STUDY - Technical - New Dacian's Medicine
Melena
(Classical / Allopathic Medicine)
A common sign of
upper GI bleeding, melena is the passage of black, tarry
stools. Characteristic color results from bacterial
degradation and hydrochloric acid acting on the blood as it
travels through the GI tract. At least 60 ml of blood is
needed to produce this sign.
Severe melena can
signal acute bleeding and life-threatening hypovolemic shock.
Although melena usually indicates bleeding from the esophagus,
stomach, or duodenum, it can also indicate bleeding from the
jejunum, ileum, or ascending colon. This sign can also result
from swallowing blood as in epistaxis, certain drugs, and
alcohol. Because false melena may be caused by ingestion of
lead, iron, bismuth, or licorice (which produces black stools
without the presence of blood), all black stools should be
tested for occult blood.
ALERT:
If the patient is experiencing severe melena:
- quickly take orthostatic vital signs to detect hypovolemic shock
- look for other signs of shock, such as tachycardia, tachypnea, and cool, clammy skin
- institute emergency measures, if necessary.
If the patient's condition permits, perform a focused assessment.
If the patient is experiencing severe melena:
- quickly take orthostatic vital signs to detect hypovolemic shock
- look for other signs of shock, such as tachycardia, tachypnea, and cool, clammy skin
- institute emergency measures, if necessary.
If the patient's condition permits, perform a focused assessment.
HISTORY:
Ask the patient when he first noticed that his stools were black and tarry.
Ask the patient about the frequency and quantity of his bowel movements.
Ask the patient if he has had melena before.
Ask the patient about other signs and symptoms, notably hematemesis or hematochezia.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs, especially anti-inflammatory drugs and other GI irritants. Also, ask the patient about alcohol intake.
Review the patient's medical history for GI lesions.
Ask the patient when he first noticed that his stools were black and tarry.
Ask the patient about the frequency and quantity of his bowel movements.
Ask the patient if he has had melena before.
Ask the patient about other signs and symptoms, notably hematemesis or hematochezia.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs, especially anti-inflammatory drugs and other GI irritants. Also, ask the patient about alcohol intake.
Review the patient's medical history for GI lesions.
PHYSICAL
ASSESSMENT:
Inspect the patient's mouth and nasopharynx for evidence of bleeding.
Perform an abdominal examination that includes inspection, auscultation, palpation, and percussion.
Inspect the patient's mouth and nasopharynx for evidence of bleeding.
Perform an abdominal examination that includes inspection, auscultation, palpation, and percussion.
SPECIAL
CONSIDERATIONS:
For general comfort, encourage bed rest and keep the patient's perineal area clean and dry to prevent skin irritation and breakdown.
For general comfort, encourage bed rest and keep the patient's perineal area clean and dry to prevent skin irritation and breakdown.
PEDIATRIC
POINTERS:
Neonates may experience melena neonatorum due to the extravasation of blood into the alimentary canal.
In older children, melena usually results from peptic ulcer, gastritis, and Meckel's diverticulum.
Neonates may experience melena neonatorum due to the extravasation of blood into the alimentary canal.
In older children, melena usually results from peptic ulcer, gastritis, and Meckel's diverticulum.
AGING ISSUES:
In elderly patients with recurrent intermittent GI bleeding without a clear cause, angiography or exploratory laparotomy should be considered when the risk from continued anemia is deemed to outweigh the risk associated with the procedures.
In elderly patients with recurrent intermittent GI bleeding without a clear cause, angiography or exploratory laparotomy should be considered when the risk from continued anemia is deemed to outweigh the risk associated with the procedures.
PATIENT
COUNSELING:
Instruct the patient on what to expect from diagnostic testing, which may include blood tests, gastroscopy or other endoscopic studies, barium swallow, and upper GI series.
Instruct the patient on what to expect from diagnostic testing, which may include blood tests, gastroscopy or other endoscopic studies, barium swallow, and upper GI series.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common symptoms,
Edition V, McGraw - Hill, 2002.