WHAT NEXT?

[ROBETTE]

I HAD SURGERY ON OCT 25, WHICH COMPLETED A HYSTERECTOMY. SINCE THE FIRST WEEK IN NOV I HAVE BEEN UNABLE TO KEEP SOLID FOOD DOWN. FIRST IT WAS THOUGHT THAT THE PAIN MEDICATION WAS CAUSING THIS SO I STOPPED THE PAIN MEDICATION. I WENT TO MY GYN AND WAS GIVEN PHENEGRAN PILLS AND SUPOSITORIES.THIS DID NOT HELP AND THEN IT WAS THOUGHT THAT I MIGHT HAVE ACID REFUX,(NO ACID COMING UP AND NO HEARTBURN)I WAS THEN GIVEN PREVACID NO HELP.I HAVE HAD AN UPPER GI,(SHOWED REFUX),GALLBALDDER ULTRASOUND, NORMAL, I HAVE CON'T TO REGURITATE ALL SOILDS. GI DR. HAS DONE AND ENDOSCOPE WHICH SHOWED IRRITATION. BEEN IN THE HOSPITAL TWICE FOR FLUIDS. I HAVE HAD THE HIDA SCAN, GASTRIC EMPTYING,MOTILTIY &24 HR PH WHICH LASTED AN HR. BECUZ I THREW UP THE PROBE WHEN TOLD TO EAT. I HAVE BEEN ON REGLAN, BUSPAR AND NINE OTHER DIFFERNT KINDS OF MEDS WITHOUT ANY POSTIVE RESULTS. I HAVE DULL PAIN UNDERNEATH RIGHT RIB CAGE. WAS TOLD THAT THIS COULD BE HORMONAL INBALANCE. HAD THIS CHECK OUT AND ON DIFFERNT HORMONE PILLS. I AM LOSING MY MIND I HAVE LOST 30 LBS AND COUNTING. WHAT ELSE IS LEFT? I GO TO DR ON WED FOR RESULTS OF MOTILTIY TEST WHICH NURSE SAYS SHOWS SOME PRESSURE AROUND THE SPHINTER MUSCLE. WHAT QUESTIONS DO I NEED TO ASK? WHAT ELSE IS LEFT? I AM LOSING MY LIFE. PLEASE SOMEBODY....

[Kevin Pho, MD]

Hello - thanks for asking your question.  

I cannot diagnose you over the internet - you should absolutely follow this up with your personal physician.  

Here are some possibilities for chronic nausea and vomiting.

Rumination
The rumination syndrome is increasingly recognized among adults of normal mental capacity. It is included in the differential diagnosis, but differs from vomiting. The behavior consists of daily, effortless regurgitation of undigested food within minutes of starting or completing ingestion of a meal.

Gastroesophageal reflux disease
The most common symptoms of gastroesophageal reflux disease (GERD) are heartburn (or pyrosis), regurgitation, and dysphagia. Patients typically regurgitate acidic material mixed with small amounts of undigested food.

Eosinophilic gastroenteritis
Benign eosinophilic infiltration of the gut is a rare disorder which can occur anywhere from the esophagus to the colon, causing symptoms dependent upon the area and tissue layer of bowel involved. Gastric mucosal disease is typically associated with nausea and vomiting.

Viral gastroparesis
Approximately 50 percent of patients with chronic idiopathic nausea and vomiting evaluated in referral centers have gastroparesis. A viral etiology was suggested in these patients and in other series when there was an acute onset of nausea and vomiting with other features of a viral illness (fever, myalgia, diarrhea, fatigue, or abdominal cramping).

Chronic idiopathic intestinal pseudo-obstruction
This is a syndrome that suggests mechanical bowel obstruction of the small or large bowel in the absence of an anatomic lesion that obstructs the flow of intestinal contents.

Cyclic vomiting syndrome
Cyclic vomiting syndrome is a disorder characterized by repeated episodes of nausea and vomiting that last for hours to days separated by symptom-free periods of variable length. In adults, the disorder has been described as consisting of episodes of nausea and vomiting lasting for three to six days in a patient-specific stereotypic pattern.

There are many other causes of nausea and vomiting including the following:
- acute non-GI infections (pyelonephritis, pneumonia)
- hepatobiliary disease
- pancreatic disease
- peptic disease of the esophagus, stomach, or duodenum
- gastric or ovarian carcinoma
- CNS diseases - infections, tumors, multiple sclerosis
- metabolic disturbances - diabetes, adrenal insufficiency,
hypercalcemia, pregnancy

You seem to have undergone a comprehensive battery of tests.  I would strongly suggest that you follow this up with your personal physician or gastroenterologist.

I stress that this answer is not intended as and does not substitute for medical advice - please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

[ROBETTE]

PRIOR TO SURGERY I WAS FINE. NOW THIS. COULD SOMETHING DURING SURGERY TRIGGERED THIS?  ARE THERE TYPES OF MEDICATION TO SOLVE THIS PROBLEM?  MOTILITY TEST THAT SHOWS PRESSURES, WHAT COULD THAT MEAN?

[surgeon]

I assume the problem of partial small bowel obstruction has been addressed? This can follow any operation, but especially pelvic surgery. Sometimes either a "small bowel follow through" xray, or a CT scan with oral contrast can show it.

[ROBETTE]

I HAVE BEEN POKED PROBED... EVERYTHING AND NO OBSTRUCTIONS OF ANY KIND.THE ONLY PROBLEM THAT ANYONE CAN TELL ME IS THE A HA THAT COMES WHEN YOU TAKE TESTS. I HAVE BEEN TOLD ABOUT THE PRESSURES DURING THE MOTILITY TESTS BY THE SPHINCTER AND HAVE  BEEN TOLD THAT EVEN THOUGH MY GALLBLADDER IS FUNCTIONING, THERE IS A PROBLEM WITH HOW IT CONTRACTS.

[surgeon]

if by gallbladder problem you mean that you had a HIDA scan with CCK injection (a test where dye is given, taken up by the gallbladder, and then the gallbladder is made to contract by another injection); there is a situation called "biliary dyskinesia" wherein the gallbladder appears normal but squeezes abnormally. Removing the gallbladder may relieve symptoms. But it's not possible to predict with certainty who will get better and who will not; if the gallbladder empties poorly, and if the second injection reproduces the symptoms the person is having, then there's a fair chance it can help. But it's a condition that's not entirely understood, and surgical outcomes are often less than curative.

[Bionic Granny]

I just read the post from the surgeon and would like to know whatis idiopathic intestional pseudo-obstruction. I haven't been to this forum in quite some time, because of the surgeries I've had. I just had my 11th surgery in less than 3 years. In Dec. I had a lysis done and thought everything was going to be alright. Less than a month later, I had a partial small bowel obstruction. I have never heard of the above mentioned and would like to know if anyone here knows what it is. I am still having digestive problems and nausea, and I have had every test imaginable. Please help!!!!!!!

[Marlasinger3]

What exactly is Eosinophilic gastroenteritis?  When getting copies of my files from my last GI, it was noted in my bloodwork that my eosinophils were consistently low.  They never mentioned it (although they didn't mention a moderate-sized hiatal hernia either).  Just wondering what they did to realize someone has this.