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melena
Melena is a black, sticky stool with a characteristic odor, usually indicating GI bleeding proximal to the cecum.
At least 50-60 mL of blood in the GI tract is necessary for occurence of melena in adults.
Etiology:
1) true melena (secondary to blood) upper GI bleed
a) peptic ulcer disease
b) gastritis or stress ulcers
c) esophageal or gastric varices
d) reflux esophagitis
e) Mallory-Weiss tear
2) black stool secondary to other causes (NOT blood)
a) iron
b) licorice
c) bismuth (Pepto-Bismol)
d) blueberries
e) blackberries
f) chocolate (occasionally)
Laboratory:
1) tests for occult blood positive with true melena
2) test for occult blood negative with other causes of black stools
Special laboratory:
- upper GI endoscopy after hemodynamic stabilization [3]
Related
lower gastrointestinal hemorrhage
upper gastrointestinal hemorrhage
General
sign/symptom
References
- Manual of Medical Therapeutics, 28th ed, Ewald & McKenzie (eds),
Little, Brown & Co, Boston, 1995, pg 352
- Guide to Physical Examination & History Taking, 4th edition,
Bates B, JB Lippincott, Philadelphia, 1987
- NEJM Knowledge+ Gastroenterology