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Gastroenterology (Expert Forum)
Gallbladder Polyps - Surgery?
Answered by
Kevin Pho, MD - Internal Medicine
Kevin Pho, MD
Boston - MA
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/ Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
Gallbladder Polyps - Surgery?
by pete59, Nov 13, 2006 12:00AM
I’m a 47 year old male (5’10’/210lbs) with no previous health concerns. I’m on medication (Monopril) for mild high pressure (140/90) and my overall cholesterol is in the 160 range but my HDL is only 25. I’ve been a very light drinker my entire life.
A month ago I went to my doctor for a mild upper right abdominal discomfort that I had for about two weeks. This is not what I would describe as a pain but rather a dull ache/mild cramp like sensation. In fact, when I’m busy I don’t even notice the ache. There was no loss of appetite, change in sleep or bowel movements, no diarrhea, nausea, or fever.
The results of my blood work indicated a slightly elevated ALT of 56 (AST = 26) with all other results in the normal range. My doctor wasn’t concerned since a history of prior blood tests show similar ADL reading. He than suggested an abdominal ultrasound the results which indicate:
1)fatty infiltration of the liver
2)sludge and cholesterol polyps seen throughout the gallbladder
3)no wall thickening or pericholecystic fluid collection
4)the common bile duct measures 4mm at its greatest AP diameter which is within normal limits
5)pancreas shows no evidence of focal inflammatory disease
My doctor recommends laparoscopic removal of the gallbladder.
These dull aches/mild cramp like sensations now occur intermittently, they may disappear for several days and than they may reappear for several days again. Questions that I have:
1)Are there other potential underlying causes that should be considered?
2)Does fatty infiltration of the liver mean that I have fatty liver disease? I’m surprised that my doctor didn’t mention the fatty infiltration of the liver to me and that I found this out by reading the copy of the ultrasound report which I requested.
3)Could the dull ache/mild cramps I’m experiencing be related to the fatty liver and not the gallbladder?
4)Because of the polyps, should I have the surgery soon or take a longer wait and see approach?
5)Are there any dangers in waiting? Do polyps increase in size over time?
6)What percentage of patients with gallbladders removed experience diarrhea? For those patients that do experience post operative diarrhea, does it diminish with time?
7)Are there other treatments that may be considered (drugs, i.e. Actigall) as an alternative to surgery?
8)I’ve read that people who have had their gallbladders removed are at a higher risk for colon cancer? Is this true? How much of a higher risk?
9)Is my low HDL and gallbladder issue somehow related?
10)Could I have metabolic syndrome?
A month ago I went to my doctor for a mild upper right abdominal discomfort that I had for about two weeks. This is not what I would describe as a pain but rather a dull ache/mild cramp like sensation. In fact, when I’m busy I don’t even notice the ache. There was no loss of appetite, change in sleep or bowel movements, no diarrhea, nausea, or fever.
The results of my blood work indicated a slightly elevated ALT of 56 (AST = 26) with all other results in the normal range. My doctor wasn’t concerned since a history of prior blood tests show similar ADL reading. He than suggested an abdominal ultrasound the results which indicate:
1)fatty infiltration of the liver
2)sludge and cholesterol polyps seen throughout the gallbladder
3)no wall thickening or pericholecystic fluid collection
4)the common bile duct measures 4mm at its greatest AP diameter which is within normal limits
5)pancreas shows no evidence of focal inflammatory disease
My doctor recommends laparoscopic removal of the gallbladder.
These dull aches/mild cramp like sensations now occur intermittently, they may disappear for several days and than they may reappear for several days again. Questions that I have:
1)Are there other potential underlying causes that should be considered?
2)Does fatty infiltration of the liver mean that I have fatty liver disease? I’m surprised that my doctor didn’t mention the fatty infiltration of the liver to me and that I found this out by reading the copy of the ultrasound report which I requested.
3)Could the dull ache/mild cramps I’m experiencing be related to the fatty liver and not the gallbladder?
4)Because of the polyps, should I have the surgery soon or take a longer wait and see approach?
5)Are there any dangers in waiting? Do polyps increase in size over time?
6)What percentage of patients with gallbladders removed experience diarrhea? For those patients that do experience post operative diarrhea, does it diminish with time?
7)Are there other treatments that may be considered (drugs, i.e. Actigall) as an alternative to surgery?
8)I’ve read that people who have had their gallbladders removed are at a higher risk for colon cancer? Is this true? How much of a higher risk?
9)Is my low HDL and gallbladder issue somehow related?
10)Could I have metabolic syndrome?
Doctor's Answer
by Kevin Pho, MD, Nov 14, 2006 12:00AM
, Nov 14, 2006 12:00AM
To answer your questions:
1) Obtaining a HIDA scan with CCK stimulation can help evaluate the gallbladder ejection fraction. You can also consider evaluation of the upper GI tract to look for GERD, ulcers, or inflammation.
2) It can be the beginnings of fatty liver disease.
3) Possible, but unlikely that this can lead to the pain.
4) There is sludge, but no mention of gallbladder stones. I would obtain a second opinion regarding this.
5) Polyps may increase during time.
6) This can vary from patient to patient. Diarrhea is typically more common after a fatty meal. However, the vast majority of patients do not have this complication after gallbladder removal.
7) Actigall treats gallstones, and does not seem to be applicable here. I would discuss this question with a surgeon.
8) The evidence does not support this.
9) I am not aware of a connection between low HDL and the gallbladder.
10) Yes, metabolic system is possible with your weight and low HDL. I would also test your triglycerides.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
kevinmd_
1) Obtaining a HIDA scan with CCK stimulation can help evaluate the gallbladder ejection fraction. You can also consider evaluation of the upper GI tract to look for GERD, ulcers, or inflammation.
2) It can be the beginnings of fatty liver disease.
3) Possible, but unlikely that this can lead to the pain.
4) There is sludge, but no mention of gallbladder stones. I would obtain a second opinion regarding this.
5) Polyps may increase during time.
6) This can vary from patient to patient. Diarrhea is typically more common after a fatty meal. However, the vast majority of patients do not have this complication after gallbladder removal.
7) Actigall treats gallstones, and does not seem to be applicable here. I would discuss this question with a surgeon.
8) The evidence does not support this.
9) I am not aware of a connection between low HDL and the gallbladder.
10) Yes, metabolic system is possible with your weight and low HDL. I would also test your triglycerides.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
kevinmd_
As with any kind of operation, it is best done when things are quiet and there is no inflammation or infection present. Your doctor is just being cautious in suggesting you have the gallbladder out now because he knows it will almost certainly flare up at some time in the future. A vast majority of people have the procedure done and experience no problems at all afterwards so I would go ahead and have it done....