University of Pennsylvania Health System

Penn Gastroenterology Q&As

Friday, December 30, 2011

What are the Symptoms of Whipple's Disease?

Question:
I am at my wit's end with a GI condition that has yet to been diagnosed. I have lost 85 pounds in six months and am in constant pain. All blood work and tests have been negative except for an exploratory surgery which showed an enlarged spleen and accessory spleens (which were removed). My neurologist thinks I may have Whipple's disease — I have 14 out of the 16 symptoms, including non-epileptic seizures. I am progressively getting worse with weakness, joint pain, memory loss and ability to focus. I have an endoscopy scheduled with Penn Gastroenterology.

Answer:
An enlargement of the spleen beyond its normal size is called a splenomegaly. Because of its wide variety of functions, the spleen may be affected by infection, cancer, liver disease, parasites and many conditions involving the blood or lymph system. Extra "accessory" spleens are separate from and very much smaller than the main spleen. Failure to remove all of these tiny extra spleens may cause certain spleen problems.

Whipple's disease is an extremely rare condition in which an infection prevents the intestine from properly absorbing nutrients. This disorder primarily affects middle-aged white men, and the onset of symptoms is usually slow. Without treatment, it may be fatal. An endoscopy is a diagnostic test involving an endoscope (a medical device consisting of a camera mounted on a flexible tube). The endoscope is inserted through the mouth, anus or small incision. A sample of suspicious tissue is removed for testing. Based on the results of your endoscopy, your Penn gastroenterologist will suggest further tests and recommended treatment.

Thursday, December 29, 2011

What Causes Abdominal Pain in Patients with GERD and a Hiatal Hernia?

Question:
I am experiencing severe pain in the upper abdomen by the sternum area with pain in the back between both scapular muscles. I have a hiatal hernia and GERD. I do not experience GERD symptoms very often. About two years ago, I had my gall bladder removed. There were only a few very small stones, but my gallbladder was severely inflamed. I am confused as to what is going on inside of me and need direction on where to proceed to find out what is causing this pain.

 
Answer:
If you are experiencing severe abdominal pain, you should seek prompt medical attention. Tracking the following information will aid your doctor in a diagnosis:
  • When you have pain
  • Exactly where the pain is located
  • Type of pain (such as aching, stabbing, throbbing or cramping)
  • How long the pain lasts
  • What triggers the pain
  • What helps relieve the pain
  • How the pain affects you (such as limiting activities or missing work)

A Penn gastroenterologist can evaluate your condition and recommend the best treatment. To make an appointment, please call 800-789-PENN (7366) or you can also request an appointment online.

Tuesday, December 27, 2011

Need Diagnosis for Severe Nausea and Vomiting

Question:
My son is 45 and has been vomiting continuously for months. He also gets hot and cold sweats. He recently had his gall bladder removed but still getting sick – no matter what he eats. Please tell me what we can do.

Answer:
Pain and nausea are often associated with many types of gastrointestinal conditions. A gastroenterologist can properly diagnose these conditions and recommend the best course of treatment. To schedule an appointment with Penn Gastroenterology, please call 800-789-PENN (7366) or request an appointment online.

Friday, December 23, 2011

Need Diagnosis for Pain in Rib Cage Area

Question:
I am having pain on my right side under the rib cage and dry heaving during the night. I've had an x-ray, CT scan, ultrasound, and endoscope done – they could not find anything. Do you have any suggestions?

Answer:
Nausea and vomiting can be a symptom of many conditions. Pain near the rib cage can suggest a rib injury, but could be one of many conditions. If these diagnostic tests did not reveal the source of your problem, your doctor may consider an MRI (magnetic resonance imaging) test.

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

Tuesday, December 20, 2011

Need Diagnosis for Bloating and Chronic Diarrhea

Question:
I am a healthy 44 year-old male. Several months ago, I developed symptoms of bloating, lots of gurgling (even after eating) and chronic diarrhea. The gurgling seems to be located on my left side slightly above the belly button. I eat healthy food and quantity does not seem to affect symptoms. Any thoughts?

Answer:
Diarrhea and bloating are usually caused by bacteria, viruses, parasites, certain medicines, food intolerances and diseases that affect the stomach, small intestine or colon. If you are experiencing chronic diarrhea – lasting more than three days – you should see a gastroenterologist, as this may be an indication of a more serious problem.

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

Monday, December 19, 2011

What Treatment Options Exist for "Frozen Pelvis?"

Question:
My mother-in-law has something called a "frozen pelvis." She has had surgeries but nothing relieves the pain. Now she is on TPN and still vomiting. Is this something you deal with?

Answer:
A “frozen pelvis” usually refers to marked inflammation within the pelvic tissues, the most common cause being endometriosis. Endometriosis is a gynecological condition that can cause widespread problems, including bowel problems. She should see a gynecologist and colorectal surgeon.

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

Thursday, December 15, 2011

Is it Possible to Have Carcinoid Tumors that do not show up on CT Scans?

Question:
Is it possible to have carcinoid tumors that do not show up on a CT scan of the abdomen? I have had bad flushing, wheezing and diarrhea for one and a half years. A CT scan showed multiple non-specific lymph nodes in mesentery, a possible hematoma on left side of the liver and a sub-centimeter hyper vascular lesion on the posterior right side of the liver. My GI doctor said he can't think of anything that would be causing my symptoms.

Answer:
Carcinoid tumors are very small, slow growing tumors of neuroendocrine origin, most commonly found in the gastrointestinal system. Due to their slow-growing nature, it often takes many years before symptoms present in a patient. These tumors can excrete an overload of hormone like substances that cause a wide variety of symptoms resulting in carcinoid syndrome. This syndrome manifests itself by causing flushing of the face and upper chest, diarrhea, and difficulty breathing (wheezing).

Urine and blood tests, as a first step, are beneficial in identifying specific excretions of tumors. In addition, a CT scan may be used to determine whether or not a tumor is present. Occasionally, a diagnostic procedure called an OctreoScan® picks up a missed tumor. This test involves injecting a nuclear tag, which attaches to tissue usually found in carcinoid cancers. David Metz, MD and Gregory G. Ginsberg, MD are Penn gastroenterologists who specialize in neuroendocrine tumors. They 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.

Tuesday, December 13, 2011

Are Cancer Patients at Penn Medicine Educated About the Importance of Good Nutrition?

Question:
My son is being treated at Penn for cancer of the esophagus, which has spread to his stomach. He is on radiation and chemotherapy (pill form). I am concerned over the lack of appetite he is now experiencing. I keep impressing upon him the need for essential vitamins to fight the cancer. Are patients educated about the importance of good nutrition?

 
Answer:
Esophageal cancer is a malignant (cancerous) tumor of the esophagus, the muscular tube that moves food from the mouth to the stomach. If the patient cannot tolerate surgery or the cancer has spread to other organs, chemotherapy or radiation may be used to help reduce symptoms. If your son is having difficulty swallowing or has a decreased appetite, the following measures may help:
  • Avoiding acidic, salty, spicy and rough foods.
  • Drinking liquid nutrition supplements such as Ensure®, Boost®, or Carnation Instant Breakfast® to increase protein and calorie intake.
  • Mixing food with butter, thin gravies and sauces to make it easier to swallow.
  • Trying soft, blended foods such as casseroles, ice cream, yogurt, cheesecake, mashed potatoes, spaghetti with cream sauce, soups and eggs.
  • Trying foods with a variety of tastes and textures. Tolerance for foods constantly changes during treatment.
  • Using a blender or trying baby foods.

Monday, December 12, 2011

Are There Physicians at Penn Medicine Who Specialize in Gastrointestinal Stromal Tumors?

Question:
Are any of the gastroenterologists on staff at any of the three hospitals that make up the University of Pennsylvania Health system familiar with gastrointestinal stromal tumors, otherwise known as GIST? My family is one of only 2 that are included in a genetic study being conducted at Sloan Kettering in New York.

Answer:
Gastrointestinal stromal tumor (GIST) is a very rare cancer affecting the digestive tract or nearby structures within the abdomen. Known as a sarcoma, GIST is a cancer that grows from cells of the body's connective or supportive tissues such as bone, cartilage, tendons, nerves, fat, muscle, synovial tissue or blood vessels. Random genetic mutations are the apparent cause of GISTs, as there are no known environmental or behavioral risk factors contributing to the cancer. Nuzhat Ahmad, MD specializes in gastrointestinal cancers, including GIST, using endoscopic ultrasound. She sees patients at the Hospital of the University of Pennsylvania.

You can make an appointment with Dr. Ahmad by calling 800-789-PENN (7366) or you can also request an appointment online.

Thursday, December 8, 2011

Why Do I Still Have Pain After Gallbladder Surgery?

Question:
I had gallbladder surgery in October. I felt great for several weeks, but then the same pain I had prior to surgery came back. Is it possible I could now have sphincter of Oddi dysfunction? I still have right quadrant pain with elevated liver tests.

 
Answer:
It is not uncommon to have lasting pain in the upper right quadrant after gallbladder removal. This pain can have a number of different causes, such as:
David A. Ingis, MD, FACG, is a Penn gastroenterologist who can evaluate your condition. To make an appointment, please call 800-789-PENN (7366) or request an appointment online.

Tuesday, December 6, 2011

Do I Need to Watch My Diet After Having My Gallbladder Removed?

Question:
I had my gallbladder removed a week ago. Do I need to watch my diet or can I eat everything I used to before?

Answer:
After a gallbladder removal surgery (cholecystectomy), you should consume a low-fat diet, but no major diet change is necessary. Some foods to reduce or avoid:
  • Coffee
  • Fried food
  • Red meat
  • Dairy products (Eggs, milk, cheese)
Some foods that promote good digestion:

  • Fruits
  • Vegetables 
  • Lemon juice
  • Fish (mackerel)
If you have difficulty with digestion when following these healthy eating suggestions, it may be beneficial to speak with a gastroenterologist. To schedule an appointment with a gastroenterologist at Penn, please call 800-789-PENN (7366) or request an appointment online.

Monday, December 5, 2011

Should I have my Malfunctioning Gallbladder Removed?

Question:
I have been diagnosed with a malfunctioning gallbladder with an ejection rate of five percent with no stones. I recently had a flare up and ended up in the ER. The ER suggested I see a gastroenterologist. I had an endoscopy that came back clean as well as a CAT scan and ultrasound. A HIDA scan caught the abnormality. My GI doctor says that I should have my gallbladder removed. What are your feelings on this?

Answer:
To determine whether or not the removal of your gallbladder is necessary, a doctor needs to evaluate the frequency and severity of your symptoms. You should see David Jaffe, MD, a Penn gastroenterologist with expertise in the gallbladder from a medical viewpoint, who can evaluate your condition and make a treatment recommendation, please call 800-789-PENN (7366) or request an appointment online.