WHAT S WRONG WITH MY GALL BLADDER? GALL BLADDER POLYPS

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1 WHAT S WRONG WITH MY GALL BLADDER? GALL BLADDER POLYPS

2 This is a patient information booklet providing specific practical information about gall bladder polyps in brief. Its aim is to provide the patient & his or her family with useful information on this particular gall bladder problem, the procedures and tests you may need to undergo, treatment approaches, risks involved, duration, expenses and helpful advice on coping successfully with the problem. If you require more information, Dr. D.R.Kulkarni or your doctor will be able to provide more information. WHAT IS GALL BLADDER?

3 Gall is an old-fashioned word for what we now call bile. The gallbladder is a small sac that lies beneath the liver in the right upper abdomen under the rib cage. It is joined to the bile duct, a tube that comes from the liver and carries bile to the intestine. Bile is a yellow-green viscous fluid helpful in digesting food is produced in liver. WHAT IS THE FUNCTION OF GALL BLADDER? The gallbladder stores bile that is produced by the liver and removes water and salt from it. It contracts when we eat, especially fatty food and pushes bile down the bile duct into the intestine. IS GALL BLADDER NECESSARY FOR

4 DIGESTION / GOOD HEALTH? The gallbladder is not necessary to maintain good health. After the gallbladder is removed, bile duct increases in diameter slightly and bile flows directly from the liver to the intestines, and digestion proceeds normally. WHAT IS A POLYP? A polyp is a protrusion from the lining of the organ concerned, caused by an abnormal multiplication of cells. It may look like a grape with a narrow stalk, or have many fine projections, resembling the pile of a carpet. Polyps are commonly found in the colon, stomach, nose, sinus(es), urinary bladder and uterus. They may also occur elsewhere in the body where mucous membranes exist like the cervix and small intestine & GALL BLADDER. ARE GB POLYPS COMMON? Gall bladder polyps though relatively uncommon compared to most other organs, are not actually uncommon. In fact, it is estimated that as many as 4 percent of gallbladders examined by ultrasound will have evidence of polyp formation. They are usually detected during abdominal ultrasonography performed for other reasons & are more common among men than women.

5 WHAT IS THE NATURE OF GB POLYP? Polyps can be of different types depending on the way they are formed e.g. cholesterol, adenomyomatosis, inflammatory, adenomatous and cancerous. Most small polyps (less than 1 cm) are not cancerous and may remain unchanged for years. Larger polyps are more likely to develop in cancer. Cholesterol polyps or Cholesterolosis is characterized by an outgrowth of the mucosal lining of the gallbladder into fingerlike projections due to the excessive accumulation of fats (cholesterol and triglycerides) within cells (macrophages) in the innermost lining. These cholesterol polyps account for most gallbladder polyps, are usually multiple, have a stalk and range in size from 2-10 mm. These polyps occur as part of focal or generalized cholesterolosis of the gallbladder and are not neoplasms nor do they can turn cancerous. Occasionally, cholesterol polyps can slough off and cause biliary colic from cystic duct obstruction or acute pancreatitis by blocking the common bile duct. Adenomyomatosis describes a diseased state of the gallbladder in which the gallbladder wall is excessively thick, due to proliferation of subsurface (inner to the innermost) cellular layer.

6 It represents the second most common type of gallbladder polyp, are usually single, involve only small portion of the gal bladder wall & somewhat larger ranging in size from mm on average. Only very rarely are they associated with cancer. Inflammatory polyps are the third most common type, occur as a result of chronic or recurrent inflammation, are generally solitary and range in size from 5-10 mm. Collectively these 3 types of benign focal gallbladder lesions account for 95% of all gallbladder polyps. Adenomas of the gallbladder are rare. They range in size from 5-20 mm and are usually have a stalk. These lesions are potentially cancerous that is, they can grow into a malignancy. Adenoma larger than 1 cm is at more risk to develop cancer. Gallbladder adenomas are much less common than gallbladder cancer and most gallbladder cancers probably do not arise from previously benign gallbladder adenomas. Miscellaneous neoplasms of the gallbladder represent the fifth class of gallbladder polyps. These polyps are all rare lesions. They are usually solitary, benign, and range in size from 5-20 mm.

7 WHICH POLYPS CARRY A RISK OF CANCER? Of the benign polyps only certain adenomyomatous polyps have a risk of cancer. Cholesterol & inflammatory polyps have no risk. Adenomas certainly have a risk. Polyps more than 1 cm in size have higher chance that it may be cancerous or will become malignant in future DO THEY CAUSE SYMPTOMS? Most polyps do not cause noticeable symptoms unless they grow large in size or they dislodge and cause a biliary colic. Most polyps are detected incidentally. HOW ARE THEY DIAGNOSED? Gallbladder polyps are usually found incidentally when examining the abdomen by ultrasound for other conditions, usually abdominal pain or during routine health checkup. However once they are found it is important to establish to the best capacity the benign or malignant nature of the polyp. Obviously, short of removing the gallbladder surgically, there is no way to tell if a gallbladder polyp has adenomatous features or if it is the more common noncancerous type. Best effort is usually done by doing investigations like CT

8 scan, MRI or EUS to predict the histology. But there are limitations. EUS is probably the best investigation to predict the nature. But it still cannot replace a formal biopsy, which is not possible in most situations. It is also important to know that frequently there are false polyps (pseudopolyps) DO GB POLYPS NEED TREATMENT? There is a great deal of controversy in the management of an asymptomatic patient who is discovered to have a gallbladder polyp. If the size is more than 1 cm then there is more chance that it is malignant or can turn malignant. Therefore if the polyp is greater than one centimeter in size, then the gallbladder should be removed. WHAT IS THE TREATMENT? Most polyps are benign and do not need to be removed. Small benign appearing polyps are usually followed up by 3-6monthly USG. Polyps, which are growing in size or polyps larger than 1 cm especially with co-existing gallstones occurring in people over the age of 50 may have the gallbladder removed (cholecystectomy). Laparoscopic surgery is an option for small or solitary benign polyps. However when malignancy is suspected an open surgery with

9 intraoperative histopathological examination is preferred. Above information will help you to make an informed decision but it cannot replace the professional advice and expertise of a doctor who is familiar with your condition. You may have questions that are not covered; you should discuss these with your surgeon. You must remember every individual is different. DOCTORS DEALING WITH GALL BLADDER DISEASE THAT YOU MAY MEET Endoscopist: This may be a gastroenterologist or a surgeon who is able to undertake endoscopy (examination of the stomach or bowel using a flexible telescope). A few endoscopists can also perform ERCP and EUS, which are special forms of endoscopy that examine the biliary and pancreatic ducts and the pancreas Gastroenterologist: A physician who is highly specialised in gut problems. General physician: A consultant medical doctor who works in a hospital and who is broadly specialised including gut problems.

10 General surgeon: A consultant surgeon who works in a hospital and who is broadly specialised including gut problems. HepatoPancreatoBiliary surgeon: A surgeon who is highly specialized in pancreato-biliary & liver operations. GLOSSARY MRI -- Magnetic Resonance Imaging Atype of scanning performed to diagnose problems not picked up by regular investigations CT SCAN Computerized Tomography Atype of scanning performed to diagnose problems not picked up by regular investigations ERCP Endoscopic Retrograde Cholangiography. An endoscopic procedure performed to visualize bile & pancreatic ducts & treat the disease endoscopically whenever possible EUS -- Endoscopic UltraSound. An endoscopic procedure performed to visualize pancreas & biliary tract from very close, diagnose problems, obtain biopsies and at times treat the disease too.

11 MRCP Magnetic Resonance Cholangio- Pancreatography A special type of MRI performed to visualize bile & pancreatic ducts.