RB asks:
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.

Anil Rustgi, MD responds:
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.

Richard asks:
Is there a connection between having a colonoscopy procedure and then developing a spigelian hernia?

Anil Rustgi, MD responds:
A colonoscopy is an internal examination of the colon and large intestine, using an instrument called a colonoscope (a small camera attached to a flexible tube). The colonoscope is inserted through the rectum and advanced to the other end of the large intestine. Bleeding and puncture of the colon are rare but possible complications of colonoscopy.

A spigelian hernia — named for the Flemish anatomist Adrian van der Spieghel — is located just below the navel, to the side of the abdominal muscles. This type of hernia is relatively uncommon and tends to occur in patients around 50 years of age. This is no known connections between the colonoscopy and a spigelian hernia. In fact, there is usually no obvious cause of a hernia, although they are sometimes associated with heavy lifting.

To schedule an appointment with a Penn gastroenterologist who can evaluate your hernia and recommend the best course of treatment, please call 800.789.PENN (7366) or request an appointment online.

Arthur asks:
I'm constantly bloated. I have irregular bowel movement and there is a lump formed by the left side of my pelvis. What could be the problem?

Anil Rustgi, MD responds:
I recommend starting with your primary doctor. The lump may or not be the result of a gastrointestinal problem. Your doctor knows you best and based on the details of your symptoms, he or she can help diagnose the problem and if necessary, refer you to Penn Gastroenterology.

SK asks:
Last year, I turned 50 and had a colonoscopy. Since then, my stomach is always making gurgling noises – as though liquid is rushing through my intestines. I'm in great shape for my age. Can the colonoscopy procedure stretch or relax your intestines? Could my hormones be causing this? Is there a medical reason to have this checked out?

Anil Rustgi, MD responds:
A colonoscopy is an internal examination of the colon and large intestine, using an instrument called a colonoscope – small camera attached to a flexible tube. The colonoscope is inserted through the rectum and advanced to the other end of the large intestine. Bleeding and puncture of the colon are rare but possible complications of colonoscopy – this is accompanied by severe abdominal pain and rectal bleeding.

It is usually to your advantage to have any gastrointestinal changes checked by a physician. A Penn gastroenterologist can evaluate your symptoms and recommend a treatment plan if necessary.

It is important for anyone over 50 — or younger if you have a family history of colon cancer — to have a screening colonoscopy. Penn gastroenterologists perform this important test at several locations, including Penn Medicine at Radnor. To schedule an appointment, please call 800.789.PENN or request an appointment online.

Ruth asks:
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.

Anil Rustgi, MD responds:
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.

Ruby asks:
My nephew has been in the hospital several times with nausea and pain that makes him double over. Doctors cannot find out what is wrong and discharged him again. He has lost 40 pounds in about five months. They removed his gallbladder, but he still has the same symptoms. What can we do?

Roberta asks:
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.

Anil Rustgi, MD responds:
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.

Rob asks:
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?

Anil Rustgi, MD responds:
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.

Brent asks:
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?

Anil Rustgi, MD responds:
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.

Penny asks:
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?

Anil Rustgi, MD responds:
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.