Polyposis is a disease of collective significance, which refers to formations from tissues of various origins and are most often observed on mucous membranes. These peculiar neoplasms (polyps) connect with the mucosa with the help of the base and legs, in which there are lymphatic and blood vessels. Polyps there are different shapes, sizes, and densities. If they are localized as single entities, they are called polyps, and for multiple localization it is polyposis.
As a rule, polyps are observed in the digestive tract, endometrial uterus, in the nasal cavity, bronchi and lungs. They grow into these organs, causing polyposis. With this disease, inflammatory processes with bleeding and swelling are very often noted. Sometimes the leg of the polyp can be twisted, causing it to die and spontaneous rejection. Polyposis of somatic organs, such as the stomach, intestine, uterus, refers to the precancerous state, as it is very often transformed into an oncology.
Mostly diagnosed polyposis of the stomach and intestines, which are pathological development of the mucous membranes. In most cases, they are a hereditary disease, such as congenital familial polyposis.
The symptomatology of the disease largely depends on the location of the polyp, its structure, the magnitude and changes in the secondary plan. Sometimes the polyposis can proceed almost asymptomatically, and in some cases causes bleeding, narrows or closes the lumens of the organs.
When diagnosing polyposis, various instrumental methods of examination are used. These include fluoroscopy, gastroscopy, bronchoscopy, sigmoidoscopy, and others.
For the treatment of polyposis, a surgical method is used, in which the excision of the polyp, resection of the organ or its total removal is performed.
Causes of Polyposis
For today, numerous experiments in the laboratories of Europe to determine the causes of polyposis have not yielded positive results. Therefore, up to now, the main reasons for its occurrence have not been established. Although at the moment it is believed that the formation of polyposis is changing at the genetic level, which lead to increased multiplication of cells resembling layers.
In practice, many doctors polyps are mainly found in women in the gallbladder and stomach (80%). Such selective predisposition is explained by the influence on the development of polyposis of estrogens. But, despite this, it is very difficult to say why some people have this disease, but others do not.
It can be stated unequivocally that polyposis is never formed in cells of healthy tissue. Such growth of tumors is promoted by chronic diseases with inflammatory processes, which cause rapid aging of the epithelium. Sometimes the formation of various types of polyposis can also be affected by chronic sexual infections.
This pathology is the formation of multiple formations of benign etiology in the uterine cavity. These formations are called polyps, which are a hyperplastic process, as a result of which the basal layer of the endometrium grows; one of the inner layers of the uterus.
Endometriosis polyposis is mainly characteristic for women from thirty-five years to fifty, but can also develop in young as well as in old age.
All polyps have a body and a leg, which consist of epithelial cells. In the polyposis of the endometrium, several forms of polyps are distinguished, which depend on their structural structure. They can be glandular and consist of glands and stroma; glandular fibrous - from a small number of glands and connective tissue; fibrotic and adenomatous - with the available malignant cells.
In women of young reproductive age, there is mainly polyposis, which consists of glands, and in elderly women it is more often possible to meet fibrous polyposis and adenomatous. But polyps with a glandular fibrous structure can be observed in any age category.
The exact reasons for the development of endometrial polyposis are unknown. But there are assumptions about the causes that can contribute to the formation of the disease. These can include both an excessive amount of estrogen and an insufficient content of progesterone in hormonal disorders; with the trauma of the uterus as a result of abortion, prolonged wearing of intrauterine spirals, scraping for diagnostic purposes, after interruption of pregnancy, childbirth with insufficient removal of the placenta (the remnants grow into connective tissue, forming polyposis), miscarriages. Endocrine system disorders and diseases such as hypertension, obesity , diabetes , changes in the thyroid gland may have a definite effect on the occurrence of endometrial polyposis.
In addition, stress, depression , various inflammatory processes in the appendages, infections, endometritis and reduced immunity are considered a possible cause in the development of the disease.
The clinical symptomatology of polyposis of the endometrium is very diverse. With a small size of polyps, the disease does not manifest itself clinically and is detected absolutely accidentally during examination on ultrasound. But if the endometrial polyposis manifests itself, it occurs in the form of irregularities in the menstrual cycle, which can be characterized by lean spotting blood between cycles that are not due to menstruation. And sometimes and a menorrhagia.
Clinical symptoms in the postmenopausal period are manifested by single blood extracts. Also there are pains of cramping in the lower abdomen, which become stronger at the moment of sexual intercourse. Pathological excretions appear in the form of whites from the genital tract. And with polyps of endometrium of large size, bleeding occurs after sexual contact, and infertility in reproductive age develops.
Very often, endometrial polyposis is diagnosed as endometriosis or uterine myoma, and bleeding between menstruation is considered a threat of miscarriage in the first half of pregnancy. Therefore, consultation of a gynecologist and a survey is simply necessary for any deviation from the norm.
To exclude or confirm the diagnosis, ultrasound of all organs in the pelvis is performed. In this case, it is possible to determine the homogeneous mass of the neoplasm (polyp). In addition, hysteroscopy is used, with the help of which during the diagnosis can remove the formation and at the same time visually monitor the uterine cavity. The use of histological examination allows you to determine the structure of the polyp.
Polyposis of the endometrium can cause various complications in the form of infertility, anemia, there are relapses and degeneration of benign polyps into malignant pathologies. To avoid this, it is necessary to observe the gynecologist systematically, to prevent obesity, to stop abortion, to treat inflammatory diseases of the appendages and the uterus in a timely manner, and to use hormonal contraceptives.
Polyposis of the gallbladder
In 6% of people, ultrasound is diagnosed with polyposis of the gallbladder, and in 80% of cases it occurs in women after thirty-five years. However, ultrasound does not always determine the structure of the tissue and in the absence of tumors in the gallbladder, an incorrect diagnosis is made in the form of a polyposis of the gallbladder. In addition to ultrasound, a promising endoscopic ultrasonography is used, which layerwise distinguishes the walls in the gallbladder.
So far, the underlying causes of the development of gallbladder polyposis have not been established, and there are only theoretical guesses. Many experts argue that the disease occurs without certain symptoms.
At the moment, the polyposis of the gallbladder can manifest itself in two forms. Cholesterol type polyps, i.e. pseudotumors, which are presented in the form of cholesterol deposits, towering above the mucous gallbladder. This accumulation of cholesterol is caused by a violation of metabolic processes, which contain calcined inclusions. They create a picture of gallstones in the bladder, which are fixed to the walls.
The second type of polyposis of the gallbladder is inflammatory polyps. This is also a pseudotumor. Such neoplasms are characterized by the inflammatory process of the mucous membrane of the gallbladder, as a result of which its internal tissue grows. All adenomas, papillomas, neoplasms with papillae are considered to be benign polyps, but in 30% they develop into malignant forms.
As a rule, polyposis of the gallbladder proceeds without certain complaints of patients. Sometimes patients may experience epigastric pain or discomfort in the right hypochondrium, and may not tolerate certain types of food. Changes in the blood formula are not determined. Neither duodenal sounding, nor cytological examination of information does not.
Polyposis of the nose
This disease with an abnormal growth of the mucosa of the paranasal sinuses. The concept of a polyp was introduced in ancient times by the physician Hippocrates, which means "many-legged". With a significant amount in the nose of these tumors, the diagnosis is a polyposis of the nose.
The tumor is characterized by a translucent soft gelatinous consistency, which easily moves, is absolutely painless, does not show sensitivity to touch. Sometimes polyps can acquire different shades, such as red, pink and burgundy.
Polyposis of the nose is very often accompanied by a rhinitis of an allergic nature. Therefore, this disease can be diagnosed as polypous rhinosinusitis. Polyps in a mature state are a kind of a bunch of grapes.
The symptomatology of the polyposis of the nose is composed of various manifestations. The basis of complaints of patients lies in a prolonged difficult nasal breathing, in a sense of nasal obstruction and in the sensation of a foreign body in them. Also in patients there is a constant rhinitis with mucous or mucopurulent discharge. In addition, patients often suffer from colds. A characteristic sign of polyposis of the nose is anosmia, in which the patient absolutely loses sensitivity to smells with a preliminary disorder of smell. Sometimes the disease occurs with a violation of sensations of taste.
Very often polyposis of the nose causes pain in the head and in the sinus area near the nose. Patients may have a voice disorder, hoarseness, nasal congestion, snoring during sleep, and patients complain of persistent chronic fatigue due to lack of oxygen.
Polyposis of the nose has been known for five thousand years, it is diagnosed in almost 5% of all adults. This disease has long been studied extensively, but the etiological factors in the onset of polyposis of the nose remain unknown. As a rule, when infectious diseases occur, the upper layer of the nasal mucosa cells exfoliate simultaneously with the pathological microorganisms. Correctly conducted treatment promotes recovery, in which the mucous membrane of the nose recovers. And it, in turn, can again fully function, while performing a protective function. When not treating the underlying disease, it gradually becomes chronic. This manifests itself in the constant course of the inflammatory process in the sinuses of the nose. Then the protective function of the mucosa is depleted, and it gradually expands, captures large areas to cope with the infection. Thus, polyps are formed from the thickening of the nasal mucosa.
In the development of nasal polyposis, the often occurring diseases of the common cold and infectious etiology, such as sinusitis, and such chronic processes as etmoiditis, frontal sinusitis and sinusitis can play an important role. Various forms of allergic diseases, among which are bronchial asthma, pollenosis and rhinitis with allergic etiology. Even to the formation of polyposis of the nose, the curvatures of the septum, the cysts in the paranasal sinuses, the narrow nasal passage, etc., can also have a direct bearing. In addition, diseases such as cystic fibrosis , mastocytosis, Yang syndrome, hereditary factor, immune system abnormalities and fungal pathologies can provoke development polyposis of the nose. The emergence of this disease is mainly influenced by many causes in the complex.
The process of polyps formation can last many years. Therefore, at the beginning of the development of polyposis, patients do not pay attention to a slight runny nose or a small nasal congestion. As a rule, polyps are related to benign pathology, but they gradually grow in the nasal cavity and close the breathing passage, while hindering it.
Before the appointment of treatment, the nasal cavity of the patient must be inspected by an otolaryngologist, using a rhinoscope. To clarify the diagnosis, a computer tomography of the sinuses of the nose is performed. If there is a suspicion of malignancy, the material is taken for a biopsy.
Polyposis of the stomach
This disease is a benign tumor that is formed from the epithelial tissue of the walls of the stomach. The development of polyposis of the stomach is based on the process of regeneration, which accompanies gastritis with a chronic form of percolation.
Polyps in the stomach can manifest as single, and multiple elements. Polyposis of the stomach can occupy huge areas and develops more often in people older than fifty years.
As a rule, polyposis of the stomach is revealed absolutely randomly during the X-ray study. This is because the disease lasts for a long time without manifestations of obvious symptoms.
Polyps in the stomach can be of several kinds, such as adenomatous, hyperplastic and juvenile. The first variant of polyps develops from glandular tissue, which is located inside the stomach. So adenomas are formed, which are considered less common, but more often than others develop into malignant pathology. If adenomatous polyps were found during the examination, a surgical operation is immediately prescribed.
Polyps of hyperplastic etiology are formed as a result of the body's reaction to a chronic inflammatory process in cells that lining the stomach from the inside. Very often this type of polyps can be found in people with gastritis. Basically, they do not turn into cancer, but at large sizes there is a chance of becoming a malignant disease.
The most rare types of neoplasms are juvenile polyps or hamartomas . This form of tumors is located at the bottom of the stomach and does not grow into a malignant one.
Causes that can provoke polyposis of the stomach may be various hereditary diseases. But the factors that contribute to the occurrence of these polyps inside the stomach are: Helicobacter pylori infection, age category after fifty years, genetic predisposition (for adenomas).
Polyposis of the stomach begins to progress rapidly as a result of the abuse of food, such as fatty, spicy and fried, and also with frequent use of alcoholic beverages.
It is important to always remember that polyposis of the stomach, when untimely treatment is very dangerous. This benign abnormality can always be transformed into a cancerous formation.
The clinical picture of polyposis of the stomach consists of a variety of symptoms. Quite often, the disease occurs under the guise of other pathologies. Therefore, it is necessary to undergo examination if there are suspicions of gastritis , which occurs with pain in the epigastrium, nausea and vomiting, bad breath and bitter aftertaste, bloating and belching.
When ulcers appear bleeding, which is rarely characterized by its abundance, but sometimes cause death. When complications, dizziness , weakness and pallor are noted.
To diagnose polyposis of the stomach, endoscopic and radiographic studies are used, which play a decisive role in the diagnosis. Endoscopy makes it possible to accurately detect polyps, to determine their size and shape, and to determine the state of the gastric mucosa. Radiographic examination can reveal defects associated with the filling of the stomach, which can reflect the size and shape of the polyp. As a rule, it has an oval or round shape and precise smooth contours. With polyposis of the stomach, various defects of filling with different sizes are revealed.
Studies of gastric juice indicate a decreased secretion. Although in some patients, especially at a young age, it can be normal, even slightly elevated.
About 15% of patients suffer from hypochromic anemia , which is caused by blood loss due to ulceration of the walls of the stomach. Such anemia can cause disturbances in the metabolic processes due to Achilles.
Various methods of treatment are used to treat the disease, such as surgical, medicamentous and diathermocoagulation.
For the treatment of endometrial polyposis one of the main methods of therapy is applied - this is surgical intervention. Polyps from one to three centimeters use polypectomy. The place where the polyp was located is cauterized. To do this, use liquid nitrogen or discharge electrical current to exclude relapses. Four days later, a second ultrasound is scheduled for monitoring.
The further tactics of treating endometrial polyposis will depend on many factors, such as the size and shape of the polyp, the age of the woman, the existing or missing disorders during menstruation.
In case of violations of the menstrual function with the fibrous structure of the polyp, hysteroscopy is limited, in which the uterine cavity with the polyp is scraped. If glandular or glandular fibrous polyps are found, then hormone therapy in the form of gestagenic combined oral contraceptives for women up to thirty-five years is prescribed, according to the scheme (Yarina, Regulon, Janine, etc.). And after 35 years - Utrozhestan, Norkolut and Dyufaston. Treatment lasts for six months.
For women who do not plan pregnancy in the coming months or even years, or when combined with endometrial polyposis with uterine myoma or adenomyosis, put the hormonal spiral with Levonorgestrel into the uterine cavity for five years.
When diagnosing adenomatous polyposis, women in the pre-menopausal and postmenopausal age are removed from the uterus. To prevent the development of oncology, as well as metabolic and endocrine disorders, the appendages are also removed.
To prevent the treatment of inflammatory complications, Ceftriaxone or Cefazolin are prescribed. For ten days after scraping manipulation, a diet low in calories and lack of sexual relations is followed.
Polyposis of the gallbladder is treated, as a rule, by operative removal of the organ. The indication for the operation is an increase in the size of the polyp, i.e. his height. But if a polyp in diameter up to 10 mm, then it is observed for two years, and then once a year, for life. The rapid growth of the neoplasm is 2 mm throughout the year. When the appearance of a peculiar symptomatology is also carried out a total removal.
Modern methods of surgical intervention for polyposis of the gallbladder include: video laparoscopic cholecystectomy, OLHE, TCE and endoscopic polypectomy (rarely used).
For the treatment of nasal polyposis, a conservative and surgical method of therapy is used. The choice of the treatment method will depend on the etiological factor of the growth of the nasal mucosa, at what stage the disease is located, on the size of the polyps and the complications that exist. The appointment of medication is used in the first stages of polyposis of the nose. For conservative therapy, corticosteroids are used in the form of tablets and sprays that can reduce the size of the lesions, and sometimes even completely eliminate them. Antiallergic drugs are prescribed in a pronounced allergic process. With chronic diseases of the nose, antibiotics are used. In addition, therapy is provided to improve immunity.
Surgical methods for treating nasal polyps are used to remove polyps. This manipulation is performed using a special loop for the polyp. The procedure is very painful, can occur with the appearance of bleeding. This operation allows you to remove at a time a large number of polyps that are visible in the nasal cavity.
Nasal polyps can also be removed with a laser beam. In this case, the tissue of the polyp is heated and evaporated. This operation proceeds without bleeding, since the laser immediately seals the blood vessels. The entire procedure is very quick and with minimal pain. The drawback of this manipulation is the removal of only single and small polyps. And their tissue in the sinuses is not removed, and this can lead to relapse of polyposis.
For the endoscopic operation, special medical equipment is used, which allows the surgeon to see everything that happens inside the nasal cavity on the screen monitor. Therefore, it is possible to operate even in places that are inaccessible during normal surgery. Polyps are removed through the nasal apertures using a shaver that reduces the tissue of the polyps and takes them outside. This tool is able to maximally remove polyps and not affect the healthy mucous membrane of the nose. With this operation, there is a slight bleeding. And the appearance of relapses of polyposis with proper further treatment is virtually impossible.
Always surgical intervention is followed by subsequent conservative treatment. To remove the remaining tissue, the nasal cavity is washed daily with brine. To prevent the development of secondary plan infections, antibiotics are prescribed, and locally - steroids for the preventive treatment of recurrent processes. It is also very important to constantly observe the specialist and maintain the immune system.
For treatment of polyposis of the stomach, medicamentous and surgical treatment is also used. First of all, regular drugs are prescribed to stimulate the digestive process, as well as the means that envelop the walls of the stomach. In inflammatory processes, antibiotics are prescribed. In general, therapy is used, as for peptic ulcer.
If the conservative treatment of polyposis of the stomach is ineffective, surgical intervention is indicated. In addition, the polyps are removed with the likelihood of their transformation into cancerous tumors or in the abnormal gastrointestinal tract. To date, for surgical treatment of polyposis of the stomach, resection, gastrectomy and endoscopic polypectomy are performed. The last manipulation has more advantages. Firstly, it has virtually no contraindications, it is easily tolerated by patients and does not require special preparation for the patient. Such a procedure can be performed both in hospital and outpatient settings.
Resection and gastrectomy in the treatment of polyposis of the stomach are less safe operations for patients, and with more complex techniques. They are performed with polyps from two centimeters.
Removal of polyps obliges the patient to observe the gastroenterologist with a regular endoscopic examination. For preventive purposes it is necessary to comply with the regime of rational nutrition, restrict smoking and alcohol.
After fifty years of age, the possibility of stomach polyposis increases, so if there are any abnormalities in the digestive tract, an endoscopic polypectomy is urgently needed to take the material for a biopsy.
When localizing polyps, for example, in the large intestine, polypectomy is performed using colonoscopy. In this case, a radical removal of the affected area is performed, and sometimes an ostomy is applied.