A patient complaining of abdominal pain has normal liver enzymes and a gallbladder wall polyp (but no stones) on ultrasound. What further intervention do you recommend?
—Cynthia Lewin, ARNP, Sioux City, Iowa

Gallbladder wall polyps can act similar to gallstones and have been associated with abdominal pain and dyspeptic symptoms. Polyps can also be potentially precancerous, particularly those >5 mm. Consider referral to determine if surgical intervention or serial ultrasounds are indicated based on symptoms and size of the polyp. Since the polyp does not generally migrate into the bile duct, obstructive symptoms, such as jaundice and elevated liver enzymes, are not likely to occur.

Additional workup for the abdominal pain would depend on its character and location. Upper endoscopy should be considered to rule out acid peptic disease if the pain is epigastric or in the right upper quadrant.
—Bruce D. Askey, MSN, CRNP (102-15)