Melena Flashcards
What is Melena?
Black tarry stool that is offensive smelling due to upper GI bleeding
Why is Melena difficult to flush away?
Due to alteration and degradation of blood by intestinal enzymes
What are the three most common causes of Melena?
Peptic ulcer disease, liver disease and gastric cancer
Who should peptic ulcer disease be suspected in?
Patients with history of NSAIDs or steroid use and h pylori positive
What artery is usually affected in peptic ulcer disease?
Gastroduodenal artery as the ulcer erodes through the posterior gastric wall
What are variceal bleeds? (oesophageal varices)
dilations of the porto-systemic anastomoses in the oesophagus
What is the most common cause of oesophageal varices?
Alcoholic liver disease
What should be asked about if Melena is present and upper GI malignancy is suspected?
Other symptoms, weight loss, family history
What are some less common causes of Melena?
gastritis, oesophagitis, mallory-weiss tear, meckels diverticulum, vascular malformations
What are the clinical features of melena?
jet black, tar like stools, haematemesis, abdominal pain, dyspepsia, dysphagia or odynophagia, smoking, alcohol, IBD, steroids, NSAIDs, anticoagulants and iron tablets
What examinations should you do for melena?
PR exam, full abdominal exam
What blood tests would you do for Melena?
Hb drop as may show acute bleed, Liver function tests for liver damage as potential cause, rise in urea and creatinine and lower HB may mean upper GI bleed, group and save and 4 units cross matched, should also do arterial blood gas
What investigations show be done for Melena?
Oesopagogastroduodenoscopy, also can manage, CT abdomen with IV contrast can be useful to assess active bleeding
What is the management for Melena?
A-E approach, give blood endoscopy, depends on cause
If peptic ulcer disease is causing Melena what is the management?
injections of adrenaline and cauterisation of the bleeding, high dose IV PPI
