The gallbladder is an organ that forms part of the digestive system. The function of the gallbladder includes participating in the production, storage and transportation of bile, a yellowish-brown liquid produced by the liver and used to break down and digest fatty foods in the small intestine [1,2].

Gallbladder diseases are common in everyday practice. Some are usually not adequately diagnosed, such as in gallbladder polyps, which often present as an accidental finding when an abdominal ultrasound is done or when the resected gallbladder is examined for another indication. However, it can have a particularly important clinical impact, if an appropriate diagnostic and therapeutic approach is not followed [3,4]. This study aims to describe the histopathological clinical profile of patients with gallbladder polyps, focusing on factors considered as risk factors for malignant transformation of adenomas [5].

A person with this type of cholecystitis may not have any symptoms and in other cases, symptoms similar to those that appear on a person with acute cholecystitis may appear, such as abdominal pain, nausea and vomiting [6,7].

The pain associated with chronic cholecystitis is characterized by intermittent pain that resembles attacks and this type of cholecystitis is not accompanied by the appearance of fever, unlike the previous type [8]. Acute cholecystitis among patients with acute cholecystitis, 90% are patients with gallstones. It is more common in the elderly and acute cholecystitis, pathological changes occur in the gallbladder wall hardening, circulatory disorders and Mechanical damage to the mucous membrane due to gallstones, the impaired outflow of bile due to partial or complete obstruction of the cystic duct contribute to its development [9,10].

The infection (Escherichia coli or Pseudomonas aeruginosa, Enterococcus) rejoins and ultrasound reveals a three-layered structure of the gallbladder wall [11].

Chronic canine cholecystitis is the most common complication of cholelithiasis It occurs more often in the form of dyspepsia, biliary colic rarely develops. Ultrasound reveals the uneven thickness of the gallbladder wall [12].

Gallbladder detachment is one of the most common complications of cholelithiasis. The main cause of disruption of the gallbladder is a calculus curvature of his neck, less often-a clot of pasty bile (GC) and cervical cholecystitis is a contributing factor [13].

Ascites of the gallbladder develop as a result of obstruction of the bile duct with stones or clots in the gallbladder accompanied by the accumulation of transparent contents (serous effusion) in the bladder with an admixture of mucus. In this case, the gallbladder increases in size and its wall becomes thinner on palpation - enlarged gallbladder, elastic and painless (Courvoisier's symptom). Ultrasound diagnosis is sometimes supplemented with Computed Tomography (CT) [14,15,16].

Gallbladder empyema develops against the background of a separated gallbladder as a result of the addition of an infection. Clinical manifestations can be alleviated in some cases, especially in the elderly, but can also correspond to an intra-abdominal abscess [17,18].

Gallbladder wall phlegmon is the result of acute calculous cholecystitis. It is often accompanied by the formation of various fistulas. Diagnosis is based on data from clinical, laboratory and instrumental studies (ultrasound, computed tomography) [19, 20].

Patient Sample

About 100 patients were collected from Yarmouk Teaching Hospital, Baghdad, Iraq, where a descriptive study was conducted and the patients who underwent cholecystectomy due to various diseases of the gallbladder were relied upon.

Research Design 

A descriptive study was conducted on patients who underwent cholecystectomy due to various diseases of the gallbladder, where the samples were divided into two parts (33 women and 67 men). Age and gender), clinical data (symptoms) and ultrasound data (visualization or not of tumor and size, presence of cholelithiasis, single or multiple polyps) and the statistical analysis also included a description of the type of relationship present and a quality-risk analysis for malignant transformation of this type.

The clinical impact of this disease mainly lies in the possibility of neoplasia of some adenomatous polyps, which can turn into adenocarcinoma of the gallbladder in about 3-8% of cases.

Period 

Patient information and data were collected from Yarmouk Teaching Hospital, Baghdad, Iraq from 9-11-2019 to 12-19-2020.

Aim of Research

The research aims to evaluate the study and knowledge of the clinical profile of Patients with Gallstones.

Diseases of the gallbladder are common in everyday practice; some are usually underdiagnosed and are often detected during an ultrasound examination and are specific to patients who have had their gallbladder removed by mitral to remove stones. A cholecystectomy is a surgical procedure to remove the gallbladder - a pear-shaped organ located below the liver is directly on the upper right side of your abdomen, the gallbladder collects and saves digestive fluids that are produced in the liver.

About 100 patients were collected from Yarmouk Hospital, Baghdad, Iraq. The research or study was based on the diagnosis of the clinical file on patients suffering from gallstones and who underwent laparoscopic cholecystectomy. The samples were divided into two parts: 38 women and 62 men as shown in Table 1.

The ages were divided into 4 groups and the largest group containing more patients was between the ages of 40-49 and pain in the upper abdomen was found for 77 patients and pain in the right side of the abdomen was found for 23 patients (Table 2).

The statistical analysis program SPSS soft 25 was used to analyze demographic data and information, in addition to finding the quality of relative risk and error rate and by relying on real value analysis to ages and standard regression, the results of ages to patients were 40.93±9.90. The highest value in the average age was 60 years and the lowest age was 20 years (Table 3).

Different research groups have found different relative distributions of different gallbladder polyps' subtypes, with the majority agreeing that non-neoplastic subtypes are the most common. 6-8 One of the largest studies developed recently is that published by Xu et al.,9 who retrospectively discovered that 87.1% (1260 patients) had cholesterol polyps in 1446 patients, 11.2% (162 patients) were benign non-cholesterolemic polyps and 1.7% (24 patients) had malignant lesions, in addition, they observed that more than 50% of non-cholesterolemic polyps   (adenomas)  were smaller than 10 mm (Table 4). 

Table 1: The Result of the Patient Depends on Gender 

Table 2: The Result of the Patient Depending on Age and Type of Pain 

Table 3: Frequencies According to Age

Table 4: Symptomatic Results

Table 5: Symptomatic Depend on Gender

Table 6: Gallstones Place Formation

Table 7: The Type of Disease

Table 8: p-value of Results 

They also showed that age greater than 50 years, presence of symptoms, size greater than 10 mm and coexistence of cholelithiasis were independent prognostic factors for malignant polyps. One of the most recent studies in which these results can be replicated was that by Bugosen who in 1707 cholecystectomy observed a prevalence of gallbladder polyps in 10% (172 cases), of which 95.4% (164 lesions) cholesterol polyps, 4% (7 lesions) adenomatous polyps and 0.6% (one lesion) hyperplastic polyps; Only 89 cholesterol polyps were recorded, of which 69.7% were smaller than 10 mm. Similarly, only 4 adenomatous polyps were identified, 75% of which are greater than or equal to 10 mm. Our study, like the few research work conducted in our environment, confirms the results of the two investigations mentioned above. The gallbladder may be affected by the presence of undissolved stones, which consist of either cholesterol or bilirubin. Doctors resort to removing the gallbladder in the case of the large size of these stones, which prevents the preservation of the gallbladder during the removal of such stones (Table 5).

One of the most important diseases that affect the gall bladder is the formation of gallstones in this gallbladder and this is usually the result of the deposition of solid materials in the bile.

About 70% of these stones consist of cholesterol, bilirubin and calcium. The stones may consist of bile pigments or calcium mixed with bilirubin.

Symptoms of gallstones range from the absence of asymptomatic symptoms and the stones are detected here by chance or symptoms resulting from chronic cholecystitis as well as acute cholecystitis (Table 6).

The symptoms of gallstones or cholecystitis caused by gallstones are severe pain in the upper abdomen that may be in the upper right part.

The symptoms of gallstones may be symptoms resulting from the complications of stones, such as acute inflammation of the gallbladder, which is accompanied in addition to the above, very severe pain accompanied by high temperature and shivering and it may reach the symptoms of shock resulting from blood poisoning (Table 7).

Also, the migration of these stones to the bile ducts may lead to inflammation of the collecting bile ducts and hepatic ducts cholangitis, or even inflammation of the pancreas gland (Table 8).

In our study, it was concluded that the symptoms of diseases are present in males more than females and that the ages that are most common in infection are between 40-49 years.

Complete recovery from laparoscopic cholecystectomy requires only a short period, after which the patient can return to his normal life with all its activities in addition to returning to work within days, while open cholecystectomy requires longer periods and greater comfort.

Recommendation

• It's important to focus on adjusting your diet and lifestyle for the better and eating a healthy diet several weeks before surgery, staying as active as possible and quitting or cutting down smoking if you're a smoker

• Quitting smoking is one of the changes doctors highly recommend before surgery. Smoking can cause many complications during any surgery, including breathing problems, an increased risk of pneumonia (compared to non-smokers), an increased infection line and a slower healing process

• Laparoscopic cholecystectomy surgery is characterized by being less invasive and less painful, which allows the patient to move after the surgery in a short time and enables him to go home on the same day and the incisions are negligible compared to normal surgery, which limits complications and reduces the chance of their occurrence

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