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Difficulty in defecating, feeling of vomiting. Ultrasonography says cysts in liver, water in lungs.What should be done?

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My grandmother's age is 81 yrs. Her skin has turned pale, she is having lot of difficulty in defecating, and the stool is black in color, she is also having a feeling of vomiting all the time. Doctor suggested Ultrasonography and the report says multiple cysts in liver, kidney squeezed and water in lungs. Please suggest about what should we do now?
Posted Thu, 23 May 2013 in Kidney Conditions
Answered by Dr. Ravi Bansal 38 minutes later

Thanks for the query.

The problems I can identify with the short history you have given -
1. Anemia- pale colour- due to lack of hemoglobin- likely explanation is intestinal bleed as you say she is passing black stools.
2. Feeling of vomit and general ill health - can be part of gastric ulcers or renal failure - need to verify her serum creatinine levels. Please provide the detail if available.
3. The description of ultrasound is not clear. It would be better if you can kindly provide the detailed report. Also investigations like hemogram, Kidney function test, stool occult blood are of importance. If you have these reports, please upload them on this page using the site's uploader.

I think in this condition best is to hospitalize the patient for control of the situation and investigations.

In case you have any reports with you, kindly provide then I can give more specific information to you.

Hope this helps, let me know if you have other concerns.

Best wishes.
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Follow-up: Difficulty in defecating, feeling of vomiting. Ultrasonography says cysts in liver, water in lungs.What should be done? 24 hours later
Dear Dr. Bansal,

Thanks for your prompt reply. I have consulted a local doctor and he said that my grand mother will not survive, she has got multiple organ failure as I mentioned in my query. I will surely post the reports of USG, hemogram, Kidney function test, stool occult blood as you mentioned. However, what I know is she is not Anemic and her stool report reported black colored stool, she is having pain in defecating. As I mentioned, she has multiple cysts in her liver. I will upload the reports soon for your detailed investigation. Its not possible to hospitalize her at the moment as she is very much underweight and bedridden. She has just undergone an operation of partial hip replacement during the month of February 2013. Its even difficult to take her for the tests.

Thanks & Regards

Answered by Dr. Ravi Bansal 2 hours later

I am sorry to hear about your grand mother's condition. I shall give my opinion based on the reports.

Pain in defecation in bedridden patients can be because of fecoliths, very hard stools that get stuck and do not come out. Second is the possibility of anal fissure, that is there is some crack of skin at the opening of the anus. Management includes per rectal examination, to be done by a doctor to evacuate any hard stools and to confirm any fissure.

Rest advice is as previous.

Best wishes
Above answer was peer-reviewed by
Follow-up: Difficulty in defecating, feeling of vomiting. Ultrasonography says cysts in liver, water in lungs.What should be done? 3 days later
Dear Dr. Bansal,

Kindly find the reports uploaded herewith for your kind reference. The reports given are chest x-ray, stool test, blood test, CT-scan & USG-whole abdomen. Creatinine level test is due. If you suggest this test after checking the uploaded reports, then we will proceed accordingly. Thanks a lot for your help.

We look forward to your kind suggestion about the treatment. We would be grateful if you also can prescribe medicines accordingly.

Best Regards,
Answered by Dr. Ravi Bansal 7 hours later

I have gone through all your reports.

Your grandmother is suffering from obstructive jaundice secondary to possible cancer of the bile duct. This needs to be confirmed by doing an ERCP. The other reports show anemia and deranged liver tests and jaundice. Stool occult blood report is not done in the stool sample.

There is no doubt that she is to be hospitalized if an attempt has to be made for her diagnosis and management. There is no single medicine or tablet which will help her. She would require I/v fluids I/v antibiotics and ERCP for diagnosis of malignancy

She should be managed under care of a gastroenterologist.

Hope this clears the doubts,

Bye for now
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