University of Pennsylvania Health System

Penn Gastroenterology Q&As

Wednesday, March 2, 2011

Are There Physicians At Penn Medicine Who Specialize In Small Intestine Bacterial Overgrowth?

Question:
Is there a doctor or group of doctors that deal with small intestine bacterial overgrowth (SIBO)? I am from Lancaster, PA and cannot find anyone who is knowledgeable about treating it and its effects.

Answer:
The main purpose of the small intestine is to digest and absorb food into the body. The entire gastrointestinal tract, including the small intestine, normally contains bacteria. Small intestinal bacterial overgrowth (SIBO) refers to a condition in which abnormally large numbers of bacteria are present in the small intestine. The coordinated activity of the muscles of the stomach and small intestine moves the food from the stomach, through the small intestine, and into the colon.

Even when there is no food in the small intestine, muscular activity sweeps through the small intestine from the stomach to the colon. This activity is important for the digestion of food, but it also is important because it sweeps bacteria out of the small intestine and thereby limits the numbers of bacteria in the small intestine. Anything that interferes with the progression of normal muscular activity through the small intestine can result in SIBO. David Metz, MD, is a Penn gastroenterologist who specializes in motility and bowel disorders.

To schedule an appointment with Dr. Metz, please call 800-789-PENN (7366) or you can also request an appointment online.

Tuesday, March 1, 2011

Are Chinese Herbal Remedies Effective In Treating Hemangiomas Of The Liver?

Question:
I have seen Chinese herbal ads on web sites discussing hemangiomas of the liver – Hemantin, Hemnotab, and so on. Are these remedies effective and safe?

Answer:
A hepatic hemangioma, or hemangioma of the liver, is a noncancerous liver tumor consisting of dilated blood vessels. It is believed to be a birth defect and is usually not discovered until medical pictures are taken of the liver for some other reason. Hepatic hemangiomas can occur at anytime, but are most common in women in their 30s to 50s.

Most cavernous hemangiomas do not show symptoms. In rare cases, hemangiomas may cause bleeding or interfere with organ function, depending on their location. Most hepatic hemangiomas are treated only if there is persistent pain. No medical or herbal therapy is known to reduce the size or eliminate hepatic hemangiomas – surgical removal is the only treatment. A Penn hepatologist, a physician who specializes in diseases of the liver, can evaluate your condition.

To schedule an appointment, please call 800-789-PENN or request an appointment online.

Is It Possible For Liver Damage To Not Show Up In A Blood Test?

Question:
I have an uncomfortable bloated feeling in my upper abdomen and a nagging ache in my back that sometimes includes numbness or a tingling feeling. I drink close to a bottle of wine every night and a little more on the weekends. I know it's not good for me and I am trying to cut down. I have had a CT scan, colonoscopy and ultrasound — all have revealed nothing.

My blood tests have come back normal. My doctor said my liver enzymes are perfect and if my liver was damaged enough to hurt, this would show up in blood work. Is it possible that a damaged liver would not show up in routine blood work? Are there other tests for liver disease?

Answer:
The symptoms you describe could indicate any number of conditions. In addition to abdominal pain and swelling, symptoms of liver disease could include jaundice — discolored skin and eyes that appear yellowish, itchy skin, chronic fatigue, nausea, loss of appetite or abnormally colored urine or stool. For women, having more than one drink a day over many years may be enough to lead to cirrhosis — irreversible scarring that causes the liver to shrink to a fraction of its size. Excessive alcohol consumption is a leading cause of liver disease.

In addition to standard blood tests, a liver biopsy or liver scan is sometimes used to diagnose liver disease or confirm other test results. A biopsy involves removing a liver sample for examination. A liver scan uses a radioactive material, injected into a vein, to help determine liver function. A Penn hepatologist, a physician specializing in diseases of the liver, can evaluate your condition.

To schedule an appointment, please call 800-789-PENN or request an appointment online.

What Tests Can Be Done To Diagnose Primary Sclerosing Cholangitis?

Question:
Our 23 year-old daughter has had abnormal liver enzymes in her last two blood tests (done three weeks apart). She is waiting for a liver biopsy to determine if she is suffering from primary sclerosing cholangitis (PSC). Her doctor says it may be too early to show anything.

Is there another test that should be done in addition to or instead of the biopsy? If it is indeed PSC, what do we do next? How quickly will the disease progress? Isn't she too young for this? She also suffers from ulcerative colitis. Is there a relationship to that disease? I am in a complete panic because I don't know what to expect. Any advice would be very helpful.

Answer:
Primary sclerosing cholangitis (PSC) is a disease that primarily involves the bile ducts both inside and outside the liver. The disease begins when the walls of the bile ducts become inflamed, causing scarring and hardening. This narrows the ducts and restricts the draining of bile, so the bile is forced into the liver where it damages liver cells. After a period of time, so much bile is stored in the liver that it slowly seeps into the bloodstream. After long term damage to the liver cells, the liver develops cirrhosis and hardens so that the liver can not function properly anymore. PSC is a slow progressing disease.

Early symptoms include abnormal liver enzyme levels and can later cause fatigue, loss of appetite, weight loss, jaundice and itching. Typically, a diagnosis is made by reviewing the patient's history and performing an endoscopic retrograde cholangiopancreatography (ERCP), which involves injecting dye into the bile ducts to see if they are narrowed and restricting flow.

An MRCP (magnetic resonance cholangiopancreatography) is a type of MRI that could also help confirm a diagnosis. Though your daughter is a bit young to develop this disease, about 70 percent of people diagnosed with PSC also have an inflammatory bowel disease – most commonly ulcerative colitis. There is no cure for PSC, but treatments are available to effectively manage the symptoms. Karen Krok, MD, is a Penn hepatologist specializing in liver diseases who can evaluate, diagnose and appropriately treat your daughter.

To schedule an appointment, please call 800-789-PENN (7366) or request an appointment online.

What Are The Treatment Options For Alcoholic Hepatitis?

Question:
My brother was diagnosed with alcoholic hepatitis. What is the protocol for treatment to help the liver heal?

Answer:
Abstaining from alcohol consumption is the number one treatment for alcoholic hepatitis – inflammation of the liver due to alcohol intake. It is the only way to reverse liver damage or prevent it from getting worse. This disease is complex because although it most often occurs in moderate to heavy drinkers, it can affect a person who drinks excessively just once.

Some other treatments for alcoholic hepatitis are:
  • Nutritional therapy – A high-calorie diet containing nutrient dense foods can help regenerate damaged liver cells, as well as supplementing the diet with vitamins like B-1, B-2, B-6, calcium and iron.
  • Lifestyle changes – Maintaining a healthy weight and quitting smoking can help improve liver function.
  • Drug therapies – Corticosteroids can be a useful short-term treatment.
  • Antioxidants – Antioxidants and some supplements have been shown to help repair damaged liver cells.
  • Liver transplant– In severe cases, liver transplant may be the best treatment option.
Karen Krok, MD is a Penn hepatologist, a physician specializing in diseases of the liver, who can review your brother's case and help put together a treatment plan.

To schedule an appointment, please call 800-789-PENN (7366) or request an appointment online.

Are There Physicians At Penn Medicine Who Specialize In Enlarged Liver And Spleens?

Question:
A recent abdominal ultrasound showed an enlarged liver and spleen. What is the most direct action to see the best qualified physician to determine what is wrong and how to resolve it?

Answer:
An enlarged liver and spleen is called a hepatosplenomegaly. It can have a number of causes and without knowledge of your medical history and symptoms it is impossible to speculate. Your next action should be to see a gastroenterologist specializing in liver disease. Thomas Faust, MD is a Penn gastroenterologist specializing in liver disease who can evaluate your condition.

To make an appointment, please call 800-789-PENN (7366) or request an appointment online.

Can A Liver Hemangioma Interfere With The Adrenals?

Question:
Can a liver hemangioma interfere with the adrenals? I was told it can put pressure on organs and interfere with their functioning such as the gallbladder releasing bile. My whole system has been going haywire with anxiety, insomnia, flushed face, extreme fatigue, constant nausea, and constipation or diarrhea.

Answer:
A hepatic hemangioma, or hemangioma of the liver, is a noncancerous liver tumor consisting of dilated blood vessels. In rare cases, hemangiomas can interfere with organ function or may cause bleeding, depending on their location. Karen Krok, MD is a Penn hepatologist, a physician specializing in diseases of the liver, who can evaluate your condition.

To schedule an appointment, please call 800-789-PENN or request an appointment online.