Melaena

Question 1

What is melaena?

Answer 1

• black tarry stool caused by upper GI bleeding

Question 2

What are the features of melaena?

Answer 2

• black tarry
• offensive smell
• difficult to flush

Question 3

What are the differentials for melaena?

Answer 3

• PUD
• Oesophageal varices
• Gastric cancer
• Mallory-weiss tear
• Meckel’s diverticulum
• Vascular malformation - Dielafoy lesion

Question 5

What are the clinical features of melaena?

Answer 5

• Stool
  
  • colour and texture *as described above
• Sx
  
  • haematemesis
  • abdo pain
  • dyspepsia, dysphagia, ordynophagia
• PMH
  
  • smoking
  • alcohol
  • IBD
• DHx
  
  • NSAID
  • steroid
  • anticoagulant
  • iron tablets

Question 6

What other examinations would you perform for pt c melaena?

Answer 6

• DRE
• full abdo exam

Question 7

What Ix would you order for melaena?

Answer 7

• Routine bloods (FBC, LFT, U&E, clotting)
  
  • dec in Hb and inc in urea:creatinine ratio indicates upper GI bleed
• G&S
  
  • 4 units cross match
• ABG
• OGD - definitive

Question 8

How would you mx melaena?

Answer 8

• A-E approach to stabilise pt
• Arrange for OGD once stabilised
• if PUD
  
  • inject adrenaline
  • cauterisation
  • IV 40mg PPI (high dose)
• if Oesophageal varices
  
  • endoscopic banding
  • prophylactic abx
  • somatostatin analogue
  • Sengstaken-Blakemore tube
• if upper GI cancer
  
  • biopsy