Dale asks:
I have been diagnosed with colonic inertia and a sphincter problem. I have seen multiple GI doctors and surgeons — no one seems to have an answer to this other than an ileostomy. I am looking for another route.

I have been to sphincter therapy at Penn Medicine at Radnor. They tell me my sphincter is working, but the biofeedback checks "holding in" and not "pushing out." My quality of life has been greatly affected for the past two years. Any suggestions would be greatly appreciated.

Anil Rustgi, MD responds:
Colonic inertia is a type of functional constipation caused by a decrease in muscle activity in the colon. Functional constipation means that the bowel is healthy but not working properly. It stems from problems in the structure of the anus. These abnormalities result in an inability to relax the anal sphincters – the rectal and anal muscles that allow stool to exit.

An ileostomy procedure is a type of ostomy surgery in which a surgeon removes the colon and rectum, and attaches the bottom of the small intestine to the stoma (an opening in the abdomen), bypassing the bowel.

A Penn gastroenterologist specializing in motility and bowel disorders can examine you and recommend further diagnostic tests and treatment options. To make an appointment, please call 800.789.PENN or request an appointment online.

Rebecca asks:
I have a 7-centimeter liver hemangioma.  Do these ever shrink on their own?

Anil Rustgi, MD responds:
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.

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 therapy is known to reduce the size or eliminate hepatic hemangiomas — surgical removal is the only treatment.

Anna asks:
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?

Anil Rustgi, MD responds:
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.

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.