With the increasing number of people's health examinations, many people are worried about the words nodules and polyps that are often seen in the physical examination reports. This is not Xiao Li looked at the "gallbladder polyp" on the physical examination report, and his heart was full of doubts, "I don't feel any discomfort! How can I have polyps? Is this the same thing as the gallstones that everyone is talking about? Is this a serious disease? Is it a tumor? Will it become malignant?" In response to everyone's doubts, let's talk about what gallbladder polyps are about?
1. What is a gallbladder polyp? Are gallbladder polyps and gallstones the same thing?
The gallbladder is the organ in the human body that stores bile, bile can help digestion, when we eat after eating, especially after eating some greasy food, bile will enter the common bile duct from the gallbladder and then enter the intestine, promoting the digestion and absorption of fat.
Gallbladder polyps, also known as "gallbladder polypoid lesions," are lesions that originate in the wall of the gallbladder and protrude or bulge into the gallbladder cavity. The most common type of gallbladder polyp is cholesterol polyps (Figure 1), which are cholesterol polyps that increase cholesterol secretion in the bile due to cholesterol metabolism disorders in the body, accumulate under the gallbladder mucosa, and are filled with a large number of lipid-containing foam cells (macrophages), small nodules composed of multiple swollen mucosal folds, protruding into the gallbladder cavity, and can be multiple bayberry-shaped or small mulberry-shaped. When the pedicle of this polyp is thin, it tends to fall off the wall of the cyst and form stones.
Gallstones are caused by abnormalities in the secretion and metabolism of bile in the gallbladder, which precipitate crystals and form so-called stones over time. The pathological nature of the two is different, but their pathogenesis is related to each other, so gallbladder polyps and gallstones are often accompanied by each other. The cause of gallbladder polyps is not fully understood, but may be related to irregular diet and rest, smoking, hepatitis B virus infection, gallstones and cholecystitis, and cholesterol metabolism disorders.
Fig.1 Cholesterol polyps of the gallbladder
2. Is gallbladder polyp serious, is it a tumor, and will it become malignant?
Most patients with gallbladder polyps are generally asymptomatic, more males than females, the incidence rate in the population is 3%~6%, and more than 85% of patients are found in routine physical examinations. A small number of patients may have epigastric discomfort with abdominal pain radiating to the right shoulder and right back due to stones or chronic cholecystitis, and a very small number of patients may have dyspeptic symptoms such as diarrhea, nausea, vomiting, and oil aversion.
Gallbladder polyps can be divided into non-neoplastic polyps (e.g., cholesterol polyps, inflammatory polyps, etc.) and neoplastic polyps (e.g., gallbladder adenoma). Among them, 95% of gallbladder polyps are benign nonneoplastic (pseudo) polyps with no tendency to malignant, and only a small percentage of 5% of neoplastic polyps have a tendency to become cancerous.
3. How are gallbladder polyps generally found?
The vast majority of gallbladder polyps are found during physical examination and ultrasonography, and CT and MRI are difficult to detect or often miss polyps below 3-4 mm.
Ultrasound, as a non-invasive imaging modality, is the preferred method for diagnosing and monitoring gallbladder polyps. It accurately shows the size, location, number of gallbladder polyps, the walls of the cyst, and the distribution of blood flow inside. After ultrasound detects gallbladder polyps, the first step is to distinguish between true and pseudo polyps.
Cholesterol polyps are the most common pseudopolyps, which are often multiple, strongly echogenic, and often accompanied by "comet tail sign". The most common true polyp is gallbladder adenoma, which is more likely to occur at the bottom of the gallbladder and neck, nodular shape, hyperechoic or isoechoic, no sound shadow in the back, can be single or multiple, the size is generally about 10mm, generally not more than 15mm, pedunculated, the volume is generally larger than cholesterol polyps, the use of highly sensitive color Doppler blood flow imaging can show the blood flow in the adenoma, if necessary, ultrasound can be carried out, the blood flow in the polyp and the surrounding cyst wall can be observed more clearly and dynamically in real time, and help to identify the nature of gallbladder polyps。
4. What should I do if I find gallbladder polyps?
After the discovery of gallbladder polyps, if the diameter is less than 10 mm, ultrasound follow-up can be performed at regular intervals (six months or one year). Adenomatous larger than 10 mm or with stones should be highly suspicious for malignant transformation. If a polyp is found to have a rough surface, a wide base >15 mm or more in a single lesion of small nodular type, and a blood flow signal is detected inside, gallbladder cancer should be alerted (Fig. 2). In the past, polyps larger than 10mm were mostly used as indications for surgery. If multiple gallbladder polyps or large polyps are diagnosed, surgery is the mainstay of treatment, especially in patients with suspected gallbladder cancer. Gallbladder removal can be performed laparoscopic surgery, which is less invasive and has a faster recovery.
Fig.2 Gallbladder cancer
The gallbladder is small, but it has an important role. When you find gallbladder polyps, you don't need to be too nervous, most of them are benign, when the polyps are larger than 10mm, or when the shape is irregular, the surface is not smooth, and the base is wide, you need to pay attention to it and seek medical attention in time. Choose the appropriate treatment according to your condition.
Expert Profile
Wang
Department of Ultrasound Medicine, Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine
Chief physician, professor and doctoral supervisor
Vice President of Chinese Society of Ultrasound Medical Engineering
President of Shanghai Society of Ultrasound Medical Engineering
Associate Editor-in-Chief of Chinese Journal of Ultrasound in Medicine
Vice Chairman of the Cranial and Cervical Vascular Committee of the Chinese Society of Ultrasound Medical Engineering
Member of the Standing Committee of the Superficial and Peripheral Vascular Committee of the Chinese Society of Ultrasound Medical Engineering
Vice Chairman of the Imaging Committee of the Chinese Women Physicians Association
Vice Chairman of the Ultrasound Female Professional Committee of Shanghai Women Physicians Association
He is good at ultrasound diagnosis of abdomen, superficial organs and peripheral vascular diseases
Specialist Clinic Hours:
Specialist clinic on Wednesday and Friday mornings
Monday and Thursday afternoons for special outpatient services
Wu Qiong
Department of Ultrasound Medicine, Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine
Attending physician, MD
He is a young member of the Cranial and Cervical Vascular Ultrasound Professional Committee of the Chinese Society of Ultrasound Medical Engineering
He is a member and secretary of the Musculoskeletal Ultrasound Professional Committee of the Shanghai Society of Ultrasound Medical Engineering
He is good at ultrasound diagnosis of abdominal, musculoskeletal, superficial organ and peripheral vascular diseases and the application of new technologies
He has published more than 10 SCI papers as the first author
As a backbone, he has participated in a number of research projects of the National Natural Science Foundation of China
Authors: Wu Qiong and Wang Yan, Department of Ultrasound Medicine, Shanghai Sixth People's Hospital
Editor: Zhou Yun
Reviewer: Chen Shirui
Issued: Daley Red