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Kevin Pho, MD  
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Specialties: Internal Medicine

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Fecal Incontinence
Nov 12, 2009 in the Gastroenterology / Digestive Disorders Expert Forum
There are several potential causes for the incontinence. Various types of infections are possible, along with malabsorption or inflammatory bowel disease. More uncommonly, but still possible, is cancer - which can cause any sustained change in bowel movements. I would send the stool off for culture and analysis. A colonoscopy would be a good idea. ...
skinny stools, follow up question
Nov 11, 2009 in the Gastroenterology / Digestive Disorders Expert Forum
I agree with the colonoscopy. Of course, with changes in the stool shape or caliber, most will focus on excluding cancer first. Other, less serious, causes would include non-cancerous polyps, or irritable bowel syndrome, both of which can cause your symptoms. But the colonoscopy is needed to rule out dangerous possibilities first. This answer is ...
re: gallbladder
Nov 09, 2009 in the Gastroenterology / Digestive Disorders Expert Forum
You clearly had a comprehensive evaluation. There are small studies suggesting that removing the gallbladder in cases of low ejection fraction may help the symptoms. The problem is, however, there is no guarantee and the data behind this is not conclusive. I would consider another GI or surgical opinion to ensure there isn't any other causes. If not...
fullness, skinny stools
Nov 06, 2009 in the Gastroenterology / Digestive Disorders Expert Forum
With the extreme fatigue, I would do some basic blood tests, including a blood count looking for iron deficiency. Changes in stool shape or caliber warrants a colonoscopy, especially if this is in the setting of anemia. This test can exclude cancer, masses, or other anatomical causes. A feeling of fullness can be due to upper GI disorders. If your do...
Colonoscopy needed or can it wait?
Nov 06, 2009 in the Gastroenterology / Digestive Disorders Expert Forum
I can't give specific recommendations over the internet. In general, a colonscopy would be the more comprehensive test, as the sigmoidoscopy only looks at 1/3 of the colon. That said, blood in the stool with changes in the stool shape or caliber may warrant a more thorough evaluation, especially if you're having symptoms up in the rib area. Eithe...
Stomach upset and overall bad feeling
Nov 06, 2009 in the Gastroenterology / Digestive Disorders Expert Forum
I would consider an upper endoscopy at this time to further evaluate the upper digestive tract for various causes of dyspepsia, including an ulcer, inflammation of the esophagus or stomach, or GERD. I agree with the Nexium. If the upper endoscopy remains negative, a 24-hr pH study can be done to exclude GERD, or a gastric emptying scan can be done to look...
Gall Bladder and Heart Rate?
Nov 04, 2009 in the Gastroenterology / Digestive Disorders Expert Forum
Yes, I would get your gallbladder checked. Liver function tests and an abdominal ultrasound would be tests to consider. If the results remain negative, you can also consider further imaging with a CT scan or an upper endoscopy to look for disorders of the upper GI tract. These options can be discussed with your personal physician. This answer is not...
Stomach Pain - Need Answer / Direction
Nov 04, 2009 in the Gastroenterology / Digestive Disorders Expert Forum
You have had a comprehensive workup, including the CT scan and upper endoscopy, both of which could not pinpoint a specific condition. Many of the major GI disorders would have been found already. You can consider more specialized tests, including a 24-hr pH study or esophageal dysmotility studies. Looking outside the GI system, for instance, looking...
mid term alcohol abuse.
Nov 03, 2009 in the Gastroenterology / Digestive Disorders Expert Forum
To answer your questions: 1) It would depend on what is elevating your ALT. There are many causes that are reversible. I agree with repeating the test, but if your doctors agrees, evaluation for viral hepatitis and imaging the liver with an ultrasound can also be considered. 2) Health insurance companies can deny coverage for a variety of pre-existing...
Hydrocephalus
Nov 02, 2009 in the Undiagnosed Symptoms Expert Forum
Difficult to say without evaluation. There are several reasons for a persistent cough, including, asthma, chronic post nasal drip from allergies, or GERD. They can be evaluated for individually, with tests like a 24-hr pH study, pulmonary function tests, allergy testing, or imaging the sinuses to evaluate for an infection. Medications can also lead...