Melaena, also spelled melena, refers to the passage of black, tarry stools that are often foul-smelling. This condition is usually a sign of gastrointestinal (GI) bleeding, specifically from the upper GI tract. It is not a disease in itself but rather a symptom pointing toward a potentially serious underlying issue. Recognizing melaena early and understanding its causes, symptoms, and treatment is vital for prompt medical attention.
Types of Melaena
While melaena generally presents as black, tar-like stools, it can be classified based on the source and duration of bleeding:
Acute Melaena: Sudden onset due to a rapid upper GI bleed, commonly from ulcers or trauma.
Chronic Melaena: Slow, continuous bleeding over time, often due to malignancy or chronic inflammatory conditions.
Occult Melaena: Not visible to the naked eye, detected only through stool tests. Often related to early-stage GI disorders.
Signs & Symptoms
The primary symptom is black, sticky, tar-like stools. Other symptoms may include:
Foul odor in stool
Abdominal pain or discomfort
Fatigue and weakness
Dizziness or lightheadedness
Pale or clammy skin
Rapid heart rate
Shortness of breath
In severe cases, signs of shock
Melaena is a red flag indicating that blood has been digested in the gastrointestinal tract before being expelled, which differentiates it from bright red rectal bleeding.
Causes of Melaena
Melaena results from upper gastrointestinal bleeding, usually from the esophagus, stomach, or duodenum. Key causes include:
Peptic Ulcers: The most common cause, often linked to Helicobacter pylori infection or NSAID use.
Gastritis: Inflammation of the stomach lining, possibly due to alcohol, stress, or infections.
Esophageal Varices: Dilated veins in the esophagus that rupture, often seen in liver cirrhosis.
Mallory-Weiss Tear: A tear in the esophageal lining from severe vomiting.
Tumors: Cancers of the stomach or esophagus.
Medications: Blood thinners or anti-inflammatory drugs can erode the GI lining.
Swallowed Blood: From nosebleeds or oral injuries, which can darken the stool.
Stages of Melaena
Initial Stage: Presence of minor GI irritation or bleeding without noticeable symptoms.
Progressive Stage: Visible black stools, fatigue, and general discomfort.
Advanced Stage: Significant blood loss with symptoms like dizziness, rapid heartbeat, and potential collapse.
Complicated Stage: Shock or multi-organ involvement due to uncontrolled bleeding, requiring emergency care.
Diagnosis
Melaena is diagnosed through:
Physical examination and medical history
Stool occult blood test
Endoscopy to locate the bleeding source
Blood tests (hemoglobin, hematocrit levels)
Imaging like CT scan if needed
Treatment Options
Treatment focuses on stopping the bleeding, replacing lost blood, and treating the underlying cause:
Stabilization: IV fluids and blood transfusion if necessary.
Endoscopic Therapy: To cauterize or clip bleeding vessels.
Medications:
Proton pump inhibitors (PPIs) for ulcers
Antibiotics for H. pylori infection
Octreotide for variceal bleeding
Surgery: For uncontrollable bleeding or tumors.
Lifestyle Changes: Diet modifications, stopping NSAIDs, and reducing alcohol intake.
Precautions to Be Taken
Avoid overuse of NSAIDs or aspirin
Limit alcohol and smoking
Manage chronic conditions like liver disease or GERD
Take prescribed medications for ulcers or infections regularly
Monitor stool color and consistency
When to Consult a Doctor
You should seek immediate medical attention if:
Stools are black, tarry, or unusually foul-smelling
You experience dizziness or fainting
There's severe abdominal pain
You vomit blood or have coffee-ground vomitus
You feel extremely fatigued without explanation
Early intervention can prevent serious complications and may save your life.
Melaena is a warning sign that should never be ignored. While it can stem from relatively manageable causes like ulcers, it may also signal life-threatening conditions. Recognizing symptoms, understanding its potential severity, and seeking timely medical care are crucial steps in effective treatment and recovery.
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