Gall Bladder Problems
Questions Received:
Responses:
What is polyps in the gall bladder and is it bad? I am 69 years old male.
31st March 2000
A polyp is an outgrowth, generally attached by a stalk to the mucous membrane from which it has arisen. Polyps are formed in a variety of locations, for example within the lumen of the intestines or the nasal cavity, and are generally harmless and asymptomatic. Just occasionally a polyp can give rise to cancer, and this is why the presence of polyps is taken seriously by doctors. Gall bladder polyps are quite commonly observed during examinations of the abdomen, especially in ultrasound scans, and the majority are benign and symptom-free (Moriguchi et al, 1996).
For many years now there has been a discussion about what should be done when gall bladder polyps are detected. Some clinicians feel that the affected gall bladder should be removed, just in case, while others have been developing tests which can distinguish between the majority of harmless polyps and the occasional malignant polyp so that operations are carried out only on selected people.
New techniques such as colour Doppler ultrasonography (Hirooka et al, 1996) and endoscopic ultrasonography (Sugiyama, Atomi, and Yamato, 2000) are making the pre-operative distinction between benign and malignant polyps much more reliable.
The present consensus appears to be that an operation should be considered if symptoms have appeared, if the polyp is 1.0 cm or more in diameter, if it is associated with gallstones, and when the patient is over 50 years of age (Yang, Sun, and Wang, 1992; Toda et al, 1995; Mainprize, Gould, and Gilbert, 2000).
It will be helpful to discuss these matters with your doctor so that you can understand the thinking behind any treatment decisions that are made.
References
Hirooka, Y., Naitoh, Y., Goto, H., Furukawa, T., Ito, A., and Hayakawa, T. (1996) Differential diagnosis of gall-bladder masses using colour Doppler ultrasonography. Journal of Gastroenterology and Hepatology, 11(9), 840-846 (Sep).
Mainprize, K.S., Gould, S.W., and Gilbert, J.M. (2000) Surgical management of polypoid lesions of the gallbladder. British Journal of Surgery, 87(4), 414-417 (Apr).
Moriguchi, H., Tazawa, J., Hayashi, Y., Takenawa, H., Nakayama, E., Marumo, F., and Sato, C. (1996) Natural history of polypoid lesions in the gall bladder. Gut, 39(96), 860-862 (Dec).
Sugiyama, M., Atomi, Y., and Yamato, T. (2000) Endoscopic ultrasonography for differential diagnosis of polypoid gall bladder lesions: analysis in surgical and follow up series. Gut, 46(2), 250-254 (Feb).
Toda, K., Souda, S., Yoshikawa, Y., Momiyama, T., and Ohshima, M. (1995) Significance of laparoscopic excisional biopsy for polypoid lesions of the gallbladder. Surgical and Laparoscopic Endoscopy, 5(4), 267-271 (Aug).
Yang, H.L., Sun, Y.G., and Wang, Z. (1992) Polypoid lesions of the gallbladder: diagnosis and indications for surgery. British Journal of Surgery, 79(3), 227-229 (Mar).
I have been diagnosed with gall stones and need my gall bladder removing. Why can't they be zapped? Also my haemoglobin level is always between 10 and 10.5. As I am not vegetarian what might cause this?
29th June 2000
There is indeed a technique for pulverising gallstones. It is called extracorporeal shock wave lithotripsy (ESWL), and was introduced in the mid-1980s. However, this form of treatment is not effective for everyone with gallstones. There has to be careful selection of patients - usually only those with a single radiolucent stone with a diameter of 2 cm or less and a functioning gallbladder will be chosen. About 1 in 10 people with gallstones meet these criteria. Following shock wave treatment, bile acid dissolution therapy may be required for several months to disperse remnants of the fragmented stone. The technique is not successful in every case, and the risk of recurrence of gallstones is quite high. (For a recent review, see Mulagha and Fromm, 2000).
Gallstones are present in 15-20% of adults in most western societies. About half of those with gallstones do not have symptoms, while symptoms develop over 2 to 5 years in the others. Removal of the gallbladder (cholecystectomy) has been the main treatment for many years, but now there are several other options such as oral dissolution, direct dissolution, invasive endoscopy, and lithotripsy plus oral dissolution agents. Darzi et al (1994) feel that laparoscopic cholecystectomy is the treatment of choice for gallstone disease, because although shock wave therapy is noninvasive and associated with minimal disturbance of normal tissues, it is costly and in the long-term does not have such a high success rate.
With regard to your somewhat low haemoglobin level, there are several possible causes. There may be a deficiency in your diet of substances essential for blood formation, for example iron, folic acid, vitamin B12, protein, and pyridoxine, even though you eat meat, or there may be a slight imbalance between the production of new red blood cells and the removal of old ones. You may or may not have any symptoms that could be attributed to your haemoglobin level - if you haven’t done so already it will be worth discussing this with your doctor to see if anything needs to be done.
References
Darzi, A., Geraghty, J.G., Williams, N.N., Sheehan, S.S., Tanner, A.N., and Keane, F.B. (1994) The pros and cons of laparoscopic cholecystectomy and extracorporeal shock wave lithotripsy in the management of gallstone disease. Annals of the Royal College of Surgeons of England, 76(1), 42-46 (Jan).
Mulagha, E., and Fromm, H. (2000) Extracorporeal shock wave lithotripsy of gallstones revisited: current status and future promises. Journal of Gastroenterology and Hepatology, 15(3), 239-243 (Mar).