What are gallbladder polyps. How are they diagnosed. What are the risk factors for developing gallbladder polyps. What treatment options are available for gallbladder polyps. How can gallbladder polyps be prevented.

Understanding Gallbladder Polyps: An Overview

Gallbladder polyps are small growths that form on the lining of the gallbladder, a small organ responsible for storing bile produced by the liver. These growths are typically benign, with only about 5% being cancerous. However, they can serve as an early indicator of gallbladder cancer before more serious symptoms manifest.

The gallbladder plays a crucial role in the digestive process by storing and releasing bile, which helps break down fats in the small intestine. When polyps develop on this organ, they may interfere with its normal function, although many individuals with gallbladder polyps remain asymptomatic.

Causes and Risk Factors of Gallbladder Polyps

The exact causes of gallbladder polyps remain unclear, with limited research available on the subject. However, medical professionals have identified several factors that may contribute to their development:

• Fat metabolism: There appears to be a connection between gallbladder polyps and the body’s ability to process fat. Individuals whose gallbladders struggle to break down fat efficiently may be at a higher risk of developing polyps.
• Genetic predisposition: Family history seems to play a role in the likelihood of developing gallbladder polyps. If a close relative has had this condition, you may be at an increased risk.
• Cholesterol levels: Many gallbladder polyps are composed of cholesterol, suggesting a potential link between high cholesterol levels and polyp formation.

Interestingly, unlike some other gastrointestinal conditions, gallbladder polyps do not show a clear correlation with factors such as gender, age, obesity, or diabetes. This makes it challenging to identify high-risk groups based on these common demographic and health indicators.

Recognizing the Symptoms of Gallbladder Polyps

Gallbladder polyps often go unnoticed due to their typically asymptomatic nature. However, when symptoms do occur, they can include:

• Nausea
• Vomiting
• Intermittent pain in the upper right abdomen

It’s important to note that these symptoms are not exclusive to gallbladder polyps and can be associated with various other gastrointestinal conditions. Additionally, research has shown no significant difference in symptoms between individuals with cancerous polyps and those with benign growths, making it crucial to seek medical attention for proper diagnosis.

Diagnostic Procedures for Gallbladder Polyps

Diagnosing gallbladder polyps can be challenging due to their often asymptomatic nature. In many cases, polyps are discovered incidentally during examinations for other conditions. The primary diagnostic tool for gallbladder polyps is ultrasound imaging.

Ultrasound Examination

Ultrasound technology allows doctors to visualize the internal structures of the gallbladder, providing valuable information about the presence, size, and characteristics of polyps. During this non-invasive procedure, a trained technician uses a handheld device to send sound waves through the body, creating detailed images of the gallbladder and surrounding tissues.

Size Matters: Assessing Polyp Risk

The size of gallbladder polyps is a crucial factor in determining their potential risk. Polyps larger than 1.5 cm (about half an inch) in diameter are considered to have a higher likelihood of being cancerous or developing into cancer over time. For this reason, polyps of this size often warrant closer monitoring or surgical intervention.

Additional Diagnostic Techniques

In some cases, additional imaging techniques may be employed to gain a more comprehensive understanding of the polyps:

• CT scans: These can provide detailed cross-sectional images of the gallbladder and surrounding structures.
• MRI: This technique offers high-resolution images and can be particularly useful in distinguishing between different types of gallbladder lesions.
• Endoscopic ultrasound: This procedure combines endoscopy with ultrasound to obtain detailed images of the gallbladder and bile ducts.

Treatment Options for Gallbladder Polyps

The treatment approach for gallbladder polyps depends on several factors, including the size of the polyps, the presence of symptoms, and the overall health of the patient. Here are the primary treatment options:

Watchful Waiting

For small polyps (less than 1.5 cm in diameter) that are asymptomatic, doctors often recommend a “wait and see” approach. This involves regular monitoring through ultrasound examinations to track any changes in the size or characteristics of the polyps. How often should these follow-up examinations occur? Typically, doctors recommend ultrasounds every 6 to 12 months, but the frequency may vary based on individual circumstances.

Surgical Intervention

Cholecystectomy, or surgical removal of the gallbladder, is often recommended in the following situations:

• Polyps larger than 1.5 cm in diameter
• Rapid growth of polyps observed during monitoring
• Presence of symptoms causing significant discomfort
• High suspicion of malignancy based on imaging characteristics

This procedure is typically performed laparoscopically, involving small incisions and a camera-guided approach, which results in shorter recovery times compared to open surgery.

Dietary Modifications

While not a direct treatment for polyps, dietary changes can play a supportive role in managing gallbladder health. These modifications may include:

• Reducing intake of fatty and high-cholesterol foods
• Increasing consumption of fruits and vegetables
• Maintaining a balanced diet rich in fiber

These dietary adjustments can help improve overall gallbladder function and may contribute to preventing the formation of new polyps.

Recovery and Long-term Management of Gallbladder Polyps

The recovery process and long-term management strategy for gallbladder polyps vary depending on the chosen treatment approach. What can patients expect during recovery?

Post-Surgical Recovery

For patients who undergo cholecystectomy:

• Hospital stay: Typically 1-2 days for laparoscopic procedures
• Return to normal activities: Usually within 1-2 weeks
• Dietary adjustments: Gradual reintroduction of fatty foods as tolerated
• Follow-up appointments: To monitor healing and address any concerns

Ongoing Monitoring

For patients under watchful waiting or those who have undergone surgery:

• Regular ultrasound examinations: To track any changes or new polyp formation
• Routine check-ups: To assess overall health and address any emerging symptoms
• Lifestyle modifications: Maintaining a healthy diet and exercise routine

It’s crucial for patients to maintain open communication with their healthcare providers and report any new or worsening symptoms promptly.

Preventing Gallbladder Polyps: Lifestyle Considerations

While not all risk factors for gallbladder polyps are within an individual’s control, certain lifestyle choices may help reduce the likelihood of their development. What steps can be taken to promote gallbladder health?

Dietary Habits

Adopting a balanced diet can support overall gallbladder function:

• Limit saturated and trans fats
• Increase fiber intake through whole grains, fruits, and vegetables
• Stay hydrated to support proper bile flow
• Consider including foods rich in omega-3 fatty acids, such as fish and flaxseeds

Regular Exercise

Physical activity can help maintain a healthy weight and support metabolic processes:

• Aim for at least 150 minutes of moderate-intensity exercise per week
• Include a mix of cardio and strength training exercises
• Consider activities that promote core strength, which may indirectly benefit gallbladder function

Stress Management

While the direct link between stress and gallbladder polyps is not well-established, managing stress can contribute to overall health:

• Practice relaxation techniques such as meditation or deep breathing exercises
• Ensure adequate sleep (7-9 hours per night for most adults)
• Engage in hobbies and activities that promote mental well-being

The Role of Regular Health Check-ups in Managing Gallbladder Health

Regular health check-ups play a crucial role in the early detection and management of gallbladder polyps. How can routine medical examinations contribute to gallbladder health?

Preventive Screenings

While there are no specific screening guidelines for gallbladder polyps in asymptomatic individuals, routine health check-ups can include:

• Physical examinations to assess overall health
• Blood tests to monitor cholesterol levels and liver function
• Discussions about family history and potential risk factors

Prompt Symptom Evaluation

Regular check-ups provide an opportunity for patients to discuss any concerning symptoms with their healthcare provider. This can lead to timely investigations and appropriate management of gallbladder issues.

Personalized Health Strategies

Based on individual risk factors and health status, healthcare providers can offer personalized recommendations for maintaining gallbladder health, which may include:

• Tailored dietary advice
• Guidance on appropriate exercise routines
• Recommendations for stress management techniques

By prioritizing regular health check-ups, individuals can take a proactive approach to their gallbladder health and overall well-being.

Gallbladder Polyps | Endocrinology | Mercy Health

What are gallbladder polyps?

Your gallbladder is a small organ. It’s responsible for storing bile after your liver releases it. It also moves the bile from your liver to your small intestine. Gallbladder polyps are small growths that can form on the outside of the organ. The growths are usually not cancerous. The possibility for these growths to be cancerous is small. About 5% of gallbladder polyps are. They can be the first way a doctor can tell someone has gallbladder cancer before serious symptoms start happening.

Causes of gallbladder polyps

Unlike gallstones, there isn’t a lot of research and understanding about what causes gallbladder polyps. Doctors think there’s a connection to the way your body processes fat. Bile helps your body break down and digest the fat you eat. If your gallbladder doesn’t help break down the fat well, you might be more likely to get polyps.

Risk factors for gallbladder polyps

There’s some evidence that family history plays a role in whether you’re at risk of getting gallbladder polyps. If someone else in your family has had gallbladder polyps, you may be more likely to get them. This condition isn’t more common in certain genders, ages, obesity rates or medical conditions like diabetes.

Symptoms of gallbladder polyps

If you have gallbladder polyps, you might not have any symptoms. However, some people do experience some symptoms. Scientists have found there’s no difference between the symptoms of people with cancerous polyps compared to those whose polyps were noncancerous, or benign.

Symptoms of gallbladder polyps include:

• Nausea
• Vomiting
• Occasional pain in the upper right part of your abdomen

Diagnosis of gallbladder polyps

Without clear symptoms, it can be difficult for doctors to diagnose gallbladder polyps. Often, doctors discover this condition when they’re checking another condition. If your doctor finds something that looks like polyps, they may remind you that the chance of gallbladder cancer is very rare. The next step in the diagnosis is a process called an ultrasound. This test shows your doctor the inside of your body so they can look at your gallbladder. They can usually tell by looking at your gallbladder if the growths are polyps. Gallbladder polyps that are larger than a half-inch around are more likely to turn into cancer over time. Most polyps are made of cholesterol.

Treatments for gallbladder polyps

If your gallbladder polyp is smaller than a half-inch wide, your doctor may just want to wait and see if it changes. They might schedule regular ultrasounds to see if the polyps grow. This is a common situation if you don’t have any symptoms.

Other treatments for gallbladder polyps include having surgery to remove your gallbladder. This is also a potential if your gallbladder polyp is larger than a half-inch wide. Regardless of whether you have surgery or not, it helps to improve your diet. This can help you avoid fatty or high-cholesterol foods. You can also start eating more fruits and vegetables.

Recovery from gallbladder polyps

Gallbladder polyps are fairly common. They’re rarely cancerous and often cause no symptoms. Unless there’s a very high chance of cancer or you have gallstones, which are painful, your doctor might not recommend you do anything.

You should continue to have regular visits with your doctor. That way, they can monitor any changes — and your overall health. Eating a balanced diet, exercising regularly and having good sleep patterns are part of the process for staying healthy.

If you have any symptoms related to gallbladder polyps, it’s important that you contact your doctor right away. When your doctor finds one polyp, there’s a higher chance they might discover more they’ll want to monitor.

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Gallbladder Polyp – StatPearls – NCBI Bookshelf

Mark W. Jones; Jeffrey G. Deppen.

Author Information and Affiliations

Last Update: April 24, 2023.

Continuing Education Activity

Gallbladder polyps describe several conditions that present as projections into the gallbladder lumen. They may be asymptomatic, or they may be related to symptoms of cholecystitis (right upper abdominal discomfort, nausea and food intolerances). Often gallbladder polyps are found inadvertently on ultrasound or CT scanning or can be incidentally found on pathologic examination of the gallbladder. These polyps can be true neoplastic growths or pseudopolyps of cholesterol balls clinging to the wall of the gallbladder. This activity reviews the evaluation of gallbladder polyps and the role of the interprofessional team in managing this condition.

Objectives:

• Describe the expected signs and symptoms of gallbladder polyps.

• Discuss the frequency of gallbladder polyps.

• Outline the management of gallbladder polyps.

• This activity reviews the evaluation and treatment of gallbladder polyps and the role of the interprofessional team in evaluating and managing patients with this condition.

Access free multiple choice questions on this topic.

Introduction

Gallbladder polyps describe several conditions that present as projections into the gallbladder lumen. They may be asymptomatic, or they may be related to symptoms of cholecystitis (right upper abdominal discomfort, nausea and food intolerances). Often gallbladder polyps are found inadvertently on ultrasound or CT scanning or can be incidentally found on pathologic examination of the gallbladder. These polyps can be true neoplastic growths or pseudopolyps of cholesterol balls clinging to the wall of the gallbladder.

Etiology

There a few risk factors associated with true gallbladder polyp formation. Some studies suggest conditions such as familial polyposis, Peutz-Jeghers, Gardner syndrome, and hepatitis B may be factors associated with polyp formation. Pseudo or cholesterol polyps can develop when the cholesterol or bile salt content in the bile is high. This leads to condensation of cholesterol clumps which can adhere to the wall of the gallbladder. This condition may be a precursor to gallstone formation and can also at times be seen in conjunction with gallstones. Other factors typically associated with gallbladder diseases such as obesity, sex, weight loss, and diabetes have not been shown to increase the formation of gallbladder polyps. [1][2]

Epidemiology

Factors associated with an increased prevalence of gallbladder polyps is unclear. Studies have shown that 4% to 7% of the population may develop gallbladder polyps. The average age of diagnosis of gallbladder polyps is around 49 years old. However, other studies have found the presence of polyps to be more prevalent in older patients. [1][3]

Pathophysiology

The most common type of gallbladder polyps are pseudo or cholesterol polyps. These account for 60% to 90% of all gallbladder polyps. They are not true neoplastic growths, but rather they are cholesterol deposits that form as projections on the inner lumen of the gallbladder wall. They are formed from precipitation of cholesterol or bile salts. Presence of cholesterol polyps may be indicative of pathologic gallbladder disease such as chronic cholecystitis. Inflammatory polyps account for 5% to 10% of all gallbladder polyps. They are associated with inflammation of the gallbladder mucosa and wall. Usually, this type is associated with repeated bouts of cholecystitis and acute biliary colic. Both pseudopolyps and inflammatory polyps carry close to a zero risk of developing a gallbladder cancer. These polyps rarely exceed 1 cm in diameter and are often multiple. True adenomatous gallbladder polyps are considered neoplastic. They are rare and are often associated with gallstones. They can range in size from 5 mm to 20 mm. Once the polyp reaches a size of greater than 1 cm, consideration needs to be made for cholecystectomy, because of the potential malignant increases above 1 cm. Adenomyomatosis is a more common true poly. It has classically been considered a benign lesion of the fundus of the gallbladder. However, recent findings suggest these lesions do have premalignant potential. Malignant polyps tend to be singular and more than 2 cm in diameter. [4][5]

Histopathology

Two percent to 12% of routine gallbladder pathology specimens may contain gallbladder polyps, but true adenomatous polyps are present in less than 0.5% of all gallbladder specimens. Cholesterol polyps show an increased cholesterol content and are associated with gallbladder cholesterolosis and sludge. Inflammatory polyps exhibit inflammation of the gallbladder wall with Rotatinski- Aschoff bodies, and findings of acute or chronic cholecystitis. True adenomatous polyps have a glandular histology. Malignant polyps can demonstrate cancerous changes characteristic of adenocarcinoma, squamous cell carcinoma, and adenoacanthoma. The degree of malignant differentiation usually correlates to polyp size.  [6][7][8]

History and Physical

Most gallbladder polyps are asymptomatic. Patients with cholesterol stones related to hypokinetic gallbladder function, cholesterolosis, or stasis may exhibit symptoms of chronic cholecystitis. Right upper abdominal pain, food intolerance, bloating, and nausea may be present. Elicitation of a positive Murphy’s sign, pain with deep palpation to the right upper abdomen, is often present. Patients with larger adenomatous lesions may have more severe and persistent right upper abdominal pain. Cases of progressive polyps that have deteriorated into a malignancy may present with jaundice, due to growth and impingement of the common or hepatic bile duct. There may also be a palpable mass in the right upper abdomen. [9]

Evaluation

Gallbladder polyps are often found coincidentally with imaging such as an abdominal CT or an abdominal ultrasound. In cases of patients being worked up for gallbladder disease, the polyps are usually seen on abdominal ultrasound. They may present as a single lesion, or they may be multiple in nature. Polyps can occur in conjunction with gallstones but are often seen in the absence of stones. Differentiation must be made between gallstones and gallbladder polyps. Gallstones are usually mobile, and polyps are fixed to the wall of the gallbladder lumen. Most polyps are hypodense and smaller than 1 cm in diameter. They can appear polypoid or sessile. Singular polyps that have a tissue density and are larger than 1 cm in diameter carry a higher malignant potential. [10][11]

Treatment / Management

Gallbladder polyps that have the appearance of pseudo or cholesterol polyps, in asymptomatic patients, can be followed with yearly gallbladder ultrasounds. These patients have a very low malignant risk. If serial ultrasounds reveal that the polyp is enlarging or if the patient becomes symptomatic, then cholecystectomy should be recommended. Patients with symptoms of chronic cholecystitis are usually best treated with laparoscopic or open cholecystectomy. Polyps that are 1 cm or greater in size should undergo cholecystectomy due to the increased risk of developing gallbladder cancer. Early intervention is preferred because an early gallbladder neoplasm has a much higher rate of cure than a more advanced lesion. In fact, stage 0 gallbladder cancer has about an 80% 5-year survival rate, and stage 1 has less than a 50% survival rate. Less than 10% of all gallbladder cancers are diagnosed at stage 1 or lower. More advanced gallbladder cancers require an open cholecystectomy with resection of the gallbladder fossa of the liver along with regional lymph node removal. [12][13]

Differential Diagnosis

• Adenomyomatosis

• Biliary sludge

• Gallstones

• Tumefactive sludge

Pearls and Other Issues

The vast majority of gallbladder polyps are asymptomatic and carry a low risk of malignant degeneration. However, a small number of true gallbladder polyps will progress to malignancy. Patients with symptomatic gallbladder polyps or with enlarging polyps should be treated with cholecystectomy. The risks of performing a laparoscopic cholecystectomy are far less than missing a potential adenomatous polyp. It is recommended that if there is any indication of a gallbladder polyp being anything other than a pseudopolyp or cholesterol polyp, that cholecystectomy should be performed. [14][15]

Enhancing Healthcare Team Outcomes

Most true gallbladder polyps are not malignant. Often times they are not even true polyps and don’t need surgical intervention. A thorough understanding of the genesis and course of gallbladder polyps needs to held by the primary care physician and surgeon. Even though they may not exhibit any sign of malignancy or premalignancy, they must be followed. Yearly ultrasounds are noninvasive and will alert the following physician to enlargement, which would suggest the need for cholecystectomy. Delay in identifying such activity could jeopardize the patient and possibly lead to a missed newly developed cancer. If caught early, these neoplasms are curable. If caught late, then the prognosis is much more dismal.

Review Questions

• Access free multiple choice questions on this topic.

• Comment on this article.

References

1.

Lee H, Kim K, Park I, Cho H, Gwak G, Yang K, Bae BN, Kim HJ, Kim YD. Preoperative predictive factors for gallbladder cholesterol polyp diagnosed after laparoscopic cholecystectomy for polypoid lesions of gallbladder. Ann Hepatobiliary Pancreat Surg. 2016 Nov;20(4):180-186. [PMC free article: PMC5325147] [PubMed: 28261697]

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Liu HW, Chen CY. Ovo-lactovegetarian diet as a possible protective factor against gallbladder polyps in Taiwan: A cross-sectional study. Ci Ji Yi Xue Za Zhi. 2019 Jan-Mar;31(1):29-34. [PMC free article: PMC6334569] [PubMed: 30692829]

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Torabi Sagvand B, Edwards K, Shen B. Frequency, Risk Factors, and Outcome of Gallbladder Polyps in Patients With Primary Sclerosing Cholangitis: A Case-Control Study. Hepatol Commun. 2018 Dec;2(12):1440-1445. [PMC free article: PMC6287476] [PubMed: 30556033]

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Sarici IS, Duzgun O. Gallbladder polypoid lesions >15mm as indicators of T1b gallbladder cancer risk. Arab J Gastroenterol. 2017 Sep;18(3):156-158. [PubMed: 28958638]

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Wu T, Sun Z, Jiang Y, Yu J, Chang C, Dong X, Yan S. Strategy for discriminating cholesterol and premalignancy in polypoid lesions of the gallbladder: a single-centre, retrospective cohort study. ANZ J Surg. 2019 Apr;89(4):388-392. [PubMed: 30497105]

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Esendağlı G, Akarca FG, Balcı S, Argon A, Erhan SŞ, Turhan N, Zengin Nİ, Keser SH, Çelik B, Bulut T, Abdullazade S, Erden E, Savaş B, Bostan T, Sağol Ö, Ağalar AA, Kepil N, Karslıoğlu Y, Günal A, Markoç F, Saka B, Özgün G, Özdamar ŞO, Bahadır B, Kaymaz E, Işık E, Ayhan S, Tunçel D, Yılmaz BÖ, Çelik S, Karabacak T, Seven İE, Çelikel ÇA, Gücin Z, Ekinci Ö, Akyol G. A Retrospective Evaluation of the Epithelial Changes/Lesions and Neoplasms of the Gallbladder in Turkey and a Review of the Existing Sampling Methods: A Multicentre Study. Turk Patoloji Derg. 2018;34(1):41-48. [PubMed: 28984336]

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An HJ, Lee W, Jeong CY. Primary Follicular Lymphoma of Gallbladder Presenting as Multiple Polyps. Clin Gastroenterol Hepatol. 2020 Jan;18(1):e5-e6. [PubMed: 30218702]

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Limaiem F, Sassi A, Talbi G, Bouraoui S, Mzabi S. Routine histopathological study of cholecystectomy specimens. Useful? A retrospective study of 1960 cases. Acta Gastroenterol Belg. 2017 Jul-Sep;80(3):365-370. [PubMed: 29560664]

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Chang KL, Estores DS. Upper Gastrointestinal Conditions: Gallbladder Conditions. FP Essent. 2017 Jul;458:33-38. [PubMed: 28682049]

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Sandrasegaran K, Menias CO. Imaging and Screening of Cancer of the Gallbladder and Bile Ducts. Radiol Clin North Am. 2017 Nov;55(6):1211-1222. [PubMed: 28991561]

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Kopf H, Schima W, Meng S. [Differential diagnosis of gallbladder abnormalities : Ultrasound, computed tomography, and magnetic resonance imaging]. Radiologe. 2019 Apr;59(4):328-337. [PubMed: 30789997]

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Xu A, Zhang Y, Hu H, Zhao G, Cai J, Huang A. Gallbladder Polypoid-Lesions: What Are They and How Should They be Treated? A Single-Center Experience Based on 1446 Cholecystectomy Patients. J Gastrointest Surg. 2017 Nov;21(11):1804-1812. [PubMed: 28695432]

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Şahiner İT, Dolapçı M. When should gallbladder polyps be treated surgically? Adv Clin Exp Med. 2018 Dec;27(12):1697-1700. [PubMed: 30141282]

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Terzioğlu SG, Kılıç MÖ, Sapmaz A, Karaca AS. Predictive factors of neoplastic gallbladder polyps: Outcomes of 278 patients. Turk J Gastroenterol. 2017 May;28(3):202-206. [PubMed: 28316322]

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Li Y, Tejirian T, Collins JC. Gallbladder Polyps: Real or Imagined? Am Surg. 2018 Oct 01;84(10):1670-1674. [PubMed: 30747692]

Disclosure: Mark Jones declares no relevant financial relationships with ineligible companies.

Disclosure: Jeffrey Deppen declares no relevant financial relationships with ineligible companies.

Gallbladder and bile ducts

Tumors of the digestive system

CANCER OF THE GALLBLADER ( Carcinoma vesicae fellae ) and CANCER OF THE BILE TRACT ( Carcinoma ductus choledochus )

Bile is a secretion produced in the liver, which is very important for the digestion process. Bile moves from the liver to the intestine through the extrahepatic and intrahepatic bile ducts. The bile ducts are a system of interconnecting and therefore increasingly expanding ducts (tubular formations) that exit the liver through the common bile duct and enter the duodenum at the beginning of the small intestine. The common bile duct and gallbladder are connected by the cystic bile duct. The bile formed in the liver is collected in the ducts and from there it moves further to the gallbladder.

The gallbladder is a pear-shaped hollow organ that is located in the right upper abdomen and is attached to the lower surface of the liver. Bile is concentrated in the gallbladder. During meals, the muscular wall of the gallbladder pushes bile through the common bile duct into the duodenum, where the bile helps digest fats.

Cancer of the gallbladder and biliary tract is a disease in which cancer cells arise and begin to multiply in the walls of the gallbladder or biliary tract.

Causes and risk factors:

• age – gallbladder cancer is usually a disease of the elderly
• gender – occurs almost twice as often in women
• cholelithiasis – causes chronic inflammation that can develop into cancer
• benign tumors (adenomas, papillomas) and cysts – rare, but up to 5% of cases can become malignant tumors
• dysfunction of the biliary tract after surgery (created connections between the biliary tract and intestines)
• ulcerative colitis, or inflammation of the intestines.

Symptoms:

• at an early stage of development often does not cause significant complaints, so it is difficult to diagnose
• yellowing of the skin and eyes due to obstruction of the bile ducts
• nausea, anorexia and weight loss
• prolonged slight high fever, lethargy and fatigue
• pale skin due to bleeding and anemia
• pain in the upper abdomen
• grayish feces, dark coffee-colored urine
• tumor can be felt by hand in the upper right abdomen

Diagnostic tests performed:

• physical examination, i.e. palpation;
• blood test – the functional parameters of the liver are determined, inflammation is excluded;
• ultrasound examination of the abdominal cavity, or sonography – shows the presence of gallstones, the condition of the gallbladder wall and the presence of a violation of the outflow of bile from the liver
• x-ray of the lungs and ultrasound of the abdomen, pelvis and retroperitoneal space (retroperitoneal) – shows the spread of the tumor to neighboring organs
• computed tomography – clarifies the location of the tumor and the capture of neighboring organs
• biopsy – a cell sample is taken from a suspected tumor site with a fine needle, which is examined histologically to determine the diagnosis of cancer
• Gastroduodenoscopy – examination of the inner surface of the stomach and duodenum
• x-ray of the bile duct and pancreatic duct – endoscopic cholangiopancreatography (contrast x-ray), during which bile can be taken from the common bile duct and examined histologically for the presence of cancer cells.

Treatment options:

Opportunities for surgical treatment and prognosis depend on the spread of the disease, i.e. stage, and the condition of the patient:

• health treatment – complete removal of gallbladder cancer is possible only when the tumor has not spread beyond the gallbladder. The entire gallbladder, part of the adjacent liver and gallbladder-related lymph nodes are removed:

in cancer with removal of the intrahepatic biliary tract, liver resection is performed, i.e. partial removal of the liver bile duct, gallbladder and part of the hilum liver tissue, a connection is made between the small intestine and the intrahepatic biliary tract
in cancer with the removal of the extrahepatic biliary tract at the site of confluence with the duodenum, the so-called. Whipple operation – the final part of the common bile duct, the head of the pancreas and the duodenum are removed along with the adipose tissue containing the surrounding lymph nodes
palliative, i. e., facilitating treatment when cancer spreads to surrounding organs (liver, colon, duodenum, stomach, pancreas) or metastases to the lymph nodes and other organs, if it is impossible to completely remove the tumor during surgery. If the cancer has developed outside the gallbladder or bile ducts, then surgery can relieve symptoms.

If, due to cancer, the outflow of bile to the intestines is blocked, and the patient becomes yellow, you can:

• stent – to repair a bile spill, a special drain, or stent, is inserted endoscopically into the clogged area
• with the help of the operation to create a bypassing complication connection, i.e. anastomosis between the biliary tract and the intestine;
• install a thin bile tube into the biliary tract, i.e. create an external biliary fistula
• radiation therapy and chemotherapy are used alone or in combination – they destroy cancer cells in the tumor focus and metastases, thus reducing the size of the tumor, inhibit tumor development and alleviate patient complaints.

If the tumor is located near the hilum of the liver and large vital blood vessels, despite its small size, it is difficult to remove it – therefore, the possibilities of radical surgery are limited. Chemotherapy and radiation therapy are also used as treatments.

Recovery

Patients with biliary tract cancer are checked every 3-6 months in the first years, once a year starting in the third year, or as directed by the attending physician.

The prognosis of patients with cancer of the gallbladder and biliary tract is considered poor, because due to few symptoms, the tumor is detected at a late stage. The disease often occurs in elderly patients, so the choice of treatment methods due to concomitant diseases is limited.

• Treatment of tumors of the digestive tract

Gallbladder – 24Radiology.ru

Signs of cholecystitis.

Thickening of the gallbladder wall is a diagnostic feature that occurs most frequently in the diagnosis of gallbladder disease. Historically, when the wall of the gallbladder thickens, doctors first of all think of the primary disease of the gallbladder, namely acute cholecystitis. In this article, I would like to analyze what pathological conditions lead to thickening of the gallbladder wall, since in addition to inflammatory diseases of the gallbladder, there are other pathologies that lead to the same pathomorphological sign as thickening of the gallbladder wall.

Schematic pathology. This figure shows a distended and hyperemic gallbladder. These changes occur in calculous cholecystitis due to obstruction by a stone of the bile duct or gallbladder neck.

Ultrasound signs of calculous cholecystitis.

Ultrasound, MRI and CT can always distinguish between normal and thickened gallbladder walls. Traditionally, ultrasonography has been used as the first imaging modality for gallbladder disease because it has high sensitivity and specificity in detecting gallbladder stones. Also, the advantages of ultrasound include:

1. real-time evaluation capability.
2. cheap method.
3. is fast in execution.
4. no radiation exposure.

However, computed tomography has become a popular method in diagnosing patients with acute abdominal symptoms. In acute abdomen, CT is the first method of examination of the gallbladder in many surgical clinics. CT is also used as an additional research method if the ultrasound did not reveal a pathology or any doubts arose.

MRI also has a high diagnostic value in visualizing the pathology of the gallbladder, but due to the high cost of the method and the long time to perform diagnostics, it is rarely used.

Normally, the walls of the gallbladder on ultrasound are visualized as follows:

1. the mucous layer is hyperechoic.
2. muscle layer – hypoechoic.
3. the outer or serous layer is hyperechoic.

The thickness of the gallbladder wall depends on how distended the gallbladder is. Also, the thickness of the gallbladder increases with the following pathologies:

1. cholecystitis.
2. cirrhosis of the liver.
3. ascites.
4. acute viral hepatitis.
5. hypoproteinemia.
6. malignant neoplasm.
7. right ventricular failure.

Above: Ultrasound of the gallbladder, normal pencil wall. Right ultrasound picture of pseudo-thickening of the gallbladder wall.

On CT, the gallbladder is normally visualized as a formation with a density inherent in soft tissues. Indicated by an arrow.

Ultrasound signs of calculous cholecystitis.

Thickening of the gallbladder wall is a common diagnostic finding. A thickening is a wall size of more than 3 mm. On ultrasound, the thickened wall has a layered appearance, and on CT, a hypodense layer is detected, which corresponds to subserous edema.

On the left — ultrasound of the gallbladder in a 59-year-old woman with acute cholecystitis. Subserous edema as hypoechoic thickening between hyperechoic layers (muscular and mucosal). On the right, contrast-enhanced CT scan of the abdomen. Subserous edema is also visualized as the outer layer is hypodense.

Acute cholecystitis is the fourth most common abdominal disease requiring immediate hospitalization. If a thickening of the gallbladder wall is visualized on ultrasound in patients admitted with an acute abdomen, then the first thing radiologists think about is acute cholecystitis. To make a diagnosis of cholecystitis, the following features must also be present, both on ultrasound and on CT:

1. Dilatation of the gallbladder.
2. Stones.
3. Positive Murphy’s sign on pressure with an ultrasonic transducer in the gallbladder area.
4. Hyperemia of the gallbladder wall in Doppler mode.
5. Inflammatory process in the fatty tissue surrounding the gallbladder.

Acute calculous cholecystitis. After contrast enhancement, a distended gallbladder (white tips) with a slightly thickened wall is visualized. A stone is visualized in the neck of the gallbladder (white arrow).

Top image of a 62 year old patient with calculous cholecystitis. Ultrasound visualizes the walls of the gallbladder stretched, with subserous edema (indicated by white arrows) and a stone and suspension in the lumen of the gallbladder. On CT, the transition of the inflammatory process from the gallbladder to neighboring tissues (pericholecystitis) is visualized.

Ultrasound non-calculous cholecystitis.

Acute acalculous cholecystitis occurs in patients during fasting and in patients who are taking drugs that cause cholestasis. The signs of non-calculous cholecystitis include all the signs of acute calculous cholecystitis except for the presence of stones in the lumen of the gallbladder, but the suspension is usually present.

74 — a year old man underwent ultrasound of the gallbladder. Diagnosis: acute non-calculous cholecystitis. On the left sonogram, the arrow indicates the thickening of the walls of the gallbladder. Suspension in the lumen of the gallbladder. On the right sonogram of the same patient, Doppler examination revealed another sign of inflammation — hyperemia.

Ultrasound of chronic cholecystitis

The term chronic cholecystitis is used to refer to an indolent inflammatory process with fibrosis of the gallbladder wall and the formation of stones in the lumen.

Presented is a patient with chronic pain in the right hypochondrium, who abstained from food every day since the evening. The thickening is mild and not physiological. Obstruction and stone are also visualized. After ultrasound, this patient was diagnosed with chronic cholecystitis.

Xanthogranulomatous cholecystitis.

Xanthogranulomatous cholecystitis is an inflammatory disease characterized by the formation of xanthomas and granulomas in the wall of the gallbladder. The study reveals a thickening of the gallbladder wall, a decrease in the size of the organ, as well as intramural nodules, which are visualized as hypoechoic inclusions on ultrasound and hypodense on a CT scan. These inclusions are similar to inclusions in gallbladder carcinoma.

Ultrasound and CT of the gallbladder. Xanthogranulomatous cholecystitis. On the left, ultrasound visualizes (marked with arrows) a thickening of the gallbladder wall with an intramural inclusion and a stone in the lumen of the organ. On the right side of the CT scan, wall thickening with hypodense inclusions is revealed.

Above is a CT scan of a 71-year-old patient with xanthogranulomatous cholecystitis. Postcontrast CT. A thickening of the gallbladder wall is visualized with inclusions that correspond to an abscess or foci of inflammation.

CT scan of the gallbladder/cancer of the gallbladder

The most common cancer of the gallbladder is carcinoma. Gallbladder carcinoma is the fifth most common cancer of the gastrointestinal tract. More often it is discovered incidentally (in 2% of cases) during histological examination after cholecystectomy. Gallbladder carcinoma is detected in the last stages of the disease, as it does not manifest itself clinically in the early stages.