ONEILL asks:
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?

Anil Rustgi, MD responds:
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.

Marge asks:
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?

Anil Rustgi, MD responds:
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.

Dotcomer asks:
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?

Anil Rustgi, MD responds:
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.

Bhanu asks:
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.

Anil Rustgi, MD responds:
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.

Tracy asks:
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?

Anil Rustgi, MD responds:
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.

Harry asks:
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?

Anil Rustgi, MD responds:
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.

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

Anil Rustgi, MD responds:
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.

Phyllis asks:
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.

Anil Rustgi, MD responds:
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:

• Upset stomach, nausea and vomiting.
• Gas, bloating and diarrhea.
• Persistent pain in the upper right abdomen.

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.

Janice asks:
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?

Anil Rustgi, MD responds:
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.