Melena A
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Melena A
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For the flowering plant, see Cymbalaria muralis . For the promontory of Anatolia, see Melaena Promontorium . For Cuban towns with similar names, see Melena del Sur and Güira de Melena .
This article includes a list of general references , but it lacks sufficient corresponding inline citations . Please help to improve this article by introducing more precise citations. ( December 2011 ) ( Learn how and when to remove this template message )
^ MedlinePlus Encyclopedia : Bloody or tarry stools , retrieved 19 July 2010.
^ Walker, Brian; Colledge, Nicki; Ralston, Stuart; Penman, Ian, eds. (2014). Davidson's Principles and Practice of Medicine (22nd ed.). Edinburgh: Churchill Livingstone. p. 854. ISBN 978-0-7020-5103-6 .
^ Navarra, Tova (2004). The Encyclopædia of Vitamins, Minerals, and Supplements . Infobase Publishing . ISBN 9781438121031 . Iron supplements cause a grayish-black stool that should be distinguished from the black, tarlike stool that occurs from bleeding ulcer.
^ Dugdale, David (2009-11-01). "Bloody or tarry stools" . National Institutes of Health . Retrieved 2009-11-30 .
^ Walker, HK; Hall, WD; Hurst, JW (1990). "Hematemesis, Melena, and Hematochezia". Clinical Methods: The History, Physical, and Laboratory Examinations . Butterworths. ISBN 9780409900774 . Melena strongly suggests, and hematemesis confirms, that bleeding is of upper gastrointestinal origin…Peptic ulcer, the most common cause of gastrointestinal hemorrhage, should be pursued through questions about epigastric distress, the relationship of symptoms to food intake, and a past history of peptic ulcer disease.
^ Talley, Nicholas ; O'Connor, Simon (2014). Clinical Examination: A Systematic Guide To Physical Diagnosis (7th ed.). Chatswood: Churchill Livingstone. p. 179. ISBN 9780729541473 .
^ Di Minno, Alessandro; Spadarella, Gaia; Spadarella, Emanuela; Tremoli, Elena; Di Minno, Giovanni (2015). "Gastrointestinal bleeding in patients receiving oral anticoagulation: Current treatment and pharmacological perspectives". Thrombosis Research . 136 (6): 1074–81. doi : 10.1016/j.thromres.2015.10.016 . PMID 26508464 .
^ Jump up to: a b Laine, Loren (2012). "41. Gastrointestinal Bleeding". In Longo, Dan L; Fauci, Anthony S; Kasper, Dennis L; Hauser, Stephen L; Jameson, J. Larry; Loscalzo, Joseph (eds.). Harrison's principles of internal medicine (18th ed.). New York: McGraw-Hill. p. 320. ISBN 978-0-07-174889-6 .
Melena or melaena refers to the dark black, tarry feces that are associated with upper gastrointestinal bleeding . [1] The black color and characteristic strong odor are caused by hemoglobin in the blood being altered by digestive enzymes and intestinal bacteria. [2]
Iron supplements may cause a grayish-black stool that should be distinguished from melena, [3] as should black coloration caused by a number of medications, such as bismuth subsalicylate (the active ingredient in Pepto-Bismol), or by foods such as beetroot , black liquorice , or blueberries. [4]
The most common cause of melena is peptic ulcer disease. [5] However, any bleeding within the upper gastrointestinal tract or the ascending colon can lead to melena. [6] Melena may also be a complication of anticoagulant medications, such as warfarin . [7]
Causes of upper gastrointestinal bleeding that may result in melena include malignant tumors affecting the esophagus, stomach or small intestine, hemorrhagic blood diseases, such as thrombocytopenia and hemophilia , gastritis , Stomach cancer , esophageal varices , Meckel's diverticulum and Mallory-Weiss syndrome . [8]
Causes of "false" melena include iron supplements , Pepto-Bismol , Maalox , and lead , blood swallowed as a result of a nose bleed ( epistaxis ), and blood ingested as part of the diet, as with consumption of black pudding (blood sausage), or with the traditional African Maasai diet, which includes much blood drained from cattle. [ citation needed ]
Melena is considered a medical emergency as it arises from a significant amount of bleeding. Urgent care is required to rule out serious causes and prevent potentially life-threatening emergencies. [ citation needed ]
A less serious, self-limiting case of melena can occur in newborns two to three days after delivery, due to swallowed maternal blood. [ citation needed ]
In acute cases, with a large amount of blood loss, patients may present with anemia or low blood pressure. However, aside from the melena itself, many patients may present with few symptoms. Often, the first approach is to use endoscopy to look for obvious signs of a bleed. In cases where the source of the bleed is unclear, but melena is present, an upper endoscopy is recommended, to try to ascertain the source of the bleed. [ citation needed ]
Lower gastrointestinal bleeding sources usually present with hematochezia or frank blood. A test with poor sensitivity/specificity that may detect the source of bleeding is the tagged red blood cell scan . This is especially used for slow bleeding (<0.5 ml/min). However, for rapid bleeding (>0.5 ml/min), mesenteric angiogram ± embolization is the gold standard. Colonoscopy is often first line, however. [ citation needed ]
Bleeds that originate from the lower gastrointestinal tract (such as the sigmoid colon and rectum ) are generally associated with the passage of bright red blood, or hematochezia , particularly when brisk. Only blood that originates from a more proximal source (such as the small intestine ), or bleeding from a lower source that occurs slowly enough to allow for enzymatic breakdown, is associated with melena. For this reason, melena is often associated with blood in the stomach or duodenum ( upper gastrointestinal bleeding ), for example by a peptic ulcer . A rough estimate is that it takes about 14 hours for blood to be broken down within the intestinal lumen; therefore if transit time is less than 14 hours the patient will have hematochezia, and if greater than 14 hours the patient will exhibit melena. [8] : 322 One often-stated rule of thumb is that melena only occurs if the source of bleeding is above the ligament of Treitz although, as noted below, exceptions occur with enough frequency to render it unreliable. [ citation needed ]
The origin of melena is dated to the early 19th century via modern Latin , via Greek melaina (feminine of melas , black). [ citation needed ]
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Home » Digestion » What Is Melena? Causes and Natural Treatment Tips
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One of the more serious cases of dark stools is known as melena. What is melena? It is a medical condition resulting in black stools of blood or tarry stools. Passing black stool does not always indicate the presence of blood since the color can change depending what you consume. We will look at these causes of melena, as well how to treat more serious cases of stools with blood.
Melena refers to the passing of tainted blood in the form of black, tarry feces as a result of upper gastrointestinal tract bleeding. Blood in the esophagus, stomach, small intestine, or duodenum can be affected by bacteria, oxidation, and digestive enzymes as it travels to the end of the large intestine and expelled through your stool. These factors can change the color of your stool to black or dark red, as well as give off a strong, unpleasant odor.
Any bleeding in the lower parts of the small intestine, such as the colon, may have collected over time and can be seen with constipation. It can also involve the passage of old blood stemming from injuries of the nasal cavities or mouth.
Dark stools can exist with only at least 50 milliliters of blood present in the duodenum, stomach, and esophagus. Melena usually is not evident until at least 100 to 200 milliliters of blood is present. Bleeding in these areas can result in bloody vomiting known as hematemesis, or hemoptysis which is bloody sputum with coughing.
A disturbance in the system can cause melena to develop as well as reactions to what we consume. Iron-enriched foods such as dark leafy vegetables, blueberries, and black licorice may cause darkening of the stool. It can also occur with medications and iron supplements. However, the presence of bloody or tarry stools needs to be investigated to rule out serious complications.
Irritation, trauma, and inflammation of the esophageal inner lining known as esophagitis, as well as esophageal ulcers, can cause blood to appear in your stool . Bleeding can also occur due to esophageal varices. These are abnormally large veins caused by an overflow of blood when the blood flow to the liver is hindered.
Gastrointestinal conditions such as gastritis , gastric ulcers, and peptic ulcers may lead to bleeding in the digestive tract and result in bloody stools. Gastrointestinal bleeding can appear as a slow blood leak from a major hemorrhage. Also, a non-bleeding ulcer can start producing blood as a result of prescribed and over-the-counter medications.
Other common issues of the gastrointestinal tract that can cause blood to appear in stools include Crohn’s disease, diverticulitis, enteritis, colitis, and ulcerative colitis, as well as cancer of the upper and lower gastrointestinal tracts. Further causes of melena include:
The most obvious sign of melena is a dark color of the stool. There are other symptoms to watch for that may also explain the origin or cause of the condition.
Anemia is seen in many cases of melena. It is a condition characterized by a lack of healthy red blood cells and shares the following symptoms:
When you see black or tarry stools, it is always best to get a medical diagnosis, as melena may not be the cause of your condition. A rectal examination, including laboratory testing of the stool, can confirm a melena diagnosis as well as any accompanying gastrointestinal conditions.
You can expect to be asked how long the dark stools have been occurring, as well as the consistency or severity. The doctor will look at your medical history for any previous gastrointestinal issues, and make a note of any medications or nutritional supplements you are taking
We know stools that appear tarry and dark may stem from leaking blood vessels, trauma to the esophagus, or a bleeding ulcer. So, the doctor may have you do a stool culture test as well as blood tests, x-rays, barium tests, and a colonoscopy.
An esophagogastroduodenoscopy (or EGD) allows visualization of the inner lining of the esophagus, stomach, and duodenum. This test involves a flexible scope with a camera lowered into the gastrointestinal tract through the mouth or nose.
Once the doctor confirms a melena diagnosis, you can begin treatment for the underlying cause. In the case of severe bleeding, you may require immediate hospitalization along with intravenous fluids, a gastrointestinal endoscopy, blood transfusions, proton pump inhibitors, or even emergency surgery.
Non-emergency instances of melena may be treated with ulcer medications, antibiotics, antacids, and anti-inflammatory drugs to target any inflamed regions. If the bleeding is caused by a current medication, the doctor may suggest switching to a less harmful medication.
Natural treatments you can follow at home may require a change in your dietary habits like increasing your intake of water, adding high-fiber foods, and limiting or avoiding spicy and fried foods, as well as alcohol and tobacco products.
You may be able to get relief for symptoms with the use of natural herbs and following a few lifestyle changes.
Ginger and Senna: Mix five grams of equal parts of dry ginger powder and dry senna leaves powder in a glass of lukewarm water. Drink at bedtime.
Buttermilk: Mix salt and pepper into a glass of buttermilk. Drink one glass daily until the symptoms clear.
Sesame Seeds: Combine half a teaspoon of raw sesame seeds with butter. Munch on this mixture daily.
Rose Petals : Ground up 10 rose petals and half a cup of water for a drinking solution. Drink once a day on an empty stomach for three days.
Melena can be alarming in most instances. Unless you have consumed food or medication that darkens the stool, chances are you may have an underlying health condition that requires attention.
Depending on the accompanying symptoms, the color of the stool may indicate a blood disorder or a more serious case of cancer within the gastrointestinal tract. Extensive diagnostic tests can narrow the cause and determine the proper course of treatment.
By making a few changes to your daily routine and using natural products, you may be able to treat or prevent melena and its symptoms.
Sources:
“Bloody or tarry stools,” Medline Plus; https://medlineplus.gov/ency/article/003130.htm , last accessed August 11, 2017.
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By Jeremias [CC BY-SA 3.0], via Wikimedia Commons
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By Samir, MD [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)], from Wikimedia Commons
Key Points
Peptic ulcer disease, oesophageal varices, and malignancy are the most common causes of melena
Urgent resuscitation is the mainstay of initial treatment for any cases of melena
Any drop in haemoglobin and rise in the urea:creatinine ratio is very indicative of an upper GI bleed
Definitive investigation in most cases of melena is via OGD
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[caption id="attachment_15418" align="alignright" width="244"] Figure 1 - Endoscopic image of a bleeding gastric ulcer[/caption]
[caption id="attachment_16353" align="aligncenter" width="316"] Figure 2 - A gastric malignancy, first presenting as melena[/caption]
[caption id="attachment_18325" align="alignright" width="321"] Figure 3 - Endoscopic banding of bleeding oesophageal varices[/caption]
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