Gastroenterology

Gastroenterologists and physicians writing on KevinMD about digestive disease: colonoscopy and when to stop screening, celiac disease and gluten, the liver, pancreatic enzyme insufficiency, the tests marketed for leaky gut, and what patients are fed in hospitals. Board-review cases make up part of this archive. One maintained record draws on this archive: Cancer: what physicians say, in their own words.

Your on-call doctor probably didn’t receive training in telephone medicine

Michael Kirsch, MD

Physician

May 3, 2017

Physicians spend a lot of time counseling patients on the phone. Often, these conversations occur at night with patients we have never met before. When I am on-call in the evenings or on the weekends, these are some typical phone calls I receive from patients I have never met.

I have a very bad stomach ache for the last hour.
I started having rectal bleeding an hour ago.
My wife tells …
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Your on-call doctor probably didn’t receive training in telephone medicine

MKSAP: 68-year-old man with new-onset ascites

mksap

Conditions and Diseases

April 22, 2017

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 68-year-old man is evaluated for new-onset ascites with lower-extremity edema. Symptoms have increased gradually over the past 4 weeks. He has consumed three alcoholic beverages per day for many years. His medical history is notable for coronary artery bypass graft surgery 8 months ago and dyslipidemia. His medications are low-dose aspirin, atorvastatin, …

Baby boomer? Why aren’t you getting tested for hep C?

J. Leonard Lichtenfeld, MD

Conditions and Diseases

April 11, 2017

Are you a baby boomer? Have you been tested for hepatitis C virus (HCV)? Do you know why you should be tested for hepatitis C? Do you even know what hepatitis C is?

According to research published by my colleagues from the American Cancer Society in the American Journal of Preventive Medicine, the odds are overwhelming that if you are in the boomer generation …

When should you introduce gluten to your baby?

Maureen Leonard, MD

Conditions and Diseases

March 28, 2017

Infants with a first-degree relative (parent or sibling) with celiac disease, and who carry an at-risk (DQ2 or DQ8) gene, have a higher risk of developing the autoimmune disorder triggered by gluten-containing foods. Many parents, especially those with a family history of celiac disease, are understandably nervous about introducing gluten into their child’s diet. They wonder whether there is an ideal time to introduce gluten, if they can prevent celiac …

MKSAP: 28-year-old man with elevated liver chemistry test result

mksap

Conditions and Diseases

March 18, 2017

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 28-year-old man is evaluated in follow-up for elevated liver chemistry test results, which were performed to assess a 3-month history of fatigue. He has no history of liver disease and has not had abdominal pain or fever. His medical history is significant for a 3-year history of diarrhea. Following a physical exam, …

MKSAP: 30-year-old woman with diarrhea

mksap

Conditions and Diseases

March 4, 2017

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 30-year-old woman is evaluated for a 2-month history of diarrhea with three to five loose stools per day. She has mild abdominal cramps, bloating, intermittent nausea, and mild anorexia that has resulted in the loss of 2.3 kg (5.0 lb). She has had no fever or blood in the stool. She works …

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MKSAP: 30-year-old woman with diarrhea

Help your IBS symptoms with a low FODMAP diet

Katherine Freeman, MD

Conditions and Diseases

February 27, 2017

FODMAP what? Have you heard? It’s the new dietary approach for the bloating and belly cramps seen with irritable bowel syndrome (IBS).

IBS affects one in seven Americans. It’s a gut condition which affects the flora in the bowels and causes abdominal pain, cramping, diarrhea or constipation, bloating, gas and overall discomfort and misery. It can be life changing and debilitating; jeans and Spanx don’t stand a chance!

IBS has been …

Do patients with celiac disease need probiotics?

Maureen Leonard, MD

Conditions and Diseases

January 28, 2017

One of the most common questions that I receive from patients diagnosed with celiac disease is if they should take a probiotic. The only available treatment for celiac disease, an autoimmune disease characterized by destruction of the absorptive surface of the small intestine which develops in genetically compatible individuals, is a gluten free diet. However, patients and providers often question whether supplementation with probiotics may hasten the healing process.

Probiotics are …

A young child’s diagnosis of celiac disease. And her mother’s reaction.

Kimberly Greene-Liebowitz, MD

Physician

January 7, 2017

“Do you think she’ll have it?”

My husband and I lay in bed the night before Kol Nidre, cocooned by darkness. In the adjacent room, my son muttered as he dreamed. Further away, my daughter slept silently. During the Days of Awe, I should have been thinking about repentance, and being inscribed in the Book of Life, but I was distracted.

He turned towards me, though he couldn’t really see me, even …

MKSAP: 29-year-old man with ulcerative colitis

mksap

Conditions and Diseases

January 7, 2017

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 29-year-old man is evaluated during a routine examination. His medical history is significant for ulcerative colitis involving the entire colon, which was diagnosed 4 years ago. His symptoms responded to therapy with mesalamine and have remained in remission on this medication. His family history is significant for a maternal uncle who died …

MKSAP: 68-year-old woman with progressive abdominal distention

mksap

Conditions and Diseases

December 24, 2016

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 68-year-old woman is evaluated for a 3-month history of gradually progressive abdominal distention. Her medical history is notable for a 20-year history of obesity, type 2 diabetes mellitus, hyperlipidemia, and hypertension. She also has had a 10-year history of elevation of serum aminotransferase levels, which was attributed to nonalcoholic fatty liver disease. …

Flash sale: A $49 colonoscopy

Michael Kirsch, MD

Physician

November 10, 2016

Cleveland took a major economic hit a few years back when United Airlines cut most of its flights from our city. An airport is the heart of a metropolis. Lack of direct flights means that business meetings, leisure travel, conventions and trade shows will likely opt for more convenient locales. This was a business decision for United which I am sure was rational. Nevertheless, their gain was our loss.

As a …

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Flash sale: A $49 colonoscopy

MKSAP: 25-year-old woman with diarrhea for 2 days

mksap

Conditions and Diseases

October 22, 2016

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 25-year-old woman e-mails her internist from Mexico with a report of diarrhea for 2 days. She is traveling and reports three to four loose bowel movements per day. She has been dining in the hotel restaurants but has also consumed foods and bottled soft drinks served with ice from local food vendors.

She …

Transplantation for alcoholic liver disease: 6-month rule or death sentence?

Robert S. Brown, Jr., MD, MPH

Conditions and Diseases

October 18, 2016

Liver transplantation for alcoholic liver disease has been controversial since the advent of the procedure. The perception that alcohol-related liver disease is self-inflicted combined with concerns of a high risk of recidivism to alcohol use, recurrent alcoholic liver disease, and non-compliance post-transplant has led a lack of support for transplantation for alcoholic patients in the public and among physicians. After initially avoiding transplants in this group of patients, the majority …

MKSAP: 68-year-old woman with gradually progressive abdominal distention

mksap

Conditions and Diseases

September 24, 2016

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

What PPIs and the Kardashians have in common

Dr. Paul Moayyedi

Conditions and Diseases

August 24, 2016

The science we conduct often reflects the society we live in. One phenomenon of current society is the rise of the reality television show. Participants are promised instant media fame without having to struggle through acting school. I worry that this has rubbed off on some of the studies we now conduct. Sir Richard Doll and Austin Hill, the architects of modern epidemiology, realized that it was hard for epidemiology …

If you think doctors make too much money, think about this

Michael Kirsch, MD

Physician

August 23, 2016

Years ago on Cape Cod, my kids and I stumbled across a man who had spent the day creating a sand sculpture of a mermaid. It was an impressive piece of art.

“How long did it take you to make it?” we asked. While I can’t recall his precise words, the response was something like “25 years and 7 hours.” I’m sure my astute readers will get his point.

We are transfixed …

How much thought do you give to health literacy?

Darrell M. Gray, II, MD, MPH

Physician

August 21, 2016

It’s Friday afternoon at 4 p.m., and Mr. Anderson walks into my endoscopy suite as the last patient of the day. He’s a 65-year-old publicly-insured male who presents for a screening colonoscopy. He’s 20 minutes late, because he went to registration in the surgery department. He is convinced “looking for cancer” requires surgery.

In triage, the nurses learn that he has held his Coumadin for five days as personally instructed by …

When should physicians lie for patients?

Michael Kirsch, MD

Physician

August 17, 2016

Even the most honest among us do not tell the truth all of the time. We are flawed human beings. We covet, we gossip, we steal, we lie, and we stand idly by. You don’t think you steal? Have you ever “borrowed” someone else’s idea and represented it as your own?

A few weeks before I penned this, I was presented with two opportunities to lie in order to save a …

After a medical error: Here’s what clinicians should do

Betsy M. Cohen

Patient

August 14, 2016

I have been a rehabilitation specialist and case manager working with patients who have neurological and neuropsychiatric impairments for thirty years. About three years ago, my life took an unanticipated detour when I was perforated during a baseline colonoscopy. All of my experience as a case manger and patient advocate could not prevent this error or the others that followed.

Although my health, body, and life were forever altered by the …