Search for tag: "intestines"

Interviewer: Today, another edition of ER or Not, with Dr. Troy Madsen. You swallowed a chicken bone. Emergency room or Not.

Dr. Madsen: So you probably don't need to go to the ER if you swallow a chicken bone. So if you happen to swallow a chicken bone, you're probably going to be fine. The things you worry about swallowing are things that are really sharp or things that are really long. If they're sharp, they can puncture the intestines as they're working their way down. If they're really long, they may not even make it past the stomach.

You got to figure most chicken bones you swallow are probably going to be splinters off a chicken bone. It's probably going to pass with no problem. But if somehow you happen to swallow a chicken bone that's longer than say three inches or a really big sharp piece, that's probably a reason to go to the ER and get a specialist there to remove it from your stomach.

updated: July 8, 2021
originally published: October 6, 2017

Announcer: Is it bad enough to go to the emergency room, or isn't it? You're listening to ER or Not on The Scope.

Interviewer: All right, let's see you how you do today. ER or Not with emergency room physician Dr. Troy Madsen. I'm going to give you the scenario. You decide whether it's worth going to the ER or not. Here is the situation, Dr. Madsen. You're helping some friends move some furniture. You lift a particularly heavy chest of drawers. You feel a little bit of a pop in your abdomen area. Now there's, like, a protrusion down there. ER or not?

Dr. Madsen: Well, this is something, I think we've all done it sometimes, lifted something, you know, these moving scenarios, you're often trying to show off, you know, your strength, trying to carry some piano down the stairs. And as you're doing it, you say to yourself, "This was a really bad idea." But then, when something pops out in your belly . . .

Interviewer: "This was a really bad idea."

Dr. Madsen: Then you think, "This was a really bad idea." So it's not uncommon. We'll see people in the ER with hernias.

Interviewer: That's what that is.

Dr. Madsen: That's what it is. So a hernia is a tear in the lining of the abdomen. And when that muscle tissue tears there, and those fibers tear, then some of the contents of the abdomen can kind of bulge out. So that's intestines that are kind of sticking out there that you're feeling beneath the skin. You've got this bulge, often around your belly button. A lot of people experience it in their groin as well, particularly men. When you had your physical exam and the doctor touched you and said, "Turn your head and cough," he was checking for a hernia. That's what we're doing there.

Interviewer: Just kind of making sure you didn't have one and didn't realize it.

Dr. Madsen: Exactly. Just a small one, something like that. So that's exactly what a hernia is, it's a defect in the wall, but it is not a reason to rush to the ER.

Interviewer: What are you talking about? My insides are coming out. It's absolutely a reason.

Dr. Madsen: Exactly. It's scary. The one time you'd want to rush to the ER would be if something changes with that hernia. And most people know they have hernias. It's happened to them. They've had hernias for years, and they know it's there and they just kind of deal with it. You can get it surgically repaired, but it becomes an emergency if it becomes what's called an incarcerated hernia. And that's a strangulated hernia.

So that's when you get enough of this stuff outside of the abdomen that the blood supply gets cut off to it. You try and touch it, it hurts, it's firm. You try and push it back inside, which you should easily be able to do, and it won't go back in. That becomes a very big deal, and it's definitely a reason to get to the ER. Often in the cases, we have to get these patients to the operating room pretty quickly to get this treated.

Interviewer: Okay, so just to be square here, I'm moving furniture or I'm lifting weights and I get that pop-out. Just because it's not a reason to go to the ER, I should go see my doctor.

Dr. Madsen: Yes, you should. Yeah, because it could get worse.

Interviewer: But it's not something I have to do, like, then.

Dr. Madsen: It's not.

Interviewer: In the next couple of days. Unless, of course, it becomes painful to touch and I can't push it back in, then a trip to the ER is necessary.

Dr. Madsen: That's right. Most people with hernias live with them for years, but if something changes, you'll know it. Get to the ER.

Announcer: Want The Scope delivered straight to your inbox? Enter your email address at thescoperadio.com and click "Sign Me Up" for updates of our latest episodes. The Scope Radio is a production of University of Utah Health Sciences.

Interviewer: All right, it's time to play the game ER or Not, where you get to play along and decide whether or not something that has happened is worth going to the emergency room. We're here with Dr. Troy Madsen, emergency room physician at University of Utah Hospital.

ER or Not? You're eating a chicken wing and you accidentally swallow a bone.

Dr. Madsen: This is tough one, Scot, so I want to know, what do you think?

Interviewer: All right, so I'm going to say that we did one on toothpicks before . . .

Dr. Madsen: Yes.

Interviewer: . . . that if you swallow a toothpick and it goes into your abdominal area it could puncture through.

Dr. Madsen: Sure.

Interviewer: I'm going to guess based on the kind of chicken wing or the chicken bone, that could be a problem here.

Dr. Madsen: Yes.

Interviewer: A bigger, duller bone, I don't know. It could be painful coming out, but it probably could pass through. I don't know. I don't know. I don't know.

Dr. Madsen: See? I'm going to put you to work in the ER. Look how much you've learned and how much you know. I'm so impressed. Those are the exact processes that are going on in my mind. I'm imagining myself having a family member call me and say, "I'm having chicken wings tonight. I was watching a game and I don't know what I did, but I swallowed a chicken bone."

My first question for them is, "Are you sure you swallowed it? Are you sure it's not in your airway?" If it's in the airway, that's an entirely different issue. Absolutely, you need to get to the ER if it feels like it's stuck in there, you're having a hard time breathing, maybe there's like a high-pitch wheezing sound, that's ER, absolutely.

Interviewer: Anytime there's an airway issue, ER.

Dr. Madsen: Yes, ABC; A stands for airway. If it affects the airway, get to the ER.

Then the next question is, let's say, okay, it's not in the airway, what are we talking about in terms of a chicken bone here? I'm thinking number one, is it something that's going to somehow puncture their intestines as it's passing through? Was this a piece of a chicken bone that splintered, and then they swallowed it down? Or is it a really big chicken bone? And by a big chicken bone, I'm talking about something usually longer than about three inches.

Interviewer: Okay, so it would've been really hard to swallow something like that.

Dr. Madsen: It would have been, exactly. If you're talking about something three inches or longer, that's really tough to swallow, and a chicken wing isn't the sort of thing that's going to do that. If they tell me, you know, I don't know why they would do this but if somehow they were chewing on this chicken wing while watching a game and swallowed a big sharp piece down there, that would be a reason to go the ER because there you do worry about possibly causing some sort of a puncture wound in the stomach or in the intestines.

Or if they said, "This was not a chicken wing. This was a chicken thigh and this was a big bone," and again, I don't know why they would have done that or swallowed it, but that's another reason to go to the ER.

Interviewer: All right, so the grey area is a dull kind of bone that's not that big.

Dr. Madsen: Exactly.

Interviewer: Maybe a half-inch long, not very big around, is that going to pass through?

Dr. Madsen: It should, yeah.

Interviewer: Do you take the chance?

Dr. Madsen: If you're concerned you can always go to the ER. We can get an X-ray, we can look at it. It's a bone; we're going to see it on an x-ray. We can call the GI doctors and ask them to look at it. My suspicion is they would not go in and put you through anesthesia to go down and fish that out and pull it out. If it's a small chicken bone, maybe half an inch long, an inch long, it should pass through okay.

Interviewer: Okay. I'm nervous now. I mean, this is one of those things where in a couple of instances, you know absolutely what the answer is, but then there's that grey area.

Dr. Madsen: It is definitely a grey area.

Interviewer: Is there a chicken wing hotline I could call, like poison control that can give me some advice?

Dr. Madsen: It's funny, if you call poison control they probably would give you advice.

Interviewer: You think so?

Dr. Madsen: Yeah, they would. And then they would get people on the phone if they needed to. So of it is a grey area and you're not sure, and it's something you've ingested like that, they would probably be able to help you out there.

Interviewer: If it's the grey area, is there a period of time or something that would make you more concerned that this might be an issue?

Dr. Madsen: That's a tough one because some things, you swallow it and it's just going to sit there or it's going to work its way into your intestines. Once it gets in there, you may have no symptoms but it may be too far down to really fish it out. If it is a concern and you're just saying to yourself, "Hey, what do I do about this?" it's worth at least talking to someone, calling your doctor, and you can always go to the ER. It's not a big deal, but certainly talk to someone if you're just wondering, "What do I need to do about this?"

Interviewer: One of those nurse hotlines or something of that nature, perhaps.

Dr. Madsen: Exactly.

updated: July 22, 2020
originally published: April 3, 2016

Dr. Gellner: One of the hot topics lately has been gluten in your diet. So what is gluten sensitivity and what is celiac disease? They're very different. I'm going to talk about that today on The Scope. I'm Dr. Cindy Gellner.

Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Dr. Gellner: So a lot people will say that their child is sensitive to gluten and think they may have celiac disease. Again, they're very different. Celiac disease is actually a digestive system problem where the lining of the small intestine makes it hard for your child to absorb nutrients from food.

If this disease is not diagnosed, it can cause serious problems including anemia, liver disease, osteoporosis, which is bone loss, and other nutrient-related deficiencies, because celiac disease is actually an autoimmune disease, that means your body is actually attacking itself. So the immune system is attacking the digestive system. If your child eats gluten and has celiac disease, your child's immune system attacks the part of the intestine that absorbs those nutrients in that food.

So what is gluten sensitivity, nonceliac gluten sensitivity? Well gluten sensitivity is when your child has similar symptoms to celiac, but it's not an autoimmune response. So it's where they have sort of upset stomach or gas when they eat foods with gluten, and they're intolerant to it. They have symptoms with it, but they are not truly having an immune response to what they're eating.

With celiac disease, it's a genetic disease. It does run in families, and it is an autoimmune disease again which is inherited. We do not know the exact cause of nonceliac gluten sensitivity. It does seem to run in families, but there's not a genetic link that we know so far.

So what are the symptoms? Well, they are actually very similar to each other. The symptoms are usually abdominal pain, bloating, cramps, gas, diarrhea, or constipation. And with celiac disease, you'll also notice that they will have foul-smelling bowel movements, and you'll also notice they will not grow well. They'll even lose weight no matter what they're eating. They'll have poor growth. They're unusually tired, and they can be very cranky sometimes.

Gluten is actually a protein that is found in wheat, barley, and rye grains, which is why it's important if your child has nonceliac gluten sensitivity or celiac disease that you need to read the food labels and know exactly what a gluten-free food is. So before you start looking at food labels, you need to figure out which does my child have if they do seem to have symptoms after eating foods containing gluten.

If they have celiac disease, there's an actual blood test that we can do to confirm the diagnosis. There is no blood test for gluten sensitivity. Now you may have your child tested for other allergies like a wheat allergy or a soy allergy, but there's no actual blood test for nonceliac gluten sensitivity.

Once you know your child has celiac disease or is gluten sensitive, how do you treat it? Well, unfortunately the only treatment for these is a gluten-free diet. And for most children, the change in diet relieves symptoms in a few weeks. The longer your child keeps eating gluten, the more the intestine is damaged in celiac disease and the greater the risk for long-term problems. But for most children with nonceliac gluten sensitivity, the diet relieves most of the symptoms completely within just a few weeks.

When you're looking at food labels, you need to make sure that for your child to have a gluten-free diet, the ingredients contain no wheat, barley, or rye. And unfortunately the American diet is based on grain, so many processed foods contain grain-based additives. You really need to do a lot of hard work looking at the food labels to determine if it's a safe food for your child.

Easy ways to remember which foods are safe and which ones are not: Look in the dairy section. Milk and milk products are safe. Go into the produce section. Fresh fruits, vegetables, they all are safe for you to have as well. Nuts, seeds, and vegetable oils without additives are safe. Beef, pork, poultry, and fish and eggs also do not contain gluten so they are safe as well.

It's important to replace carbohydrates your child cannot have from wheat, rye, and barley with carbs that they can have from things such as wild rice, quinoa, corn, and potatoes. Remember when you're looking at the food labels, wheat free does not mean gluten free because wheat-free products may contain barley or rye.

And any product that has a gluten-free label is usually okay to eat because there is an organization called the Gluten-Free Certification Organization, and it has to have that GFCO stamp on it if it has met their strict standards to be a product that is labeled gluten free.

Many companies will also send you lists of their gluten-free products, and you can also look on a menu if you're going out to eat. Many restaurants will have gluten-free labels on their items in restaurants or delis.

If your child has been diagnosed with celiac disease, you may want to talk to your physician about having your child take a gluten-free multivitamin to make sure that they get the nutrients that they need that they are missing from eating certain food categories.

So remember celiac disease and nonceliac gluten sensitivity both need to have diet changes in order to keep symptoms at bay, but they are very different diseases, and only your pediatrician can help you figure out which your child has.

Announcer: TheScopeRadio.com is University of Utah Health Sciences Radio. If you like what you heard, be sure to get our latest content by following us on Facebook. Just click on the Facebook icon at TheScopeRadio.com.

Interviewer: You've had a surgery now what do you eat afterwards? Does it matter? We're going to find out next on The Scope.

Announcer: Health information from expects, supported by research. From University of Utah Health, this is TheScopeRadio.com.

Interviewer: After you've had a surgery does your diet influence how well you'll heal? We're with Dr. Jeffrey Camden. He's a surgeon at the University of Utah Hospital. Does your diet matter after surgery?

Dr. Jeff Campsen: I think so. Let's start from the beginning, so you have some sort of inter-abdominal surgery, and you come out of the surgery, and at some point you're going to want to eat again. Some people take a couple days to feel hungry, some people want to eat right away, and it depends on what's going on. So we sit down as the managing team and really try to make sure that your intestines for lack of a better word wake back up and can accept food and basically allow you not to get sick after surgery. So the things that we look for are basically everybody hears their stomach rumble, we want to hear those sounds. So after surgery sometimes your intestines can shut down. It's called an ileus and it basically means that the intestines aren't actively moving food forward, and so if that's happening then you can't eat yet.

Interviewer: And that rumbling is that what's happening?

Dr. Jeff Campsen: That's your intestines basically waking back up. Basically being comfortable that no one's going to go in and touch them again and operate on them again.

It's interesting there's actually two things that help your intestines wake up and they've been proven. One is getting up out of bed and walking because that normalcy and the pumping of blood from the walking through the body helps, and then there is a good study out of the Mayo Clinic that said chewing bubble gum actually helps intestines come back quicker, and it's probably because you're not really creating any food but you're giving that sort of reflex of tasting something in your mouth and stimulating your stomach and your lower intestines to think that they need to be working, and so chewing gum and walking those two things are probably the best advice that you can get to moving along.

Interviewer: Got you, alright so what types of foods do you want to start eating at that point?

Dr. Jeff Campsen: So at that point when we start hearing bowel sounds, and we actually ask our patients, you know, "Are you passing gas?" This is a difficult question for some people because no one wants to admit that, but in this particular case that's a good thing and we want to hear that. What we don't want to hear from you is that you're burping. Burping's bad, that means that stuff's not going through and it's backing up in your stomach's getting distended. The reason that that's concerning is if your stomach gets too distended it can cause you to vomit, and if you vomit too much and you've just had surgery, and you're mildly sedated you can actually breathe that vomit in which is called aspiration, and it can give you a very bad pneumonia.

Interviewer: Does that have any chance at that point of rupturing those internal sutures?

Dr. Jeff Campsen: I think that it can. Your abdominal wall is going to spasm to do those violent vomiting episodes, and you probably can damage the repairs that we've made on you, and so we'd prefer that not to happen.

Interviewer: So at this point are you still under the care of a physician and a team?

Dr. Jeff Campsen: Yes.

Interviewer: Up until this point.

Dr. Jeff Campsen: Right, so you've come out of the operating room, we're in the first sort of 24 hours, 24, 72 hours, are you starting...Are you not burping, is your intestines making the rumbling sounds, and plus or minus are you passing some gas? At that point what we would start you on is basically some clear liquids. If you can see through it it's not thick, not milk which is very thick, we start you on that. If you can tolerate clear liquids then we, what we call it is advanced diet is tolerated, then you may go onto something soft, it's called a soft mechanical diet, that's not very spicy, not hot, not all these kind of things that may upset your stomach, that's very bland. Bread and sort of soup those kind of things and if you handle that then you can move along to what you would want to eat.

Interviewer: Alright and when you get discharged and you go home what should you be thinking about in your diet at that point?

Dr. Jeff Campsen: Well I think at that point you can basically go back and eat whatever you would normally want to eat. I do think it's an opportunity to really reevaluate what you are eating and basically try to eat healthy because if you've had inter-abdominal surgery you need the building blocks for healing, protein, sugars, different things that go into along your abdominal wall to heal, and if you're eating unhealthy during that time you're not going to give your body the kind of tools and building blocks that it's going to need to heal properly. So you want to look at your diet and try to eat as healthy as possible during that time. Now if you can parlay that into lifelong better dietary habits then that's great. You might as well; you've gone through the surgery you might as well benefit from it on that angle too.

Interviewer: Got you, so it sounds like if you ate healthy beforehand just continue your normal diet afterwards. If perhaps you didn't have the best diet beforehand that be a good time to reevaluate and maybe make some lifestyle changes.

Dr. Jeff Campsen: I think so; I think it's extremely important during the first month to eat healthy because again you have to have the right components in your diet to allow your body to then create a new abdominal wall, for lack of a better word. To heal that area that was, where the incision was made, and if you don't give your body that then you're not going to heal well, and then if you get an infection, a complication, a hernia it could be a result of that.

Interviewer: And what does it mean to eat well? I mean do you have to go all superstar diet, super clean foods, or...?

Dr. Jeff Campsen: No I don't think so. I think it comes down to you want to have a moderate amount of calories. So you want to look and see how tall you are and based on that how many calories you should have a day and try to stick within that, and then on top on that it needs to be balanced. You need to have the building blocks of protein and carbohydrates, but all sugars and no protein, and I think based on that and who you are going into the surgery your dietary requirements fluctuate a little bit, but again it's the basic food groups that go into it, and then moderation.

Interviewer: The stuff we've learned as kids.

Dr. Jeff Campsen: That's exactly right.

Interviewer: The stuff we all know but ignore when we go to the, you know, the fast food restaurants.

Dr. Jeff Campsen: Right. No I think the biggest thing is that everybody's intestines wake up at their own speed. It's whoever your body actually is at the time coupled with the type of surgery you have, and everybody's intestines will wake up, but if you move too quickly you can hurt yourself.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there’s a pretty good chance you’ll find what you want to know. Check it out at TheScopeRadio.com.

updated: September 25, 2018
originally published: June 12, 2014

Interviewer: This is Pancreas 101. What does it do? What can go wrong, and what can you do about it? That's coming up next on the Scope.

Announcer: Medical news and research from the University of Utah, physicians and specialists that you can use for a happier and healthier life. You're listening to the Scope.

Interviewer: All right. Time to learn your pancreas basics with Dr. Jeffrey Campsen from the University of Utah, First of all, let's start out with what is the pancreas?

Dr. Jeffrey Campsen: The pancreas is an endocrine exocrine organ, and what that basically means is it sits in the middle of your abdomen, and it secretes hormones and different substances into the bloodstream but also into the intestines. People know it mostly as the organ that secretes insulin which then controls your glucose or your sugar. And if you don't have that, you become a diabetic. But it does a lot of other functions that helps with digestion of food and regulation of the body's means to produce energy through the breakdown of sugar.

Interviewer: So a pretty important organ.

Dr. Jeffrey Campsen: It's a very important organ in the sense that you could live without it, but it's very difficult to live without it, and you can't live without it without supplementation of the products that it produces.

Interviewer: And what problems can arise with the pancreas, and are they just naturally occurring or is it lifestyle oriented?

Dr. Jeffrey Campsen: It's both. First, some people are born with deficiencies in their pancreas. They're most known as Type 1 Diabetics where early on as a child it's found that the pancreas actually doesn't work particularly right. Many people believe that it's an autoimmune disorder where the body is actually attacking the pancreas. It works maybe at birth, but sometime in the next ten years the body actually attacks it and it fails. And then they become a diabetic from that. There's also you can damage your pancreas by treating your body poorly through alcohol, drug use, different substances that you put into your body can actually destroy your pancreas. Then ultimately you become a diabetic, or a pancreas cripple from that standpoint. And then other types of infection can actually ruin the pancreas. It's attached to your liver through a series of ducts, and if you have liver disease or gallbladder disease, that can actually damage your pancreas and cause pancreatitis which then pancreatitis then heals from that, scars, and slowly becomes fibrotic and also stops working.

Interviewer: Let's get back to the lifestyle. So how do you really have to abuse your pancreas before it's going to stop working?

Dr, Jeffrey Campsen: I don't think very much actually. I think to get to the point where it's completely burnt out, that's probably years worth of abuse to the pancreas. But everybody's built differently, and some people are much more susceptible to alcohol or different type substances and can damage their pancreas. Whereas other people are built in a way that they can tolerate it more. So you don't know until it's too late whether or not those substances have hurt you to the point where you can't recover from that.

Interviewer: And what are some of the symptoms then of a pancreas not functioning? What would I experience?

Dr. Jeffrey Campsen: I think acutely, meaning immediately, if there's a problem you would have intense abdominal pain, nausea probably, vomiting. Over the long-term, it sneaks up upon you insidiously with feeling very lethargic, tired, off. And that's basically showing an imbalance of your ability to regulate your sugar. So what you're actually having is very high sugar levels in your blood creating a feeling of basically feeling sick. Then, a lot of these patients go to the doctor. They find out that their sugar which should be maybe at a level of 100 is actually at a level of 600 which actually ultimately can be life threatening. Some people are actually found in a coma before they realize what has happened. And at that point you may not actually come out of that coma.

Interviewer: What type of life do you have if your pancreas fails you?

Dr. Jeffrey Campsen: It's a very difficult life. If your pancreas fails you, you become what they call a "brittle diabetic." Not only can you control your sugars going into high, but then if you add insulin they can actually go very low. And your pancreas keeps your sugars from going too low. If your sugars go too low, the cells in your body can't work, including the cells in your brain that allow you to breathe and your heart to beat. And so it can become fatal.

Interviewer: And what about other lifestyle considerations, like are you going to have to carry a piece of equipment around with you?

Dr. Jeffrey Campsen: Many patients are able to regulate their sugar with something called an insulin pump. And this pump basically then reads your sugar levels and then doses insulin in. Some patients are able to do it with just pills. I think it depends on the type of diabetes that you ultimately have, meaning there's Type 1 where you don't really produce any insulin and then Type 2 where you actually produce insulin but you're resistant to it. To get back to what you were saying as far as lifestyle, the Type 2 diabetics that actually produce insulin but are resistant to it are the patients that you want to counsel to lose weight. Obesity is one of the major health issues in the world today, and the people that are overweight ultimately are hurting their pancreases. Their pancreases can't handle the weight, and then they become a Type 2 diabetic.

Interviewer: And finally, what's your final thought for somebody listening to this when it comes to the pancreas?

Dr. Jeffrey Campsen: I think basically the healthier your body is the better the organs that you house are going to do. And so if you want to live a long time, you have to treat your body well, which is an old concept but it still holds true.

Announcer: We're your daily dose of science, conversation, medicine. This is the Scope, University of Utah Health Sciences Radio.