Gastroenterology | Q&A | General GI Topics | Penn Medicine

What could be the cause of prolonged constipation?

2013-08-13T12:00:00.000-04:00

Question: My 19 year-old daughter started the paleo diet. When she began adding foods, she started to have severe abdominal pain and nausea. She went to the ER on Wednesday night and the doctor told her she was constipated and needed to have a bowel movement. They gave her Dicyclomine, Bentyl (20 mg) for pain, Ondanestron (4 mg) and Polyethylene Glycol 3350 Powder (17 mg). She took the Polyehthylene Glycol powder as directed. She went to the regular nurse practitioner on Friday morning and she had her mix the entire bottle into 64 ounces of Gatorade and drank it all. She also gave her a rectal exam and did not feel any blockage. She drank the mixture Friday morning and also gave herself an enema.

It’s now Saturday morning and she has not yet had a bowel movement. She is very bloated. How long should she wait? Is it possible she has a blockage? Should I take her to see a gastroenterologist on Monday or to the ER now or just wait for the powder to work? She also wants to go to work for fear she will be fired for missing another day.

Answer: Given your daughter's prolonged constipation, please do seek follow up with her physician and consulting gastroenterologist to alleviate the situation, and to initiate an evaluation thereafter.

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

What are warning signs of a hemorrhoid?

2013-08-12T12:00:00.000-04:00

Question: I have had small to no bowel movements since my gallbladder surgery four years ago. I recently started passing reddish mucus. Do I have a hemorrhoid?

Answer: It is difficult to say. I would have a gastroenterologist evaluate for further diagnostics and management.

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

Can I take blood pressure medicine prior to an upper endoscopy?

2013-08-12T09:00:00.000-04:00

Question: Can I take blood pressure medicine with a sip of water the morning of an upper endoscopy?

Answer: To properly prepare for your procedure, you may need to make certain changes to your daily medication routine. Do not take anything by mouth for at least four hours prior to your procedure, but I would suggest discussing this with your gastroenterologist first.

For more detailed information, please view the Penn Gastroenterology guidelines for upper endoscopy preparation.

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

What could be the cause of a slow GI system?

2013-08-09T10:34:00.001-04:00

Question: I have GERD, esophageal and colon spasms, and slow stomach emptying. My system is so slow; I don’t start cleaning out for colonoscopy prep until 24 hours after taking it. I have had multiple tests done and I am convinced this is a disorder of my entire digestive tract my mom and son have the same issues. No one can give me a diagnosis that explains all of my symptoms. Any ideas as to what is wrong with me?

Answer: Of course, it is important that you coordinate evaluation and management through your internist and gastroenterologist. Given the brief description and not being privy to details, it would be important to determine if there is a global GI dysmotility, which can be due to diabetes mellitus, a connective tissue disorder (e.g. scleroderma), an autoimmune disorder and I would ensure no current medication(s) are contributory. Thus, these suggestions may warrant consideration.

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

What do you do if you are unable to burp?

2013-08-09T10:33:00.000-04:00

Question: My daughter is 16 years-old and has not burped since she was born. She gets bloated, her stomach aches after eating, and she suffers moderate pain and discomfort. Is there a cure or medication to fix this problem?

Answer: I would recommend that your daughter see a pediatric gastroenterologist to determine if there is any lactose intolerance, celiac sprue or gastroparesis.

If you wish to discuss further or to schedule a consultation with a Penn physician, please call 800-789-PENN (7366) or request an appointment online.

Is one probiotic supplement more effective than the rest?

2013-06-21T08:57:00.002-04:00

Question: Is one probiotic supplement more effective than the rest?

Answer: There are different types of supplements: probiotics as well as prebiotics. These, along with antibiotics, change the gut microflora (referred to as the gut microbiota), both in health and in disease. With respect to prebiotics and probiotics, it is not clear if those that are available are necessarily better compared to each other. However, bear in mind, clinical studies would be quite complicated to ascertain this as such studies would have many variables and complicated outcomes.

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

What could be the cause of a granuloma?

2013-06-21T08:55:00.002-04:00

Question: My doctor reported that I have a calcified granuloma in my liver, after I had a CT for complaints of deep pain in my upper right abdominal quadrant. There is no plan for further investigation. Should there be an effort by my GP to determine the underlying cause of this granuloma?

Answer: There is no need for further evaluation of this calcified granuloma. Please ensure that your liver enzymes were evaluated and that you have no gallstones as well.

If you wish to discuss further or to schedule a consultation with a Penn physician, please call 800-789-PENN (7366) or request an appointment online.

What could be the cause of persistent abdominal discomfort?

2013-06-05T08:46:00.003-04:00

Question: I have had moving abdominal discomfort for 1.5 months which tends to come and go (mostly center and right). My liver panel had 2.7 and .9 bilirubin levels and my ultrasounds were clear, no jaundice. I have been on Simvastatin® and Zetia® for 2.5 months. Any ideas?

Answer: I would suggest going to see your local gastroenterologist or hepatologist. The abdominal discomfort may represent a variety of things. It would appear that you have an indirect hyperbilirubinemia or Gilbert's syndrome, which is quite common, but we would need to verify.

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

What is the cause of regular, excessive gas and bloating?

2013-06-05T08:44:00.003-04:00

Question: What would possibly cause regular, excessive gas and bloating to the point of a hard distended stomach, lots of burping, foamy excessive saliva that needs to be spit out and smells horrible and red blood in stool?

Answer: This may be due to a small bowel bacterial overgrowth. For this, we recommend a hydrogen breath test (Lactulose). In regards to the red blood in your stool, if age appropriate, then a colonoscopy would be recommended. I am not certain about the salivary complaint, but would suggest scheduling a consultation with a Penn physician.

It is best to discuss any questions with your internist or gastroenterologist to thoroughly evaluate these concerns and to receive the appropriate recommendations. To schedule a consultation with a Penn physician, please call 800-789-PENN (7366) or request an appointment online.

What can I eat prior to an Upper GI series procedure?

2013-04-26T09:50:00.001-04:00

Question: I was told that I could have toast with jelly the day before my Upper GI series. Could I have butter instead of jelly?

Answer: An upper GI series is an x-ray procedure designed to examine the esophagus, stomach and duodenum. After these organs have been relaxed by medication and distended with gas, a thin coating of barium suspension is applied to outline their inner surfaces.

It is very important to fast for the requested time before an upper GI series; Penn Gastroenterology gives our patients the following instructions:

Preparation: The presence of food or fluid materials would interfere with the accuracy of the examination. It is therefore necessary to avoid all intake of food or liquid from 9pm of the day preceding your appointment.

After Care: Resume your normal diet. Increase fluid intake and drink plenty of water.
For most patients with normal bowel habits, the passage of barium in the form of "white stools" will present no problem. Patients with a history of constipation may use a mild laxative.

For more detailed information on patient preparation view the full instruction manual.

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

What could be the cause of persistent diarrhea?

2013-04-18T16:05:00.000-04:00

Question: I am experiencing symptoms that include: sweating, clamy, hot and cold, cramping and fast heart rate. I have also had diarrhea twice in one week and frequently throughout the year. Could I have a serious problem?

Answer: You should seek evaluation with a gastroenterologist related to complete history, physical exam, blood tests, urine tests, imaging studies and endoscopic studies. It would be important to ensure there is no release of “hormones” that can trigger the diarrheal state.

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

What do you recommend for treating sessile polyps?

2013-04-09T17:00:00.000-04:00

Question: Due to right lower quadrant pain three weeks ago, a CAT scan was done that showed inflamed ileum. One week ago, a colonoscopy revealed normal ileum and diverticular disease. An upper endoscopy showed multiple semi-sessile polyps. I have been on proton pump inhibitors (PPI) for GERD for three years. A biopsy indicated no crohn’s or celiac disease. I have a family history of first degree relatives with esophageal and colon cancer that are deceased. There was no recommendation for a follow up for sessile polyps. I am looking for a GI doctor at Radnor for the above diagnosis.

Answer: It is best to see a gastroenterologist to thoroughly evaluate these concerns and recommend a course of treatment. Dr. David Jaffe and Dr. Octavia Pickett-Blakely are available for appointments at Penn Medicine Radnor. To schedule a consultation, please call 800-789-PENN (7366) or request an appointment online.

What type of doctor can help with constipation?

2012-10-25T16:17:00.001-04:00

Question: I have lost the urge to have a bowel movement and also cannot force out stool. How do I find a doctor who can help me locate the source of the problem and appropriate treatment?

Answer: The frequency of bowel movements among healthy people varies from three movements a day to three a week. Individuals must determine what is normal for them. As a rule, constipation is suspected if more than three days pass between bowel movements, or if there is difficulty or pain when passing a hardened stool.*

It is best to see an internist or gastroenterologist to evaluate these symptoms. To schedule a consultation with a Penn gastroenterologist, please call 800-789-PENN (7366) or request an appointment online.

* http://www.gastro.org/patientcenter/digestiveconditions/AGAPatientBrochure_Constipation.pdf

Does Excedrin® Damage the Intestines?

2012-09-18T15:38:00.000-04:00

Question: Will taking Excedrin® five to six times a month be harmful to my intestines?

Answer: Without knowing the exact dosage, this sounds ok, but you may want to review this with your doctor. It's best to try to avoid excessive amounts of drugs containing aspirin. To make an appointment with a Penn gastroenterologist, please call 800-789-PENN (7366) or request an appointment online.

What Causes Severe Constipation?

2012-08-14T11:12:00.000-04:00

Question: My daughter recently started with constipation. After three days, she also stopped urinating. It has now been 14 days since she urinated or has had a natural bowel movement on her own. The doctors have taken an MRI of her spine with contrast, and have done blood work and urine cultures. They are baffled. Any ideas as to what could be causing this?

Answer: Constipation is defined by three bowel movements or less in a week. The possible causes are many. Sometimes, constipation can lead to more serious complications. Your daughter should be evaluated by a gastroenterologist. To make an appointment at Penn Medicine, please call 800-789-PENN (7366) or request an appointment online.

Do I Have a Bowel Obstruction?

2012-08-02T11:19:00.001-04:00

Question:
My digestion is fine and I've been eating a lot of fiber, but for the past month and a half there seems to be an obstruction in my bowel movements. I have narrow stools and gas. I always need to drink a lot of water in order to pass my movement. It seems like there is something in the way. Could it be something temporary?

Answer:
An intestinal obstruction (also called a bowel obstruction) occurs when food or stool cannot move through the intestines. The obstruction can be complete or partial. A complete obstruction is a medical emergency. There are many causes and the symptoms can be severe.

As with all digestive concerns, it is best to see a gastroenterologist for a complete evaluation. To make an appointment at Penn Medicine, please call 800-789-PENN (7366) or request an appointment online.

How Long Will I Feel Pain After A Gallstone Attack?

2012-02-29T13:22:00.001-05:00

Question:
I recently suffered a gallstone attack. My symptoms were intense pain under my right rib cage, diarrhea and chills. My ultrasound indicated gallstones were not blocking my ducts, but they were traveling and causing intense pain.

My blood work showed an elevated white blood cell count. My gallbladder is not diseased or inflamed. My pain has dramatically improved; however, I am still tender and sore. It has been three days since my attack and I was wondering when I will feel better?

Answer:
After a gallstone attack it is normal to be sore for a few days, but if the soreness lasts for more than a week it is probably wise to see a doctor again. 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.

Should High Levels Of B12 Be A Cause For Concern?

2012-02-28T13:24:00.001-05:00

Question:
I recently had my yearly complete blood count that showed a level of 195 for B12. All other readings were normal. My doctor sent me to a stomach specialist and I am still awaiting test results. Other than some irritable bowel symptoms when I was young, I have had no other stomach problems. Is this something to worry about? People often mention stomach cancer when I mention low B12.

Answer:
To ease your mind from the start, a low B12 level is not typically an indicator of stomach cancer. Some possible causes are the following:

Diet low in B12 – usually lacking meat, fish, eggs or dairy products
Previous abdominal or intestinal surgery that affects absorption
Crohn's disease
Tapeworm infection
Malabsorption disorders
Pernicious anemia

Further testing is necessary to narrow down the cause of your B12 deficiency. 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.

Should I Worry About Having A Lemon-Sized Hiatal Hernia?

2012-02-27T13:35:00.001-05:00

Question:
I was recently told I had a hiatal hernia the size of a lemon. I was told not to be concerned until it gets to be the size of a grapefruit. Is this true?

Answer:
A hiatal hernia occurs when part of your stomach presses upwards into your diaphragm — a sheet of muscle across the bottom of the rib cage through which the esophagus passes. When you swallow, food moves through the esophagus into the stomach for digestion.

The larger the hiatal hernia is, the greater the chance that the hernia will impede food and acid from traveling through the esophagus. This can cause reflux and chest pain. It may be helpful to get a second opinion in regards to whether your hernia requires immediate treatment or not.

If you would like to schedule an appointment with a Penn gastroenterologist, Sanford L. Herold, MD, can consult with you and recommend next steps.

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

Does Anyone At Penn Medicine Specialize In Treating Parasitic Infections?

2012-02-23T13:38:00.001-05:00

Question:
A year ago, I went to southeast Asia. I believe that I have a parasitic infection as a result of that trip. I have various symptoms, but no one knows what to look for or how to find it. Does anyone at Penn specialize in finding and treating parasites?

Answer:
David Ingis, MD is a Penn gastroenterologist who can evaluate your symptoms and recommend a treatment plan.

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

What Can I Do To Alleviate Loud Noises During Digestion?

2012-02-22T13:44:00.001-05:00

Question:
I have growling and gurgling in my upper and lower abdomen that does not correlate with a specific action or food. I was diagnosed with celiac disease in 2008, but it turned out to be a misdiagnosis. I eat healthy and take care of myself, but I am never completely free of this problem.

Answer:
Stomach noises like gurgling and growling are typically signs of normal digestion. They can occur before, during or after meals. When the body is hungry, the stomach and intestines begin to contract and release acids and digestive fluids into the digestive system, which causes the noises. The thought, sight or smell of food is enough to trigger the digestive system to act. Sometimes excessive stomach noises can be a sign of irritable bowel syndrome (IBS), but IBS is usually accompanied by other symptoms like bloating, cramping or diarrhea.

To schedule an appointment with Dr. David Ingis, MD, a Penn gastroenterologist who can determine the cause of your symptoms, please call 800-789-PENN (7366) or you can also request an appointment online.

What Treatment Options Exist For Divertiulitis?

2012-02-21T13:47:00.001-05:00

Question:
My mom is concerned about the following symptoms: lower back and stomach pain, gas, constipation, mucus and blood in her stool. She has diverticulitis, but the pain and symptoms are not going away with medication.

Answer:
Diverticulitis occurs when diverticula – small, bulging pouches in the digestive tract that are common in adults over age 40 – become infected or inflamed. Mild diverticulitis can be treated with diet changes, rest and antibiotics. More severe cases may require surgery to either remove the diseased part of the colon or to drain the abscess formed by the infection. Since the pain has sustained over time, I recommend seeing a gastroenterologist.

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

Need A Diagnosis For Constant Vomiting And Diarrhea?

2012-02-20T13:49:00.001-05:00

Question:
I have been having pain on my right side for about a month that is especially painful at night. In the morning I vomit bile and have diarrhea. I have gone to my primary physician and had blood work done, which comes back normal. I had a laparoscopy done, but now they are sending me to get an MRI. I was given a prescription for Nexium®, but I've had no improvement. The doctors seem baffled. Do you have any ideas?

Answer:
Right-sided abdominal pain, vomiting and diarrhea can independently indicate a variety of conditions, such as gallstones or gastroesophageal reflux disease (GERD), among others.

To schedule an appointment with Dr. David Ingis, MD, a Penn gastroenterologist who can evaluate your symptoms, please call 800-789-PENN (7366) or request an appointment online.

Need A Diagnosis For Constant Stomach Pain.

2012-02-17T13:53:00.001-05:00

Question:
I am 38 years old. Three months ago I started having severe stomach pains on my right side. I had a colonoscopy during which my doctor found seven polyps, but he said everything looked good. I was concerned about IBS, but he said I didn't have it. I ruled out gastroenterology problems until I had a laparoscopy done two weeks ago and scar tissue was found on my small and large intestine.

I was told by this doctor he didn't know why I have scarring since I've never had GI surgery. I am still in a lot of pain on my right side, but my doctor wants me to give it time to heal and see if the pain goes away. What could this be? And is it normal to still have this much pain?

Answer:
There are a number of different problems that can cause pain on your right side, but if you are experiencing severe abdominal pain you should seek prompt medical attention. Some of the pain you're having now may resolve itself once your abdomen is completely healed from the laparoscopy.

Keeping track of your symptoms will help your doctor form a diagnosis:

When do you have pain?
Exactly where is the pain is located?
What type of pain (such as aching, stabbing, throbbing or cramping)?
How long does the pain lasts?
What triggers the pain? What helps relieve the pain?
How does the pain impact your life (such as limiting activities or missing work)?

Kashyap Panganamamula, MD is a Penn gastroenterologist who 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.

Are There Physicians at Penn Medicine who Specialize in Distached Intestines?

2012-02-16T13:56:00.001-05:00

Question:
I have been diagnosed with a floater. My organs are not attached to my abdominal wall. So my intestines float and get twisted up. I would like to know what specialist or who is experienced in this situation to seek medical care.

Answer:
I recommend you schedule an appointment with a Penn gastroenterologist who can evaluate your condition.

Please call 800-789-PENN (7366) or request an appointment online.