance in the area of wounds painful lumps;
- rash, skin redness;
- bloating, soreness of the abdomen;
- nausea, vomiting;
- muscle, joint pain.
The third stage of rehabilitation after removal of the gallbladder polyp
Long-term rehabilitation consists in dynamic observation of the patient in order to prevent relapse ( reappearance diseases). A month after the operation, it is necessary to pass a general urine test and general and biochemical blood tests. Also, in some cases, it is recommended to undergo an ultrasound examination. In the future, within a year after the operation, the patient needs to undergo an examination 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 ( worsening outflow and stagnation of bile). Also, the development of polyps is influenced by the patient's lifestyle. The directions of prevention of polyposis growth of the mucous membrane of the gallbladder are:
- dynamic observation by a doctor with a hereditary predisposition;
- prevention of stagnation of bile ( cholestasis);
- timely therapy of inflammation of the gallbladder;
- normalization of fat metabolism.
Dynamic observation by a doctor with a hereditary predisposition
Heredity is one of the key factors that increases the likelihood of gallbladder polyposis formation. Scientists explain this by the fact that close relatives have a similar metabolism and structure of the mucous membrane. 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 can detect 90 to 95 percent of all polyps. Magnetic resonance imaging is also used.Timely therapy for 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 mucous membrane. The cause of cholecystitis is most often various pathogenic microorganisms intestines, which provoke an infectious process. Infection from the intestines into the gallbladder enters with blood or lymph.Signs of the development of an inflammatory process in the gallbladder are:
- dull pain under the right row of ribs;
- swollen belly;
- dysfunction of the digestive system;
- nausea, vomiting;
- coloring of the skin and eye sclera in a yellow tint.
If you find these manifestations of inflammation, you should consult a doctor. The doctor will prescribe treatment that will prevent the formation of inflammatory polyps in the gallbladder.
Prevention of stagnation of bile ( cholestasis)
Violation 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. Various internal and external factors... One of the common reasons is the lack of food culture ( frequent snacks, long breaks between meals, dry food). The quality of the food consumed can also provoke cholestasis. Fatty foods with a minimum amount of fiber contribute to this disease. Dysfunction endocrine system and chronic diseases digestive tract also cause stagnation of bile and, as a result, the formation of polyps in the gallbladder. Disorders nervous system and a sedentary lifestyle can also cause disturbances in the outflow of bile and the formation of gallbladder polyps.Measures to help prevent gallbladder polyps are:
- adherence to the regimen when eating food;
- inclusion in the diet of plant products with fiber;
- control of the consumption of animal fats;
- maintaining an active lifestyle;
- timely treatment of gastritis, ulcers, pancreatitis;
- adequate therapy infectious diseases intestines;
- timely access to a doctor for dysfunctions of the nervous system.
Normalization of fat metabolism
In case of violation of fat metabolism ( lipids) cholesterol begins to accumulate on the walls of the gallbladder ( breakdown product of fats), which causes the formation of polyps. The main factor that causes an imbalance in the lipid metabolism system is unhealthy diet. In addition, physical inactivity ( weakening of muscle tone due to a sedentary lifestyle), bad habits. To endogenous ( internal) the causes of lipid metabolism disorders include a number of diseases gastrointestinal tract which cause impairment of fat absorption.In order to prevent gallbladder polyps, it is necessary to adhere to a certain regimen and quality of food and adjust the lifestyle. It is also necessary to promptly treat diseases of the digestive system, preventing their transition to a chronic form.
Measures to normalize fat metabolism are:
- control of the quality and quantity of consumed fats;
- an increase in the rate of consumed dietary fiber;
- control of the balance of carbohydrates in the diet;
- fight against hypodynamia;
- timely detection and treatment of diseases.
Control of the quality and quantity of consumed fats
Excessive 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 influenced by both the quantity and quality of fat consumed. All fats consumed by humans can be divided into two groups - healthy and unhealthy. The beneficial ones 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 harmful fats remain firm at room temperature. In order to prevent gallbladder polyps, people over 40 need to consume no more than 70 ( women) – 100 (men) grams of fat per day. Moreover, the proportion of unhealthy fats should not exceed 10 percent.
Healthy and unhealthy fats and foods that contain them
| Name | Products |
| Monounsaturated
(useful)fats |
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| Polyunsaturated
(useful)fats |
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| Saturated
(harmful)fats |
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| Modified
(harmful)fats |
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Increasing the intake of dietary fiber
Alimentary fiber ( cellulose) promote better absorption of fats, and also has a beneficial effect on metabolism. Fiber is only found in plant foods.
Foods that are rich dietary fiber are:
- fruit- raspberries, blackberries, banana, pears, apples, kiwi;
- vegetables- green peas, beets, broccoli, cabbage, carrots;
- cereals- pearl barley, buckwheat, bulgur ( Wheat groats whole grain), oatmeal;
- legumes- lentils, beans, chickpeas, soybeans, peas;
- nuts- walnuts, forest, almonds, cashews, peanuts.
Depending on the structure and effect on the body, carbohydrates are divided into fast and slow. Fast carbohydrates are converted into fats in the body. 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 fullness. They are found in whole grains ( bran, hard pasta), vegetables, unsweetened fruits.
To improve lipid metabolism and to prevent the formation of gallbladder polyps, the amount of carbohydrates per day should be 3-4 grams per kilogram of weight. Moreover, the norm fast carbohydrates should not exceed 30 percent.
Fight against hypodynamia
Sedentary image life negatively affects the metabolism, increasing the risk of the formation of polyposis formations of the gallbladder. 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 could be morning exercises, sports dancing, walking, active sports. Regardless of the type of the chosen lesson, a number of rules must be observed when performing them.
The rules for dealing with hypodynamia are:
- a gradual increase in loads;
- control of your own state;
- the regularity of the classes performed.
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 lesion of the pancreas);
- enteritis ( inflammatory process 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 leg of the polyp;
- complete obstruction ( overlap) gallbladder polyp.
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. The percentage of malignancy ( transition of a polyp to a malignant tumor) according to various sources 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, and vomiting are also observed. However, in cancer, they are most pronounced - vomiting is observed much more often, pains constantly bother. Jaundice and icteric discoloration of the sclera are common symptoms. Sometimes there may be a fever that appears on the background of jaundice.
Infringement of the leg of the polyp
Infringement of the leg of the polyp provokes acute, burning pain in the right hypochondrium, which is similar in intensity to hepatic colic. This complication is observed when a pedicle 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 cap are distinguished. The leg can be short, wide, or very long. When the leg is long, it can be twisted, bent and 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 ( more than 90 beats per minute), the skin becomes pale and moist.
Complete obstruction of the gallbladder with a polyp
This complication is observed when the polyp has a very large size and closes the lumen of the gallbladder neck. 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. Initially, bile begins to accumulate in the gallbladder. Due to its absence in the intestines, food fats are not digested or 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 itching of the skin occurs on the patient's body. There are also changes in the urine, which becomes dark in color.
Do I need to remove a polyp of the gallbladder?
The gallbladder polyp must be removed when it is true and there is a risk of malignancy. A true polyp is one that develops from epithelial tissue. These polyps include adenomatous polyps and gallbladder papilloma. These polyps are at the highest risk of malignancy and should therefore be removed. Pseudopolyps include cholesterol and inflammatory polyps. Cholesterol polyp is a deposit cholesterol plaques on the mucous membrane of the bladder, while an inflammatory polyp is the reaction of the mucous membrane of the gallbladder to an inflammatory process. For these polyps, a wait-and-see tactic is adopted. They are under the supervision of an ultrasound doctor and if they do not regress for a long time ( do not decrease in size) are deleted.
Gallbladder polyp should 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 come to light;
- there are destructive changes in the gallbladder;
- polyps are accompanied by stones in the gallbladder;
- the patient has a relative with cancer.
However, if the polyp exceeds 18 millimeters in size, and the patient has relatives with cancer, then an open abdominal surgery... It involves a full incision in the abdominal wall to gain access to the gallbladder. Lymph nodes and parts of the liver are removed along with the gallbladder.
How to get rid of a polyp in the gallbladder?
You can get rid of a polyp in the gallbladder medically and surgically. Medicinal 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 gallbladder mucosa 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 patient's weight 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 these drugs depends on the size of the cholesterol polyps. At least these drugs are taken for 3-6 months, maximum - 2 years. If, against the background of this therapy, dissolution of cholesterol deposits occurs, then surgical removal of polyps is not required. However, if therapy is ineffective, then the polyps are removed along with the gallbladder.
Surgical method to remove polyps
The operation to remove the gallbladder polyp is called cholecystectomy. This method of surgical intervention can be carried out endoscopically or in the usual classical way.
Most often, removal is carried out using an endoscopic technique, that is, a 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 for polyps in the gallbladder?
Ursosan is a ursodeoxycholic acid drug that is able to dissolve cholesterol pseudopolyps. It is prescribed exclusively for cholesterol polyps and is not effective for other types. Ursosan analogues are ursofalk, greenterol, ursodez, urdoxa. 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 helps to resolve cholestasis ( stagnation of bile). Since stagnation of bile 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 performed periodically to track the growth or shrinkage of polyps.
The daily dosage is 10 milligrams per kilogram of patient 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 person weighing 75 kilograms). In the first three months of treatment, it is recommended to take one capsule in the morning, at lunchtime and in the evening. Further 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 preserved, 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 glands of the gallbladder epithelium. This type of polyp has high risk malignancy, according to various sources - from 10 to 30 percent. It is considered benign neoplasm, the treatment of which involves an exclusively surgical method. These polyps tend to grow expansive and invasively. Most often, one to three adenomatous polyps are diagnosed. Adenomatous polyp manifests itself most often with symptoms of cholestasis ( stagnation of bile).
The symptoms of adenomatous gallbladder polyp are:
- bitter taste in the mouth
- nausea, periodic vomiting;
- pain syndrome;
- jaundice;
- hepatic colic.
With jaundice, the color of the patient's skin and sclera becomes jaundiced, and the urine becomes dark in color ( strong tea color). The bitter taste in the mouth, in turn, is explained by 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 impaired outflow of bile.
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