Melena

Question 1

What is melena?

Answer 1

Black tarry stools as a result of upper GI bleed

Tarry colour and offensive smell, difficult to flush

Question 2

What are common causes of upper GI bleed?

Answer 2

PUD
Liver disease
Malignancy
Mallory-Weiss tear
Oesophageal varices
Drugs - NSAIDs aspirin steroids thrombolytics anticoagulants
Gastritis

Question 3

When should peptic ulcer disease be suspected?

Answer 3

Known active PUD
History of NSAID or steroid use
Previous epigastric symptoms suggestive of ulceration
H. pylori positive

Question 4

When does most bleeding occur in PUD?

Answer 4

Ulcer erodes into posterior gastric wall into gasproduodenal artery

Question 5

What is the most common underlying cause for oesophageal varices?

Answer 5

Alcoholic liver disease
They are dilations of the port-systemic anastomoses in the oesophagus
Commonly due to portal hypertension secondary to liver cirrhosis

Question 6

What is it important to as about in melena?

Answer 6

Weight loss
Family hx
Other GI symptoms: haematememseis, abdominal pain, dyspepsia, dysphagia, odynophagia
PMH - smoking, alcohol, IBD
Drug hx - steroid, NSAID anticoagulant

Question 7

What examination for malena

Answer 7

PR and full abdo

Question 8

What investigation for melena?

Answer 8

FBC - drop in Hb
LFT - underlying liver damage
U&E - rise in U:C ratio –> upper GI bleed
G&S, Xmatch

OGD

Question 9

Management for melena

Answer 9

PUD- adrenaline and cautery of bleeding. High dose IV PPI
Oesophageal varices - endoscopic banding, prophylactic antibiotic, vasopressin to reduce splanchnic blood flow
Upper GI malignancy - biopsy and long term surgical/oncological management

Correct deranged coagulation, blood transfusions if required

Question 10

What is the scoring system for upper GI bleeds?

Answer 10

Rockall score