Hematemesis & Melena

Hematemesis is defined as the vomiting of frank blood from a source lying between the esophagus and the duodenum. The ejected blood may be bright red in colour or dark brown in colour.The dark brown colour is due to the mixture of the acid content of the stomach with hemoglobin of RBC (coffee ground).

CAUSES:

oesophageal ulcers

oesophageal varices

oesophagitis

Mallory-Weiss tear

oesophageal A-V malformations

peptic ulcer(most common )

GE

gastric cancer

NSAID abuse

induced vomiting

Dieulafoy lesion

Duodenitis

Aortoenteric fistula

Pancreatic pseudocyst

Post-sphincterotomy of duodenum

Melena is defined as the passage of black tarry stools due to presence of altered blood. Retention of blood in the digestive system is required for the blood to become black or tarry in appearance. The passage of dark black, liquid, tarry, metallic-smelling stools. Melenic stools usually indicate bleeding proximal to the right side of the colon. It usually indicates that hemorrhage has remained for > 8hrs in the GI tract. At least 60 ml of blood is required to produce a single black stool. The occurrence of melena without vomiting is due to a lesion beyond the duodenum.

CAUSES:

All causes of hematemisis

meckel's diverticulum

angiodysplasia

Chron's disease

tumors

bowel infarction

rightsided tumors of colon

inflammatory bowel disease

ulcerative colitis

colon cancer

rectal cancer

hemarroids

NOTE:

It should be noted that whether the blood is from gastrointestinal system or hemoptysis which is swallowed accidently and presented as hematemisis

In iron tablets taking patients n IV iron infusion also produces black colored stools