What types of polyps are there?
Under one word “polyp” in the ultrasound report, formations of a different nature are hidden. Cholesterol polyps make up the majority: they are small, often multiple, on a thin stalk. Inflammatory polyps are associated with chronic cholecystitis. Adenomas are true benign tumors that can degenerate as they increase in size. Sometimes a fixed stone or a clot of thick bile is mistaken for a polyp.
- Cholesterol polyps and cholesterolosis
- Inflammatory polyps
- Adenomas (true polyps)
- Adenomyomatosis of the bladder wall
- Pseudopolyps - fixed stones, sludge
Causes and risk factors
Cholesterosis is associated with lipid metabolism disorders: excess cholesterol is deposited in the macrophages of the bladder mucosa. It is more common in people who are overweight, have high cholesterol and impaired glucose metabolism. Factors that increase the risk of malignant degeneration of a polyp are taken into account when choosing tactics.
- Obesity and metabolic syndrome
- Elevated cholesterol levels
- Age over 50–60 years
- Primary sclerosing cholangitis
- Indian origin (according to research)
- Broad-based polyp
Symptoms
Polyps almost never cause complaints and are discovered by chance during an ultrasound done for another reason. Pain in the right hypochondrium is usually explained by concomitant stones, cholecystitis or functional disorders, and not by the polyp itself. A large polyp in the neck of the bladder can occasionally interfere with the flow of bile.
- More often - asymptomatic
- Dull pain in the right hypochondrium with accompanying stones
- Nausea, bitterness in the mouth - nonspecific
Diagnosis and observation
The main method is ultrasound, performed on an empty stomach by an experienced specialist: it allows you to measure the polyp, evaluate its shape, base and blood flow, and distinguish it from a stone. The timing of control depends on the size and risk factors. According to current recommendations, small polyps up to 5 mm without risk factors are observed using ultrasound after 6 months, 1 and 2 years; polyps 6–9 mm - more often and longer. If the polyp disappeared during observation, most often it was not a polyp, but a clot of bile. If the results are questionable, endoscopic ultrasound, CT or MRI are performed.
- Ultrasound of the liver and gallbladder on an empty stomach
- Control ultrasounds in dynamics
- Endoscopic ultrasonography
- CT or MRI of the abdominal cavity according to indications
- Lipid profile, glucose
Treatment
There are no drugs that dissolve polyps. Cholesterol deposits sometimes decrease due to weight loss and normalization of lipid metabolism, but true polyps are not treated with drugs. Laparoscopic removal of the gallbladder is recommended for polyps 10 mm or more, when the polyp grows during observation, for polyps 6–9 mm in people with risk factors, as well as when the polyp is combined with stones and attacks of pain. The entire bladder is removed, since the polyp is not excised separately. The decision to operate is made by the surgeon, taking into account all the data.
- Follow the timing of the control ultrasound
- Lose weight if you are overweight
- Limit fatty foods and sugar
- Control cholesterol and glucose
- Do not rely on “absorbable” agents
