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Melaena


Melaena is the passage of altered blood per rectum (PR). A melaena stool is black and tarry and has a characteristic smell. The blood is degraded by hydrochloric acid and intestinal enzymes high in the gastrointestinal tract. Melaena is unlikely to occur if bleeding comes from lower than the jejunum, although occasionally melaena may result from a bleeding Meckel’s diverticulum.

Causes

Swallowed blood

  • ●

    Epistaxis

  • ●

    Haemoptysis

Oesophagus

  • ●

    Oesophageal varices

  • ●

    Oesophageal carcinoma

Stomach

  • ●

    Peptic ulceration

  • ●

    Acute gastric erosions

  • ●

    Mallory–Weiss syndrome

  • ●

    Carcinoma

  • ●

    Leiomyoma (gastrointestinal stromal tumour – GIST)

  • ●

    Hereditary haemorrhagic telangiectasia

Duodenum

  • ●

    Peptic ulceration

  • ●

    Duodenal diverticulae

  • ●

    Aortoduodenal fistulae

  • ●

    Invasive pancreatic tumours

  • ●

    Haemobilia

Small intestine

  • ●

    Leiomyoma (gastrointestinal stromal tumour – GIST)

  • ●

    Meckel’s diverticulum

Bleeding disorders

  • ●

    Liver disease-associated

  • ●

    Thrombocytopenia

  • ●

    Haemophilia

Drugs

  • ●

    Anticoagulants

  • ●

    Aspirin

  • ●

    NSAIDs

  • ●

    Steroids

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