University of Pennsylvania Health System

Penn Gastroenterology Q&As

Wednesday, November 30, 2011

Question:
I have been diagnosed with a malfunctioning gallbladder with an ejection rate of 22 percent with no stones. For the most part I can control any symptoms with a strict diet. My GI doctor says that I should keep my gallbladder and just monitor it. What are your feelings on this?

Also, on all my blood work, my bilirubin has been high. It has been a 2.1 on all tests. My doctor says it should range between 1.4 and 2.8. He stated he is not worried about the bilirubin levels, because my ALT is an 18 and my AST is a 17. Could the high bilirubin levels be caused by the malfunctioning gallbladder?

Answer:
A malfunctioning gallbladder could be the result of inflammation, infection, stones or obstruction of the gallbladder. The gallbladder stores and concentrates bile produced in the liver. Bile aids in the digestion of food. Conditions that slow or obstruct the flow of bile out of the gallbladder result in gallbladder disease.

Bilirubin is a product that results from the breakdown of hemoglobin in the blood and is usually measured to screen for or monitor liver or gallbladder problems. Abnormal test results could indicate a number of conditions including jaundice.

Gregory Ginsberg, MD, David Jaffe, MD, Michael Kochman, MD and Nuzhat Ahmad, MD are Penn gastroenterologists who specialize in hepatobiliary disorders. To make an appointment with one of them, please call 800-789-PENN (7366) or request an appointment online.

What Can I Do to Alleviate Pain Following Gallbladder Removal?

Question:
Ten months ago I had my gallbladder removed. I did not have any stones, but had the symptoms of gallbladder disease. Since the surgery I have had increasingly more pain and discomfort on my right side, mostly above the waist, but sometimes below. I have stopped eating beef and nuts and no longer drink diet soda. Still, the pain and spasms get worse and last longer all the time. Most episodes last about 14 hours. What is your advice?

Answer:
Gallbladder removal, in most cases, eradicates the symptoms of gallbladder disease, but there are some patients that continue to have episodes of what may feel like gallbladder attacks. It may be due to a dysfunction in the muscles responsible for releasing bile and pancreatic secretions into the small intestine or it may be due to an underlying disorder, such as irritable bowel syndrome or peptic ulcer disease. It would benefit you to see a Penn gastroenterologist who can review and evaluate your case. Gregory Ginsberg, MD is a Penn doctor specializing in biliary diseases.

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

Monday, November 28, 2011

Need a Specialist To Treat Patient Currently in the ICU Following a Sever Accident.

Question:
My brother-in-law had an accident eight months ago and is still in the ICU. He has had four surgeries and is having serious intestinal complications. He is unable to take food orally and the doctors are not showing confidence in his improvement, even though before the intestinal problems they were hopeful. He previously suffered from fevers of up to 103 degrees every few days. He is 32 years old and has gone from 143 pounds to 56 pounds. If possible, please recommend a specialist who can handle this case.

Answer:
Due to the serious nature of your brother-in-law's condition, I recommend you confer with his doctor to determine if there is a physician within your region who specializes in gastrointestinal disorders.

Friday, November 25, 2011

Can Gallbladder Removal Cause Weight Loss?

Question:
I am scheduled for gallbladder removal in one week. I suffer from IBS and reflux and currently weigh 112 pounds. All of my tests have returned normal, but my personal gastroenterologist thinks that I exhibit all the signs of a gallbladder problem. Could this surgery result in me losing more weight?

Answer:
Gallbladder removal, also known as a cholecystectomy, is the removal of the organ that stores bile. Bile is used by the liver to help digest food we eat. Following surgery, your appetite may come back to you slowly, but there should not be a lasting significant weight loss issue.

To schedule an appointment with a Penn gastroenterologist who can evaluate your condition and provide a second opinion, please call 800-789-PENN (7366) or request an appointment online.

Tuesday, November 22, 2011

Need Diagnosis for Weight Loss, Severe Bloating and Nausea Following Gallbladder Removal.

Question:
I had my gallbladder removed for acute cholecystitis in August. I had relief until September when I developed constant pain below my last rib on the right side and around my belly button. I have constant burning yellow diarrhea or constipation, gas, severe bloating and nausea. I have also noticed a sulfur taste and smell.

My doctors have performed every scan, blood test and an ERCP, but still have no answer. They began treatment for irritable bowel syndrome with amitriptyline. The side effects of these drugs are brutal and restrict me to eating only bread and water, which caused me to lose 22 pounds. Do you have any suggestions?

Answer:
The gallbladder serves as the storage area for bile used by the liver to break down and digest the foods we eat every day. Following gallbladder removal, digestion can become more difficult and some patients have a period of diarrhea and abdominal discomfort. Amitriptyline is a medication that can be used to treat irritable bowel syndrome. There are also some possible post surgical complications that could cause these lasting symptoms. A Penn gastroenterologist can evaluate your condition and recommend the best treatment.

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

Monday, November 21, 2011

How Would You Treat Liver Stones in a Patient With No Gallbladder?

Question:
How would you treat liver stones in a person with no gallbladder?

Answer:
The gall bladder and the liver are two organs that work closely together. The gall bladder is located under the liver where it stores bile that the liver produces. Bile breaks down food and is released into the small intestine when food is ingested. The causes of gall stones vary from person to person. Surgical removal of the gallbladder – called a cholecystectomy – is the most widely used treatment.

In some cases, after the gallbladder is removed, stones are found to have moved to the bile duct. Other patients develop stones in the residual bile ducts after a cholecystectomy. Once identified, stones in the bile ducts should be removed. This can be performed through an endoscope or it may require surgery. Gregory Ginsberg, MD, David Jaffe, MD, Michael Kochman, MD and Nuzhat Ahmad, MD are Penn gastroenterologists who specialize in hepatobiliary disorders.

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

Thursday, November 17, 2011

What Causes Severe Belching and Gas in Patients With No Gallbladder?

Question:
Approximately five years ago, I had my gallbladder removed. Since then, I have had problems with belching bile and severe gas. At first, this occurred once or twice a month. Recently it has been becoming much more often. It is very uncomfortable. Do you have any suggestions as to what causes this? I don't eat fatty foods; only broiled, boiled or baked.
 
Answer:
When the gallbladder is removed, bile made by the liver flows directly into the intestine. Up to 40 percent of patients who have had their gallbladder removed may experience postcholecystectomy syndrome. Symptoms of postcholecystectomy syndrome include:
Some symptoms can be controlled by medication. If abdominal pain continues, your problem may be caused by something unrelated to your gallbladder removal. A Penn gastroenterologist can evaluate your condition and recommend the best treatment.

 

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

Wednesday, November 16, 2011

What Types of Procedures Are Recommended for Bile Duct Obstruction and Gallbladder Removal?

Question:
My mom has a blockage of the common bile duct and needs to have it unblocked. She also needs to have her gallbladder removed. What type of procedures do you do for this?

Answer:
Bile duct obstruction is a blockage in the tubes that carry bile, a liquid used in digestion, from the liver to the gallbladder and small intestine. When the bile ducts become blocked, bile accumulates in the liver. If the obstruction is caused by gallstones, these may be removed using an endoscope during an ERCP (endoscopic retrograde cholangiopancreatography) procedure. In some cases, surgery is required to bypass the blockage. The gallbladder is usually surgically removed if the blockage is caused by gallstones. This procedure is called a laparoscopic cholecystectomy. Our physicians are experts in minimally invasive laparoscopic surgical techniques.

To schedule an appointment with a Penn gastroenterologist who can evaluate your mother's condition and recommend the best course of treatment, please call 800-789-PENN (7366) or you can also request an appointment online.

Monday, November 14, 2011

Should I Consult a Gastroenterologist or Gynecologist for Ulcerative Colitis?

Question:
I have left-sided ulcerative colitis. When I have flare ups, I notice that the left side of my abdomen is tender. Over the last couple of months, my mid-abdomen has become really tender and feels. It seems to get worse as my period approaches, and gets a little better as it ends and for about a week afterwards. My menstrual cycles have become increasingly shorter, as well. Should I see my gastroenterologist or my gynecologist?

Answer:
Ulcerative colitis is an inflammatory bowel disease that affects the rectum and large intestine. There are several different types of ulcerative colitis, which are classified by the extent of the inflammation and its location. Left-sided ulcerative colitis is characterized by inflammation beginning in the rectum and extending up the left colon, causing diarrhea, abdominal cramps, abdominal pain and weight loss.
Left-sided Ulcerative Colitis There are other types of ulcerative colitis that affect larger areas of the colon and could cause pain or tenderness over the mid-abdomen. I recommend first seeing your gastroenterologist, so he or she can determine whether or not your symptoms are related to the ulcerative colitis. Mark Osterman, MD, MSCE is a Penn gastroenterologist who specializes in inflammatory bowel disease. He can evaluate your symptoms and recommend the best course of action.

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

Friday, November 11, 2011

Can Ulcerative Colitis Develop Into Cancer?

Question:
I am 52 years old and was diagnosed with left sided ulcerative colitis in February, 2007. I believe I may have contracted a germ or been exposed to a bacteria in October of 2006—under unusual circumstances too long to explain here—that may have caused my colitis, though I have been told that there is no known cause of ulcerative colitis. I was initially on Asacol® for a number of months and then switched to Lialda™ (4.8g per day; later changed to 2.4g per day). For the most part, my colitis has been in remission.
In April, I had a colonoscopy and was told by my gastroenterologist that he removed two small polyps. I should also note that about one and a half yrs prior to my colitis diagnosis, I was diagnosed with type 2 diabetes, for which I have been on Metformin. Over the last number of weeks, I have had two bouts of constipation and diarrhea. Prior to the second diarrhea bowel movement, while I was having constipation, my gastroenterologist told me to take MiraLax®. Following the second diarrhea bowel movement, I had a bowel movement of small thin stools. When I told this to my gastroenterologist, he told me to take Citrucel® for five to seven days to add bulk to my stool.
I am now in day three and though I do not have constipation or diarrhea, my stool is still very thin. Also, I sometimes have to go back to the bathroom in a short time to complete my bowel movement. Is it possible that another polyp or obstruction could have developed since my last colonoscopy six months ago? Could I now have colon cancer? I have had faint discomfort in the left lower quadrant of my abdomen the last few days along with these thin bowel movements, in addition to very slight nausea.
Can colitis turn to cancer in less then two years? If in fact, it was bacteria in the environment that may have caused my colitis, could that precipitate my colitis turning into cancer at a faster rate than expected compared to the average case of ulcerative colitis? Should I request that my doctor perform a colonoscopy now – six months since my last one – rather than waiting until one year has elapsed?
Answer:
Ulcerative colitis is an inflammatory bowel disease that affects the rectum and large intestine. What causes ulcerative colitis is still unknown, but attacks can be brought on by a variety of things, including physical stress or respiratory infections. Colon polyps are growths of tissue that develop. They vary in size and shape and if they are not removed, there is a higher risk of colon cancer.
Since your doctor removed your polyps just six months ago, it is unlikely that additional polyps have developed because they take around five years to reach one half inch, and it takes another five to ten years to develop into cancer. Since you do suffer from ulcerative colitis, you have a higher chance of colon cancer developing – depending on the severity of your case. However, since you have a very involved case, I recommend you see Mark Osterman, MD, MSCE. Dr. Osterman specializes in inflammatory bowel disease. He can evaluate your condition and recommend the best course of treatment.
To schedule an appointment, please call 800-789-PENN (7366) or request an appointment online.

Thursday, November 10, 2011

What Vitamins Or Dietary Approaches Relieve Symptoms of Ulcerative Colitis?

Question:
My husband has been diagnosed with ulcerative colitis and his current course of treatment is the steroid prednisone and Lialda™. While we understand this is the common course of drug treatment, is there a vitamin and diet approach that would also relieve symptoms?

Answer:
Ulcerative colitis is a type of inflammatory bowel disease that affects the large intestine and rectum. The disease usually begins in the rectal area and may eventually extend through the entire large intestine. Diarrhea, abdominal pain and weight loss vary in severity and may start gradually or suddenly. The cause of ulcerative colitis is unknown, but risk factors include a family history of the disease. Treatment options consist of medication to control acute attacks and help the colon heal, and surgical removal of the colon.

Although ulcerative colitis is not caused by diet, watching what you eat can help reduce symptoms and promote healing. Patients should maintain good nutrition and can often eat a reasonably unrestricted diet. A low-roughage diet is often suggested for those prone to diarrhea after meals. Patients appearing to be lactose intolerant should avoid milk products. In addition, taking a multivitamin regularly may be recommended. However, each patient is different and your gastroenterologist is the best person to advise your husband about his care. Mark Osterman, MD, MSCE is a Penn gastroenterologist who specializes in inflammatory bowel disease.

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

Tuesday, November 8, 2011

What Are The Treatment Options For Crohn's Disease?

Question:
In May of 2007, I had a biopsy showing severe blunting of the villi in my small intestine. I was diagnosed with celiac disease. I had a double-balloon endoscopy (DBE) done in January for bleeding due to arteriovenous malformations (AVM) — seven areas were cauterized. After the DBE, I had chronic diarrhea for 30 days. Prednisone was prescribed - starting with 40 mg for seven days and reducing the dosage by 5 mg each day afterwards.

I was fine for three weeks and then the diarrhea returned. I started taking prednisone again, this time starting with 20 mg. I am down to 10 mg now. I am also on a gluten-free diet. My GI doctor said I might have Crohn's disease instead of celiac disease. My blood tests for celiac disease have always been normal. I am going to have a Prometheus IBD test done. What is this? What is the treatment for Crohn's disease? If I have Crohn's, can I assume that I do not have celiac disease?

Answer:
The PROMETHEUS® IBD Serology 7 is a blood test that helps your physician determine if you have inflammatory bowel disease (IBD), and if so, which type – ulcerative colitis or Crohn's disease. Crohn's disease is treated with a combination of medications and may eventually require bowel surgery. Crohn's disease is not directly related to celiac disease – it is possible to have both.

To make an appointment with a Penn gastroenterologist specializing in celiac disease and Crohn's disease, please call 800-789-PENN (7366) or request an appointment online.

Thursday, November 3, 2011

Are There Physicians At Penn Medicine Who Specialize In Crohn's Disease?

Question:
I've suffered with Crohn's disease for 23 years and have had a colostomy for 12 years. I would like to see a Penn doctor that specializes in Crohn's disease and colostomy.

Answer:
Faten Aberra, MD, is a Penn gastroenterologist who specializes in Crohn's disease. To schedule an appointment with Dr. Aberra, please call 800-789-PENN (7366) or you can also request an appointment online.

Tuesday, November 1, 2011

Is It Okay To Continue Taking Iron Supplements Before Undergoing a Sigmoidoscopy?

Question:
I am having a sigmoidoscopy procedure and I didn't stop taking my iron pills until two days before my procedure. Is that okay?

Answer:
Doctors ask their patients to stop taking any medications or supplements containing iron seven days prior to a sigmoidoscopy. Iron makes your stool very dark and may inhibit the internal examination of the lower large bowel.

To schedule a colonoscopy appointment with a Penn gastroenterologist who can perform a sigmoidoscopy procedure, please call 800-789-PENN (7366) or request an appointment online.