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Suggest treatment for gall bladder polyps and cysts

Answered by
Dr.
Dr. Ramesh Kumar

Gastroenterologist

Practicing since :1986

Answered : 2352 Questions

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Posted on Thu, 25 May 2017 in Abdominal Pain
Question: 4.7mm polyp gallbladder
3.5mm cyst RL
Slight pelviectasis RT kidney
4 years gallbladder attacks and pain
Urgency to urinate for several years
Long history of drinking untreated stream water, decades from many sources, some in sheep areas. Possible hydatid exposure. VA ignoring all findings and testing that bile flow was normal.
Thoughts please?
doctor
Answered by Dr. Ramesh Kumar 1 hour later
Brief Answer:
Gallbladder polyps are usually benign.

Detailed Answer:
Hello,
Thank you for choosing HealthcareMagic for your query.
Have gone through your brief history in detail and I appreciate your concern.

You have two problems simultaneously i.e Gallstones and Renal cyst.

Let's take them one after other.

Most likely the cyst in your kidney is non cancerous simple cyst because the size of cyst is constsnt from last 4 years(You have not mentioned any increase in its size so i will consider it's size to be constant over years). A simple kidney cyst is a round pouch of smooth, thin-walled tissue or a closed pocket that is usually filled with fluid.They are not the same thing as polycystic kidney disease, which is a progressive disease that can lead to kidney failure. Simple kidney cysts most often do not cause harm or cause symptoms. As it do not cause symptoms it usually do not require treatment. However, in some cases simple kidney cysts may cause symptoms like pain or increased frequency or urgency of urine . These cysts can also get infected, causing pain, fever burning etc. However its not necessary that all symptoms are present in every patient.

Kidney involvement in echinococcosis is extremely rare, constituting only 2-3% of all cases. Primary involvement of the kidney without the involvement of the liver and lungs is even rarer. So I don't think that the cyst is hydrated (It's very very rare).

As the cyst is there from 4 years a cystoscopic biopsy of the cyst should be done or at least an MRI scan should be done initially to rule out the exact nature of the cyst.

Now lets move to gall bladder- polyps are growths that protrude from the lining of the inside of the gallbladder. Polyps can be cancerous, but they rarely are. About 95 percent of gallbladder polyps are benign. The size of a gallbladder polyp can help predict whether it's cancerous or noncancerous. Small gallbladder polyps that are less than 10 millimeters in diameter are unlikely to be cancerous and generally don't require treatment.

However in case polyp is more then 10 mm it can be malignant and surgical removal of gallbladder is indicated.

In your case size is too small to be malignant hence removal of the gallbladder is not at all indicated.


Tests advised are-
MRI scan of the abdomen.

Treatment of the cyst depends on the result of the scan.
A urine routine and microscopy should be done to see if there is any infectious agent in urine. As if present antibiotic therapy would be given fir few days.

Hope I answered your query well.In case you have any other question feel free to follow up.

Regards.

Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Ramesh Kumar 16 minutes later
Thank you Dr. XXXXXXX XXXXXXX

The cyst is actually in the liver, hence the concern of parasites. Please let me know what you think.

XXXX
doctor
Answered by Dr. Ramesh Kumar 23 minutes later
Brief Answer:
Follow up.

Detailed Answer:
Hi again,
I am sorry I got confused.

Hydatid cysts are one of the most common cause of liver cyst.As you have history of using contaminated water it is likely that cyst is due to infestation of the liver by parasite called echinococcus.In humans hydatid disease is caused by the larvae of a tapeworm called Echinococcus granulosus. This parasitic infection occurs worldwide and is endemic in some countries such as Australia and the Middle East, especially in sheep farming areas(You have a history of living in that area for years).The diagnosis is most easily set by imaging techniques such as CT-scan or MRI . Serology tests such as ELISA or immunoblotting can be used in addition, being 80-100% sensitive for liver cysts.I would initially suggest you to for these tests to reach a accurate diagnosis.
Therapy with metronidazole would be given if the cyst is proven to be hydatid.

Liver cysts do not impair the liver’s ability to function. The cyst is usually found by ultrasound or computed tomography (CT scan)

Other possibilities are-
. Simple liver cysts are always benign. The only patients who require treatment for a liver cysts are those who develop symptoms like nausea vomiting pyrexia.

Simply removing the fluid from the cyst with a needle is not effective because the cyst fills up again within several days. The best treatment is to remove a large portion of the cyst wall. This surgical procedure can usually be done through the laparoscope, which requires only 2-3 small incisions and an overnight stay in the hospital.

Unlike simple liver cysts, cystic tumors are actually growths that may become malignant over the course of many years. The benign cystic tumor seen most frequently is called a cystadenoma; its malignant counterpart is a cystadenocarcinoma. The symptoms caused by cystic tumors are the same as those seen with simple cysts; fullness, discomfort, and pain.

Hence I would recommend MRI scan to know the nature and cause of the problem.
Rest advice for polyp is the same.
Regards

Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Ramesh Kumar 8 hours later
Thank you again doctor,

I forgot to mention one thing. I have gallbladder attacks, pain daily, and the pain wakes me at night. Naturally it's usually after a fatty meal. Does that change how you feel about the gallbladder polyp?
doctor
Answered by Dr. Ramesh Kumar 6 hours later
Brief Answer:
Repeat an ultra sound abdomen.

Detailed Answer:
Hello again,
As you are having gall bladder pain daily.I would suggest you to repeat an ultrasound abdomen.Polyps can lead to crystalisation of cholestrol in gallbladder hence causing formation of gall stones.
In some cases a polyp can also lead to a condition called cholecystitis where gallbladder is inflammed and is infected.
A repeat ultrasound will also indicate the current size of the polyp which can be compared with previous size.
If the polyp is relatively large now as compared to previous ultrasound then malignancy could be suspected.

However just because you are having pain does not mean that you are having a malignant polyp.Even a benign polyp can be painful.

I would strongly suggest you to go for ultrasound abdomen and follow up with report.

Regards!
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Ramesh Kumar 3 hours later
Thank you for all of your advice, take care!
doctor
Answered by Dr. Ramesh Kumar 10 minutes later
Brief Answer:
Regards!

Detailed Answer:
Regards and get well soon!
Above answer was peer-reviewed by : Dr. Kampana
doctor
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