Melena: all about a dangerous illness. Why does black loose stool (melena) occur?

These concepts refer to defecation that is black, glossy in color, and has a pungent, foul odor. Very often, such a manifestation is not the disease itself, but only a symptom of the primary disease - internal organic bleeding.

Along with blood loss in the digestive tract, melena can also occur when blood is swallowed as a result of nosebleeds or pulmonary bleeding. In cases of this order, the smell of feces is not so strong and is present after several hours in conditions of severe blood loss.

It is worth noting that this symptom (black bowel movements) is caused by iron sulfide, which occurs after the interaction of hydrogen sulfide and hemoglobin.

Along with bleeding in a particular organ, the cause of tarry stools can be the use of certain medications, such as activated charcoal or medications containing iron. However, in such cases, black feces are noted without much varnish shine.

Causes of melena

What are the causes of melena? Despite the fact that the main reason causing tarry stool, is precisely bleeding, experts identify a number of sources of this disease.

Swallowed blood masses. This factor is accompanied by such circumstances as hemoptysis, nosebleeds, bleeding in the throat, swallowing of blood by the baby when sucking milk from the mother (sores on the nipples of a nursing mother).

Internal bleeding. Quite a variety of problems that arise in the internal organs can become sources of bleeding in them and manifest themselves in the form of melena. Such a source may be bleeding in the stomach, in cases of esophageal cancer, peptic ulcers, severe erosion, Mallory-Weiss syndrome, or in the presence of any vascular anomaly.

Bleeding in the digestive tract can become a source of tarry stools (stomach cancer, esophageal varicose veins, tumors, diverticula - intestinal protrusion, polyps, esophagitis).

Often the root cause of melena is bleeding from duodenum and small intestine, for example, in hemophilia, peptic ulcers and fistulas.

Medicinal reasons. This category includes the appearance of melena when consuming such medicines such as activated carbon, aspirin, hormonal drugs, non-steroidal antiphlogistic medications, anticoagulants, multivitamin preparations containing iron.

Blood clotting problems. A complication such as melena can also arise in the presence of blood clotting problems, for example, hemophilia, thrombocytopenia.

In exceptional cases, melena is formed in diseases of the pancreas and gall bladder.

Melena can occur with certain connective tissue problems.

Nutritional features. The cause of “black disease” can also be some features in the patient’s diet, for example, poisoning with protein metabolism products, drinking copious amounts of red wine for a long time, eating beets, blueberries and other dark-colored foods.

Melena symptoms

Signs of melena may include: general symptoms, which are also indirect signs of bleeding:

general weakness of the patient;
“flickering of flies” and darkening in the eyes;
pallor and coldness of the skin;
noise in ears;
nausea and vomiting;
loss of consciousness;
dyspnea;
cardiopalmus;
thirst;
cold sweat.

Experts include special clinical signals of melena:

Blood loss up to 500 ml. This condition does not actually have pronounced symptoms, but the stool may already have a black, shiny color.
With blood loss over 1000 ml. In this case, changes in blood blood pressure and heart contractions, which are determined by the position of the patient’s body. The patient's feeling of weakness increases significantly.
Blood loss is about 2000 ml. This condition is accompanied by hemorrhagic shock, in which loss of consciousness and hypotension accompanied by tachycardia are possible.

Melena in newborns

Tarry bowel movements can occur not only in adult patients. Melena in newborns requires special monitoring from specialists and parents, since the disease almost always develops suddenly in a baby who previously seemed quite healthy. Diagnosis and treatment of neonatal melena requires the careful and thorough involvement of qualified medical personnel.

In infants, there are two types of manifestations of this disease:

Symptomatic melena with a complex course. In this case, tarry bowel movements are one of the symptoms of a complex primary disease (sepsis, hemophilia).
Idiopathic melena. Here, isolated intestinal bleeding and a more favorable prognosis for treatment are noted.

Along with this, experts differentiate the following types of melena:

True. Occurs when there are disorders of blood clotting processes.
False. It is formed under circumstances when the baby swallows maternal blood during the birth process. This manifestation may indicate itself due to bleeding from the nose or breastfeeding if a nursing mother has bleeding cracks in her nipples.

Diagnosis of the disease

First of all, melena is detected when examining the patient's bowel movements. Since this disease is often a special manifestation of bleeding, the patient requires immediate hospitalization. Already in the hospital, to make the correct final diagnosis, doctors prescribe the following examination methods:

esophagogastroduodenoscopy;
colonoscopy.

These diagnostic methods mainly make it possible to determine the source of bleeding, after which measures are taken to stop it.

How to treat the disease

If a patient is diagnosed with melena, treatment should be immediate. Melena, as well as bleeding, which became the root cause of its appearance, can cause disability and also lead to the death of the patient. That is why, with this disease, it is necessary to urgently consult a doctor in order to identify the cause of “black stool” as early as possible and avoid an undesirable outcome.

Food and liquid intake, except cold water, until the ambulance arrives is absolutely prohibited. The patient needs rest and preferably a horizontal body position. Additionally, the patient can put something cold in the abdominal area, for example, a heating pad with cold water, ice pack, etc.

The basis of treatment for melena is to identify the source of blood loss and carry out measures (possibly even surgical) to eliminate it.

To treat melena, vitamin K and vikasol solution are often prescribed. It is rational to prescribe vitamins of other groups (P, C, B1, B3). In case of acute blood loss, blood transfusions in small doses, hemotherapy, and the use of calcium chloride solution are performed.

Melena

Melena (synonym: “chernukha”, tarry stool) is unformed black stool, resembling tar, with a fetid odor. Melena is the most important symptom of upper bleeding digestive tract. The causes of melena - see Hematemesis. Bleeding from gastrointestinal tract manifested by hematemesis followed by melena, as well as melena without hematemesis. The dark color of stool during melena is due to the formation of iron sulfide as a result of the interaction of decomposed hemoglobin with hydrogen sulfide. Scarlet blood in feces does not exclude the localization of the source of bleeding in the upper parts of the digestive canal in the presence of accelerated peristalsis. Therefore, the color of the stool depends on the time the blood remains in the intestines, and not on the location of the bleeding. Melena cannot be a reliable sign of massive bleeding.

Clinical picture in gastrointestinal bleeding is closely related to the amount of blood shed. With minor bleeding, patients experience some weakness. With massive bleeding, severe weakness and dizziness occur; patients turn pale, become covered in cold sweat, the pulse quickens, blood pressure falls. The amount of hemoglobin and the number of red blood cells immediately after the start of bleeding cannot serve as an indicator of the amount of blood loss, since their decline occurs after 24-48 hours. The death of the patient can occur even with a single heavy bleeding with symptoms of collapse (see).

The diagnosis of melena is not very difficult. Even if the paramedic himself did not see melena, and the clinical picture and description of the type of bowel movements to the patient indicate melena, the patient should be sent to the hospital to establish an accurate diagnosis and identify the underlying suffering. Cases when stool of normal consistency turns black under the influence of food composition (blackcurrants, blueberries, red wine), as well as certain medications (bismuth, iron) should not be confused with melena.

Treatment. The patient should be immediately hospitalized surgery department on a stretcher. Before sending the patient to the hospital, he should be in a state of complete rest in bed, an ice pack should be placed on his stomach, and food and liquid intake should be prohibited. You can administer 1 ml of a 1% solution of Vikasol intramuscularly.

Melena (Greek melaina, from melanos - dark, black; synonym: “chernukha”, tarry stool) - unformed black feces, reminiscent of tar, with a fetid odor. Melena is the most important symptom internal bleeding from any part of the digestive tract.

Causes, causing the appearance melena - see Hematemesis.

Bleeding from the gastrointestinal tract can manifest as hematemesis followed by melena, as well as melena without hematemesis. Previously, it was believed that if melena appeared without bloody vomiting, then the source of bleeding was located distal to the pyloric part of the stomach. Observations in recent years refute this position. Melena without bloody vomiting can occur when the pathological process (ulcer, cancer) is localized in the stomach, or with cirrhosis of the liver.

Iron sulfide, formed in the intestines from hemoglobin under the influence of enzymes, causes the dark color of stool during melena. The presence of scarlet blood in the stool does not exclude the localization of the source of bleeding in the upper intestines; with accelerated peristalsis and the associated rapid movement of blood from the upper sections of the intestine, feces may contain scarlet blood. Therefore, the color of the stool depends on the time the blood remains in the intestines, and not on the location of the bleeding. Melena cannot be a reliable sign of massive bleeding.

The clinical picture of gastrointestinal bleeding is closely related to the amount of blood shed. The intensity of blood loss can be judged by general appearance the patient, the color of the skin and mucous membranes, the frequency and nature of the pulse, the level of blood pressure. The amount of hemoglobin and the number of red blood cells in the first two days from the onset of bleeding cannot serve as indicators of the amount of blood loss, since their drop occurs after 24-48 hours.

In the first days after bleeding, some patients experience azotemia of extrarenal origin and an increase in temperature (up to low-grade and moderately febrile), which is associated with the absorption of blood proteins from the intestine.

The death of the patient can also occur with a single heavy bleeding during the phenomena of collapse (see), shock (see).

The diagnosis of the underlying suffering in the presence of melena often presents great difficulties for doctors. A carefully collected anamnesis, laboratory, endoscopic and X-ray methods research. It should be remembered that the color of normal stool can be influenced by the composition of food, as well as some medications taken by the patient. Black currants, blueberries, red wine, rich or exclusively meat foods give the stool a dark color. Some medicinal substances(bismuth, iron, animal charcoal) also change the color of feces (black). If melena is suspected, a chemical test of the stool should be performed for the presence of blood (see Benzidine test, Guaiac test).

The appearance of melena even if the patient is in relatively good condition should cause alarm to the doctor, since it can be a symptom of a severe pathological process and subsequently become threatening.

The patient definitely needs emergency care, hospitalization and detailed examination. Treatment of melena - see Hematemesis.

Why does black loose stool (melena) occur?

Melena is unformed semi-liquid feces of black (tar-like) color with an unpleasant odor. Stool of this nature indicates gastrointestinal bleeding. The dark color comes from hydrochloric acid hematin, which is the result of the interaction of hydrochloric acid of the stomach and hemoglobin in the blood, as well as iron sulfide (intestinal enzymes and hemoglobin).

Causes

The reason for the appearance dark color feces is bleeding from any part of the stomach or intestines (usually from the upper sections). The following pathologies can be noted that lead to mucosal defects and cause blood loss:

peptic ulcer of the stomach or duodenum (DPC);
varicose veins of the esophagus;
diverticula, polyps of the esophagus, stomach or small intestine;
cancer tumors of any location (or metastases);
Meckel's diverticulum in children;
blood diseases (leukemia, hemophilia, thrombocytopenia).

Symptoms

The clinic will primarily depend on the amount of blood loss, as well as the underlying cause. In some cases even small ulcerative defects the mucous membrane of the gastrointestinal tract may not show themselves for a long time, but one day they can cause severe bleeding. The larger the volume lost blood, the more liquid the stool becomes and the faster it appears.

Blood loss of up to 100 milliliters may not be visible in any way; the stool darkens after 8 hours. More heavy bleeding(ml) lead to the appearance of melena in 1-2 hours or earlier, which will depend on the rate of passage of intestinal contents. In addition to the main signs of the disease (abdominal pain, nausea, vomiting with blood), symptoms of acute blood loss appear:

weakness, pallor;
dizziness, flashing “spots” before the eyes, tinnitus;
decreased blood pressure up to collapse (fainting), increased heart rate, shortness of breath;
chills, drowsiness;
nausea, cyanosis.

Melena in newborns

Dark stools in a newborn child appear in the first days of life against the background of an existing disease. There are 2 main forms of pathology:

Symptomatic melena. Appears as a symptom general illness blood (hemophilia, lack of coagulation factors, thrombocytopenia) or infection (septicemia). Combined with bleeding from another location (bruises, petechiae on the mucous membrane, vaginal bleeding).
Idiopathic melena. Develops against the background of gastrointestinal bleeding of unknown etiology. Has a more favorable prognosis compared to the first form.

In newborns, false melena is distinguished when the stool is colored dark color due to nasopharyngeal bleeding or ingestion of maternal blood (cracked nipples, during childbirth).

Diagnostics

The diagnosis of melena is not difficult when examining the patient’s stool:

loose stool almost black;
foul odor;
sometimes blood clots in the stool.

If there is a slow passage of intestinal contents and there are signs of internal bleeding, it is recommended to perform a digital rectal examination of the rectum to assess the color of the stool.

An important point in diagnosing melena is differentiating it from false melena. The latter appears as a result of staining of the stool with medications (for example, bismuth, activated carbon, iron supplements), foods (beets, blueberries, black Rowan, red currants or wine), as well as when swallowing blood from other areas (nosebleeds, bronchial bleeding, pharyngeal cancer, etc.). In the cases presented feces decorated, do not have an unpleasant odor or shine, the patient’s condition does not suffer.

The gold standard for finding the source of bleeding is an endoscopic examination of the stomach and intestines, before which it is advisable to clarify the history and anamnesis of the disease. An assessment of general and biochemical blood tests and coagulograms is mandatory.

Treatment

First aid when melena is detected involves complete rest of the patient, cold on the stomach, and, if possible, intramuscular injection of 1 ml of a 1% solution of Vikasol.

The next step will be to assess the patient’s general condition, collect complaints and differentiate from false melena. If suspicions of internal bleeding are confirmed, you should immediately call an ambulance. Hospitalization to a hospital if melena (black stool) appears is mandatory!

You should not delay the examination, since even the slightest bleeding from erosion can develop into massive blood loss in a matter of minutes and cause hemorrhagic shock, which can lead to death.

The hospital conducts an urgent examination to find the cause of melena (fibrogastroscopy, colonoscopy, plain radiography of the gastrointestinal tract, blood test, coagulogram, blood pressure and pulse). In severe condition and severe blood loss, the patient is transferred to the intensive care unit, where intensive therapy, aimed at restoring the volume of circulating blood and preventing hemorrhagic shock.

In newborns, when melena appears, drugs are administered parenterally to stop bleeding ( calcium chloride, Vicasol, adrenaline), then treatment is aimed at the underlying disease.

Forecast

If the bleeding is stopped in time, the amount of blood loss is small, and the patient’s condition is not greatly affected, then the overall prognosis is favorable. After discharge from the hospital, observation by a doctor at your place of residence is recommended, preventive treatment and examination.

In case of severe blood loss, the cause of which was a serious illness (cancer, sepsis), there is high risk recurrent bleeding, which significantly worsens the prognosis for the patient. Such patients remain in the hospital for a long time under observation, undergo treatment and subsequent rehabilitation.

Tarry stools: causes, consequences, treatment

Black stools of unusual consistency with a strong, unpleasant odor are commonly called tarry stools or melena. Black stool is a clear deviation and a very alarming symptom, indicating bleeding in the gastrointestinal tract.

Causes of melena

Tarry stools are a very alarming symptom!

The color of stool is affected by bile, the food itself and the time it spends in the intestines. The normal color of stool is brown, in some cases yellow (if you consume a large amount of dairy products).

If blood from the upper gastrointestinal tract enters the stool, it first mixes with bile and sulfuric acid from the gastric juice, which leads to the formation of black stool. Tarry stool is always a reason to call an ambulance!

The presence of streaks of scarlet blood in it does not indicate the location of the bleeding. Only a doctor can reliably determine the focus. Although the cause is usually bleeding, there is the concept of false melena caused by physiological causes. The stool turns black due to foods or medications consumed.

You can distinguish it by its consistency, that is, the stool turns black, but the consistency is normal. Common causes of false melena:

Some berries stain the stool. These include black currants and blueberries.
Beetroot can color feces and urine. When consuming large amounts of beets, the stool becomes black and may be thinner due to the laxative effect of the vegetable. The urine turns red and may appear to be tinged with blood. All these symptoms quickly disappear after stopping consumption of beets.
Activated carbon also causes stool to become colored. The more tablets taken, the darker the stool will be. The consistency should not change.
Preparations containing iron turn stool black. This is usually stated in the instructions.

The cause of tarry stools may be bleeding that is not gastric or intestinal, but of a different nature, for example, when swallowing a large amount of blood during a nosebleed or pulmonary hemorrhage. Even if some of these products and drugs have been consumed and there are reasons to consider melena to be false, you should not make a diagnosis yourself; it is better to call an ambulance and undergo diagnostics.

An ambulance will necessarily hospitalize a patient with complaints of melena, even if the paramedic and doctor did not see “confirmation” of the patient’s words. Any bleeding can be life-threatening.

What diseases cause tarry stools?

Tarry stools as a sign of bleeding

Internal bleeding may occur in various departments Gastrointestinal tract as a result of ulcerative lesions and other diseases. The cause can only be determined through endoscopic examination. Main reasons:

Gastritis. Gastritis does not often lead to tarry stool, but in some cases it can be the cause if the stomach lining is very inflamed or ulcers have already begun to form. Gastritis can also have an erosive form, in which black feces and vomiting of blood are possible. With erosive gastritis, the mucous membrane is not just inflamed, small lesions and cracks form on it, which begin to bleed over time.
Dilated veins of the esophagus. Varicose veins can also occur in the esophagus. Blood flow is disrupted, veins become larger, swell and are easily damaged by food. Blood accumulates in the stomach and enters the intestines, resulting in black, foul-smelling stool.
Colon cancer. Cancer is accompanied by the formation of malignant tumors that protrude into the intestinal lumen and, during the passage of food through the intestines, are touched, damaged and bleed. In this case, black stools are accompanied by severe pain. This disease requires mandatory surgical treatment.
Stomach ulcer. Most common reason melena. A stomach ulcer is a small wound on the surface of the mucous membrane. In some cases, there may be several ulcers. They get damaged, bleed, blood along with gastric juice and food enters the intestines, which leads to the formation of black feces. The cause of bleeding ulcers is most often the bacterium Helicobacter pylori, as well as alcohol abuse.
Diverticulitis. Diverticula themselves, or small protrusions on the wall of the colon, are already a pathology. They are formed due to high blood pressure in the intestinal cavity. Diverticula can become inflamed and even rupture, called diverticulitis. A diverticulum rupture is accompanied by pain and black stool.
Anal fissure and hemorrhoids. As a rule, breakthrough of hemorrhoids and exacerbation of anal fissure are accompanied by the release of a certain amount of scarlet blood immediately before or during defecation.
Polyps in the intestines. With polyps in the intestinal cavity, streaks of blood can often be observed in the stool, but if they are severely damaged, black tarry stools may also appear. Polyps are a precancerous condition and require immediate treatment.

Other symptoms and consequences of the disease

Food also affects the color of stool

Black feces are not accompanied by other symptoms only if they are caused by physiological reasons. If the cause lies in bleeding caused by any disease, other signs will certainly appear that may precede melena or appear after it. Associated symptoms:

Weakness, fainting. With blood loss, anemia and weakness begin. If the blood loss is small, the weakness will not be severe, but any fainting, even short-term, is a signal for urgent action. It is necessary to call an ambulance and hospitalize the patient.
Nausea and vomiting. Stomach bleeding may cause nausea and even vomiting of blood. The vomit may also appear black and resemble coffee grounds. Often these signs indicate an exacerbation of erosive gastritis.
Stomach ache. If the bleeding is associated with tumors, polyps or ulcers, severe abdominal pain, cramps and colic occur. It is not recommended to relieve them with painkillers before the ambulance arrives, so as not to blur the clinical picture.
Fever, tinnitus. These are signs of weakness due to blood loss. You may also experience spots before your eyes and dizziness.
Increased pulse and low blood pressure. These signs indicate large blood loss and hemorrhagic shock. This is usually followed by prolonged fainting.

Don't wait for others alarming symptoms, one tarry stool is enough to seek help from a doctor.

It is difficult to determine the exact effects of melena. They depend on timely assistance, correct diagnosis and the disease itself. Of course, the most a terrible consequence is death, as well as disability as a result of excision of a part of an organ, large loss of blood, severe anemia.

Black stool does not appear immediately after bleeding begins, but only after 8-12 hours, when the blood has passed through the entire intestine. By the time tarry stools are detected, it is already necessary to call an ambulance without delay, since during this time the body has already weakened, signs of anemia may appear: pale skin, weakness, drowsiness, chills. If these symptoms precede melena, it is advisable to see a doctor before black stools appear.

Treatment

Taking certain medications can cause tarry stools

It is advisable to treat the disease that can lead to melena, even before such alarming symptoms appear. If black stool has already appeared, you should immediately consult a doctor. First aid is very important. Before the ambulance arrives, do not give the patient anything to drink or eat, or give any painkillers. He needs to be put to bed and cold applied to his stomach.

Under no circumstances should you warm the stomach, give enemas, rinse the stomach, or give any medications before the doctor arrives. As a last resort, if possible, hemostatic drugs such as Vikasol can be administered. The patient is hospitalized in the surgical department, the source of bleeding is identified and further actions are indicated.

If the bleeding is not severe, hemostatic drugs will first be instilled to help stop the bleeding. If this does not help, resort to surgical method treatment. In case of gastric bleeding, the stomach is first washed, and then part of the mucous membrane with the source of bleeding is excised and the edges are sutured.

Blood loss must be restored. For this purpose, the doctor may prescribe IVs with saline and glucose, and in severe cases, blood and plasma transfusions. Since the most common cause of melena is a stomach ulcer, the most common solution to the problem is gastric resection. During this operation, part of the stomach is removed, and most often a large part (2/3 or *), that is, more than half. Recovery after such an operation takes a long time, subject to a strict diet.

In case of gastrointestinal bleeding, it is important to monitor the patient’s condition and constantly measure pulse and blood pressure. The patient's condition is assessed according to severity, the level of hemoglobin in the blood, hematocrit, and red blood cells are determined. The severity of the condition has 4 degrees. In grade 1, the patient’s blood pressure remains at the same level, the pulse is increased, but the blood volume is reduced slightly. At stage 4 the patient is in in serious condition in reanimation.

Blood transfusions are prescribed only in extreme cases. This is an effective, but not the safest method of treatment, since mortality as a result of blood transfusion also occurs. To stop gastric bleeding, the method of irrigation of the mucous membrane with homeostatic agents is used. The mixture of special drugs should be drunk in large sips every half hour.

Melena in newborns

Tarry stool is a reason to urgently call an ambulance!

The phenomenon of melena can be encountered as early as 3-4 days of life. The child first suddenly turns pale, becomes lethargic, and then begins to vomit blood or have black stools. At mild form disease, after 2-3 times the appearance of black stool, melena goes away on its own, without significantly worsening the child’s condition. But severe melena can lead to the death of a child within 24 hours after the start of bleeding.

Determining the causes of melena in such young children can be quite difficult. As in adults, melena in children can be false, physiological. This is caused by the baby swallowing blood during labor activity or during feeding if the mother has bleeding cracks in her nipples.

Small children, as a rule, are not operated on. For melena, the doctor prescribes various vitamins, as well as intramuscular vikasol and intravenous heparin. If treatment does not help, the spleen may be removed. Very often, the phenomenon of melena in newborns is associated with hemorrhagic disease of the newborn.

Due to a lack of vitamin K in the body, blood clotting is reduced, so the likelihood of bleeding increases. Vitamin K should be supplied to the baby from the mother, but not enough is supplied through the placenta.

Premature babies, as well as children born as a result of pregnancy complicated by gestosis, are at particular risk. To avoid this, mothers are given vitamin K some time before birth. The same is done for newborn children for preventive purposes if the birth was difficult or ahead of schedule. At hemorrhagic disease Not only gastrointestinal but also pulmonary bleeding is detected, as well as bleeding into other organs.

As a rule, the disease begins to develop during fetal development. After birth, such a child exhibits various hemorrhages. Hemorrhagic disease can develop into a chronic form if the process of thrombus formation itself is disrupted.

My child has blood in his stool, what should I do? The pediatrician answers the question:

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What does black stool indicate in adults?

IN in good condition feces are colored various shades Brown color. However, this indicator is affected by the food eaten the day before or the medication taken. The color of stool can vary from yellow to green or even black. The appearance of the latter should alert a person, since it often indicates the presence of serious health problems, including internal bleeding and cancer.

At the first signs of tarry stool (melena), a person needs to analyze the possible causes of this phenomenon. The main factors that can cause feces to turn black are:

Some foods have an effect on the darkening of feces. This is especially true for foods containing a large number of iron and fat-soluble dyes. These include:

Prunes.
Chokeberry.
Blueberry.
Red and black grapes.
Pomegranate.
Blackberry.
Black currant.
Bananas.
Apples

Tomatoes.
Beet

Liver.
Blood sausage

Juices from fruits, vegetables and berries with a high iron content.
Red wine.
Coffee.
Black tea

Partial staining of stool in the form of black dots is associated with incomplete digestion of food. A similar phenomenon is caused by:

Bananas can cause black, worm-like clumps to appear in the feces, which can be confused with helminthiasis.

Various groups of medications can provoke the appearance of black stool. These include:

1. Iron preparations prescribed for anemia - Tardiferon, Ferro-Folgamma, Ferrum-Lek, Hemofer, Sorbifer Durules.
2. Vitamin complexes - Vitrum.
3. Medicines containing bismuth - Vikalin, Novbismol, De-Nol, Vikair.
4. Sorbents - activated carbon and other preparations containing it.
5. Salicylate-based products - acetylsalicylic acid, aspirin. Long-term use can cause internal bleeding, characterized by black stools.
6. Antibiotics used for diseases of the gastrointestinal tract.

The appearance of black feces due to consumption various products nutrition and medications without worsening the general condition is physiological and does not require treatment.

The presence of black feces can be a symptom of serious pathologies in the body. In this case, melena occurs suddenly and is accompanied by additional symptoms:

Dizziness.
General weakness.
Fainting states.
Decreased blood pressure.
Confusion.
Pale skin.
Deterioration of general health.
Nausea.
Vomiting.
Stomach pain.
Cold sweat.
Increased body temperature.

The combination of the above symptoms indicates the presence of disease. If they occur, you should immediately consult a doctor. Typically, tarry stools are observed with gastrointestinal bleeding caused by:

The presence of a green tint in black stool can also be a sign of a disease - an infectious process, for example, dysentery. In this case, you should immediately contact a specialist without waiting for the condition to worsen. If discoloration is the only sign, it may be caused by eating foods rich in chlorophyll, such as broccoli, spinach, arugula and other foods. In addition to color transformation, there is often a change in smell, which indicates a pathological process:

Melena: all about a dangerous disease

Melena is, first of all, the main indicator of the presence of bleeding in a person from any upper part of the digestive tract, namely from the esophagus, stomach or small intestine.

In some cases, tarry stools may occur when blood is swallowed. This happens with nosebleeds and, less commonly, pulmonary hemorrhages. A change in the color and consistency of feces will not occur immediately, but after 2-2.5 hours against the background of acute blood loss. The smell of feces will also be different - it will not be so sharp and unpleasant.

Why does melena appear?

The main reason, as mentioned earlier, is bleeding, but it can be caused by various diseases internal organs.

Esophageal bleeding

They may be due to:

varicose veins of this part of the digestive canal;
reflux esophagitis (inflammation of the esophageal mucosa caused by a reflex release of stomach contents into the esophagus);
esophageal cancer.

Bleeding in the stomach

Typically, melena is caused by diseases such as:

peptic ulcer;
acute stage of gastric erosion;
Mallory-Weiss syndrome (characterized by superficial tears in the mucous membrane of the esophagus and stomach as a result of recurrent vomiting);
stomach cancer;
leiomyoma (tumor of the stomach, formed mainly from the smooth muscle tissue of the organ);
abnormal development of gastric vessels (rare);
hemorrhagic angiomatosis, which is also called hereditary hemorrhagic telangiectasia ( hereditary disease, in which bleeding tumors form on various parts of the skin and on the mucous membranes of the mouth, lips and internal organs).

Bleeding from the duodenum

They start due to:

peptic ulcer;
aortoduodenal fistula;
duodenal diverticulum;
pancreatic tumors growing in intestinal tissue;
hemophilia.

Intestinal bleeding

Tarry stools occur when there is bleeding from the small intestine. It can be caused by:

leiomyoma;
Meckel's diverticulum (congenital malformation of the small intestine).

Bleeding due to bleeding disorders

Such bleeding is caused by:

Medicinal causes of bleeding

drinking large amounts of aspirin;
anticoagulants;
hormones;
non-steroidal anti-inflammatory drugs.

In addition, tarry stool may appear during treatment with iron, bismuth, frequent consumption of activated carbon and large amounts of licorice and red wine.

Along with this, simple gastritis can lead to a change in the consistency and color of stool. With it, this phenomenon is not so frequent, but in certain cases it becomes the cause (when ulcers begin to form, and the gastric mucosa is exposed to inflammatory processes). Since gastritis can take an erosive form, the mucous membrane will not only begin to become inflamed, but also become covered with microscopic cracks, which over time will increase in size and begin to bleed.

Main symptoms

Minor bleeding usually manifests itself as clearly defined stool of a solid consistency, while with extensive blood loss, the stool is usually loose and foul-smelling. If the patient suffers from chronic constipation, melena will appear only two days after blood enters the digestive tract.

Depending on the severity of blood loss, the patient may experience certain symptoms of hemorrhagic shock, namely:

flying spots before the eyes;
pale skin;
noise in ears;
increased sweating (cold sweat);
tachycardia;
dyspnea;
nausea;
decreased blood pressure;
short-term loss of consciousness;
spasm of peripheral vessels.

Often, most of these symptoms precede melena in one way or another. Blood loss of up to 500 ml is usually not accompanied by any clinical signs. Significant bleeding with a loss of more than 1000 ml leads to changes in blood pressure and pulse. Hemorrhagic shock begins after the loss of 2000 ml of blood. Then the patient begins to experience the symptoms described above until a gradual decrease in peripheral reflexes and their complete absence.

Melena in newborns

Melena is a symptom characteristic of both adults and, in some cases, children. In newborns, this phenomenon almost always occurs suddenly, which greatly frightens parents.

Tip: To diagnose and treat tarry, black stools in young children, contact a qualified healthcare professional as soon as possible.

In infants and infants, there are 2 types of manifestation of this symptom:

Symptomatic melena, characterized by rapid onset and complex course. With it, the tarry nature of stool is a signal that the child has a complex primary disease(hemophilia, sepsis, etc.).
Idiopathic. With this type, isolated bleeding in the intestines is observed. It is easier to treat, so melena goes away relatively quickly.

Also, melena of newborns can be false or true. True appears as a response to a bleeding disorder. It also occurs due to small but constant bleeding from the umbilical wound and hemorrhages into the skin or conjunctiva of the child.

False occurs if the baby swallows a certain amount of maternal blood during childbirth. In addition, it appears as a result of breastfeeding, if the mother has non-healing cracks in the nipples or if the child has nosebleeds.

Diagnosis of melena

The main diagnostic method for melena is examination and analysis of the patient's stool. In cases where this is impossible, but there is medical history and the patient has all the symptoms of internal bleeding, it is indicated rectal examination with the collection of feces from the walls of the rectal mucosa and its further examination.

The doctor evaluates the stool color, consistency, presence or absence of shine. It must be taken into account that the black color of stool may be due to the use of medications or certain foods (for example, blueberries or beets). However, in this case, the feces will have a normal consistency and will not have a varnish shine.

What to do and how to treat melena

If you notice black, tarry stools, you should immediately seek medical help. Melena and the bleeding that caused it often cause disability and, worse, death. That is why contacting a specialist as soon as possible, establishing the cause of “black stool” and starting treatment measures can save the patient’s life.

If the patient has all or some signs of bleeding, it is necessary to exclude any food and liquid intake until the ambulance arrives. If the patient experiences extreme thirst, you are allowed to take only a few sips of cold water.

Until the ambulance arrives, it is advisable to remain calm and take a horizontal position. You can additionally put something cold on the abdominal area, for example, an ice pack or a heating pad filled with cold water.

Treatment is aimed primarily at identifying the source of bleeding and carrying out all necessary measures to eliminate it (it is quite possible that even emergency surgery).

Vitamins are prescribed to a patient with tarry stools groups K, S, P and B3, a solution of vikasol is introduced. In case of severe blood loss, dosed blood transfusions, hemotherapy and the use of calcium chloride solution are indicated.

Preventive actions

The main direction of prevention is to prevent the occurrence of this symptom and timely treatment of all diseases that can trigger its development.

To prevent tarry stools in newborns, pregnant women are given vitamin K a day before birth. Babies also receive it in the first week of their life if the birth was difficult or in case of prematurity. In addition, it is indicated for children born from elderly mothers and for those children whose mothers suffered from toxicosis throughout pregnancy.

But perhaps it would be more correct to treat not the effect, but the cause?

Immunology and biochemistry

Black stool (melena and tarry)

Feces (stool) is the end result of assimilation of the necessary nutrients from the food we eat and removing what is left. The color, smell, composition and consistency of feces are true indicators of our health.

Black stools require special concern. The stool turns black as a result of the reaction of hemoglobin in red blood cells with hydrochloric acid stomach, so the appearance of black stools should be regarded as an SOS signal.

But before you worry about black stools, you need to analyze what was recently eaten and what medications were taken. Black stools caused by foods, supplements, medications or minerals are physiological black stools or false melena. Melena is black stool.

Foods and medications that turn stool black:

red beets, salads with red beets, berries (blueberries, blueberries), black licorice: red or black grapes, pomegranate, prunes, chokeberries, currants, blackberries, coffee, red wine, liver, blood sausage and other meat products with blood. Juices made from vegetables and fruits that have the ability to turn stool black should also be remembered. Preparations containing bismuth (De-Nol, Novbismol) and a series of drugs containing divalent and trivalent iron.

However, the use of the foods and medications listed above does not exclude the possibility of black stools as a reflection of internal bleeding. Pathological black stools usually appear against a background of persistent abdominal discomfort, painful bowel movements, vomiting, constipation or diarrhea. Internal bleeding, as a cause of black stool, may occur due to big amount health problems that are often associated with the stomach and intestines.

The most common cause of internal bleeding, and therefore black stools, is a stomach ulcer. Ulcers are open wounds that bleed profusely when touched. Ulcers that form on the surface of the stomach or lower small intestine may bleed. The blood then moves through the large intestine and eventually mixes with the stool, resulting in black bowel movements. Causes of stomach ulcers: infections with Helicobacter pylori bacteria, use of anti-inflammatory drugs (ibuprofen, naproxen) and aspirin, alcohol abuse.

Gastritis as a cause of black stool - the gastric mucosa is either inflamed or eroded.

The esophagus is a long passage between the throat and stomach. The stomach and esophagus are connected by a mucous membrane, which in some people is damaged by excessive coughing during long period and persistent vomiting. The site of damage to the mucous membrane bleeds. This condition is called Mallory-Weiss tear and causes black stool.

Black stools can be caused by bleeding from varicose veins of the esophagus. Varicose veins of the esophagus are associated with circulatory disorders in the liver (hepatitis, cirrhosis), which manifests itself reverse flow blood and its accumulation in the veins of the esophagus. The veins can eventually become damaged and become a source of bleeding. Blood from the veins of the esophagus passes all the way through the intestines, mixes with the stool, which becomes not just black, but tarry in appearance. This is tarry stool.

Diverticulitis is inflammation of diverticula. Diverticula are abnormal protrusions of the intestinal wall. At bacterial infections diverticula become inflamed and may rupture. rupture of diverticula is accompanied by bleeding and black stools. Crohn's disease and black stools: Crohn's disease is typically characterized by inflammation of the gastrointestinal tract. The inflammation is not superficial, but penetrates deeply into the intestinal tissue. The exact cause of Crohn's disease is unclear, but smokers and people with a family history of Crohn's disease have an increased risk of developing this inflammatory bowel condition.

Colon cancer and black stool. The development of colon tumors that become malignant (malignant) may be one of the causes of black stool. A tumor is nothing more than an abnormally protruding mass of tissue formed as a result of uncontrolled cell division. In most cases, tumors in the colon bleed and cause painful black stool. Colon cancer is a serious problem and requires urgent treatment. The causes of colon cancer are not known, but experts identify certain risk factors, which include smoking, poor diet, lack of physical activity and chronic intestinal problems such as Crohn's disease and ulcerative colitis.

Anal fissures and black feces. Anal fissures - painful condition associated with the anal canal. The anal canal is located between the anus and the rectum and has a length of 2.5 to 4 cm. The anal canal is the place where stool is expelled from the body. Hard stool (type 1,2, 3, 6 on the scale of stool shapes of gastroenterologists from the hospital in Bristol, England) can damage the anal canal and rupture it. This can lead to bleeding and appear as black stools. The main reason for the formation anal fissures is constipation.

Hemorrhoids and black stool. Vein expansion anal canal called hemorrhoids. When you have a bowel movement, stool can rupture a vein. Causes of hemorrhoids: constipation, pregnancy and the habit of spending a lot of time on the toilet.

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The development of bleeding in the gastrointestinal tract is indicated by a symptom such as melena stool. It is an alarming signal that requires immediate consultation with a doctor and a serious diagnosis. Melena is a symptom characteristic of many life-threatening pathologies and diseases. How it manifests itself, what are the reasons for its occurrence and what to do when a symptom appears, read the article.

Melena stool: characteristic features

Melena is a tarry, unformed black stool that has a sharp bad smell. With melena, stool looks shiny, as if varnished. Stool acquires a black tint due to the interaction of hemoglobin from the blood and hydrogen sulfide in the intestines, resulting in the formation of iron sulfide.

From Latin “melaena” is translated as “dark”, “black”, which is why melena is also called “black disease”. But in fact, this is not a disease, but a symptom that can appear in a number of ailments and pathological conditions accompanied by internal bleeding. In addition, tarry stools can occur when a person swallows blood from a nosebleed or lung bleed.

Melena stool appears 7–8 hours after the onset of bleeding, which is how long it takes for blood to pass through the gastrointestinal tract. With faster passage and heavy bleeding, this period can be significantly shortened. Melena can appear within half an hour to an hour from the start of bleeding and be accompanied by acute symptoms of blood loss, including admixtures of “fresh” scarlet blood in the stool. In people prone to constipation, black stools may appear 2-3 days after the start of bleeding.

Note: in International classification Melena diseases are assigned code K 92.1.

How does melena stool appear?

With extensive bleeding, melena stool has a liquid consistency. If the blood loss was insignificant, the density of the stool may not have changed: the stool will be formed, but have a black tint.

In addition to the main symptom - changes in the nature and appearance of stool - the patient also develops other signs:

weakness, lethargy, impotence;
pale skin;
tinnitus;
strong thirst;
“flickering of flies” before the eyes;
intense sweating, fever;
nausea;
unconscious state.

The severity of symptoms directly depends on the volume of blood lost. With minor blood loss (less than half a liter), no signs other than changes in the appearance of stool may appear. When blood loss in a volume of more than a liter occurs, blood pressure drops, shortness of breath, and a change in pulse are observed. With severe blood loss, when the volume of lost blood exceeds 2 liters, hemorrhagic shock may develop - life-threatening condition. A person may lose consciousness, his vision becomes dark, his breathing and heart rate are disrupted.

What are the causes of melena?

We have already said that melena is a condition that occurs when bleeding develops in the gastrointestinal tract. Most often, blood loss occurs in the duodenum, but damage to the higher located parts of the gastrointestinal tract - the esophagus and stomach - is also possible. In more rare cases, it is associated with damage to the pancreas and gallbladder. To determine the main causes of melena stool, we list the conditions in which bleeding develops most often. Among them:

bleeding occurring in the esophagus: possible with, cancerous tumors, reflux disease;
bleeding in the stomach cavity: develops against the background of a peptic ulcer, with Mallory-Weiss syndrome, with leiomyoma, cancer, hemorrhagic angiomatosis;
bleeding in the duodenum: can be the result of a peptic ulcer, diverticulitis, hemophilia, develop in the presence of aorto-duodenal fistulas or tumor formations in the pancreas affecting intestinal tissue;
bleeding in the small intestine: possible with leiomyoma,.

In addition, among the causes of blackened stools, it is worth highlighting the use of certain medications. These include non-narcotic analgesics, hormonal agents, and anticoagulants. Stool may acquire a black tint after taking activated carbon, medications that increase the level of iron in the body, or bismuth preparations.

Changing the color of your stool can also be caused by eating beets, blueberries, licorice and red wine. But in the above cases, the stool does not change its consistency, does not acquire the shine characteristic of melena, and other signs of blood loss do not appear.

What should you do if you have black stools?

If black stool is detected, you must urgently contact a specialist, ideally a gastroenterologist or surgeon, or call an ambulance. Before a medical examination, it is necessary to completely exclude food and drink. Only drinking cold water is allowed. You can apply cold to the abdominal area (a heating pad with cold water, ice).

In addition to examining the victim, stool is analyzed for the presence of hidden blood. This allows you to understand whether black stool is the result of eating foods with dyes or taking certain medications.

To determine the exact cause of bleeding, the patient is referred for endoscopy, during which it is often possible to eliminate the source of blood loss. The accuracy of endoscopic examination results is about 90%.

Less informative (allows you to determine the cause in 80% of cases) is an x-ray examination. During this procedure, a contrast agent is used - a barium solution. This method is used for intense bleeding.

If it is impossible to conduct an endoscopic examination due to severe hemorrhage, the method of selective arteriography can be used.

Forecast

Without medical care And proper treatment melena and the bleeding that causes it can lead to disability and even death. Timely identification of the cause of blood loss and its elimination will save a person’s life. Often, urgent surgical intervention is necessary to stop bleeding. Severe blood loss may require a transfusion.

According to medical statistics, melena caused by internal bleeding has a mortality rate of about 20% of all cases. If the symptom reoccurs, the likelihood of death doubles.

Unusual consistency with a strong unpleasant odor is usually called tarry stool or melena. Black stool is a clear deviation and a very alarming symptom, indicating bleeding in the gastrointestinal tract.

Tarry stools are a very alarming symptom!

The color of the stool is affected by the food itself and the time it spends in the intestines. The normal color of stool is brown, in some cases yellow (if you consume a large amount of dairy products).

The presence of streaks of scarlet blood in it does not indicate the location of the bleeding. Only a doctor can reliably determine the focus. Although the cause is usually , there is the concept of false melena caused by physiological reasons. The stool turns black due to foods or medications consumed.

You can distinguish it by its consistency, that is, the stool turns black, but the consistency is normal. Common causes of false melena:

Some berries stain the stool. These include black currants and blueberries.
May stain feces and urine. When consuming large amounts of beets, the stool becomes black and may be thinner due to the laxative effect of the vegetable. The urine turns red and may appear to be tinged with blood. All these symptoms quickly disappear after stopping consumption of beets.
also leads to staining of stool. The more tablets taken, the darker the stool will be. The consistency should not change.
Preparations containing iron turn stool black. This is usually stated in the instructions.

An ambulance will necessarily hospitalize a patient with complaints of melena, even if the paramedic and doctor did not see “confirmation” of the patient’s words. Any bleeding can be life-threatening.

What diseases cause tarry stools?

Tarry stools as a sign of bleeding

Internal bleeding can occur in various parts of the gastrointestinal tract as a result of ulcerative lesions and other diseases. The cause can only be determined through endoscopic examination. Main reasons:

. Gastritis does not often lead to tarry stool, but in some cases it can be the cause if the stomach lining is very inflamed or ulcers have already begun to form. Gastritis can also have an erosive form, in which black feces and vomiting of blood are possible. With erosive gastritis, the mucous membrane is not just inflamed, small lesions and cracks form on it, which begin to bleed over time.
Dilated veins of the esophagus. Varicose veins can also occur in the esophagus. Blood flow is disrupted, veins become larger, swell and are easily damaged by food. Blood accumulates in the stomach and enters the intestines, resulting in black, foul-smelling stool.
. Cancer is accompanied by the formation of malignant tumors that protrude into the intestinal lumen and, during the passage of food through the intestines, are touched, damaged and bleed. In this case, black stools are accompanied by severe pain. This disease requires mandatory surgical treatment.
. The most common cause of melena. A stomach ulcer is a small wound on the surface of the mucous membrane. In some cases, there may be several ulcers. They become damaged, bleed, and blood, along with gastric juice and food, enters the intestines, which leads to the formation of black feces. The cause of bleeding ulcers is most often the bacterium Helicobacter pylori, as well as alcohol abuse.
Diverticulitis. Diverticula themselves, or small protrusions on the wall of the colon, are already a pathology. They are formed due to increased pressure in the intestinal cavity. Diverticula can become inflamed and even rupture, called diverticulitis. A diverticulum rupture is accompanied by pain and black stool.
and hemorrhoids. As a rule, breakthrough of hemorrhoids and exacerbation of anal fissure are accompanied by the release of a certain amount of scarlet blood immediately before or during defecation.
. With polyps in the intestinal cavity, streaks of blood can often be observed in the stool, but if they are severely damaged, black tarry stools may also appear. Polyps are a precancerous condition and require immediate treatment.

Other symptoms and consequences of the disease

Food also affects the color of stool

Weakness, fainting. With blood loss, anemia and weakness begin. If the blood loss is small, the weakness will not be severe, but any fainting, even short-term, is a signal for urgent action. It is necessary to call an ambulance and hospitalize the patient.
and vomiting. Stomach bleeding may cause nausea and even vomiting of blood. The vomit may also appear black and resemble coffee grounds. Often these signs indicate an exacerbation of erosive gastritis.
. If the bleeding is associated with tumors, polyps or ulcers, severe abdominal pain, cramps and colic occur. It is not recommended to relieve them with painkillers before the ambulance arrives, so as not to blur the clinical picture.
Fever, tinnitus. These are signs of weakness due to blood loss. You may also experience spots before your eyes and dizziness.
Increased pulse and low blood pressure. These signs indicate large blood loss and hemorrhagic shock. This is usually followed by prolonged fainting.

You should not wait for other alarming symptoms; one tarry stool is enough to seek help from a doctor.

It is difficult to determine the exact effects of melena. They depend on timely assistance, correct diagnosis and the disease itself. Of course, the most terrible consequence is death, as well as disability as a result of excision of part of an organ, large loss of blood, and severe anemia.

Treatment

Taking certain medications can cause tarry stools

If the bleeding is not severe, hemostatic drugs will first be instilled to help stop the bleeding. If this does not help, they resort to surgical treatment. In case of gastric bleeding, the stomach is first washed, and then part of the mucous membrane with the source of bleeding is excised and the edges are sutured.

Blood loss must be restored. For this purpose, the doctor may prescribe IVs with saline and glucose, and in severe cases, blood and plasma transfusions. Since the most common cause of melena is a stomach ulcer, the most common solution to the problem is gastric resection. With this operation, part and most often most of it (2/3 or *), that is, more than half, are removed. Recovery after such an operation takes a long time, subject to a strict diet.

In case of gastrointestinal bleeding, it is important to monitor the patient’s condition and constantly measure pulse and blood pressure. The patient's condition is assessed according to severity, the level of hemoglobin in the blood, hematocrit, and red blood cells are determined. The severity of the condition has 4 degrees. In grade 1, the patient’s blood pressure remains at the same level, the pulse is increased, but the blood volume is reduced slightly. With grade 4, the patient is in serious condition in intensive care.

Blood transfusions are prescribed only in extreme cases. This is an effective, but not the safest method of treatment, since mortality as a result of blood transfusion also occurs. To stop, use the method of irrigation of the mucous membrane with homeostatic agents. The mixture of special drugs should be drunk in large sips every half hour.

Melena in newborns

Tarry stool is a reason to urgently call an ambulance!

The phenomenon of melena can be encountered as early as 3-4 days of life. The child first suddenly turns pale, becomes lethargic, and then begins to vomit blood or have black stools. With a mild form of the disease, after 2-3 times the appearance of black stools, melena goes away on its own, without significantly worsening the child’s condition. But severe melena can lead to the death of a child within 24 hours after the start of bleeding.

Determining the causes of melena in such young children can be quite difficult. As in adults, melena in children can be false, physiological. This is caused by the baby swallowing blood during labor or during feeding if the mother has bleeding cracks in her nipples.

Small children, as a rule, are not operated on. For melena, the doctor prescribes various vitamins, as well as Vicasol intramuscularly and intravenously. If treatment does not help, the spleen may be removed. Very often, the phenomenon of melena in newborns is associated with hemorrhagic disease of the newborn.

Due to a lack of vitamin K in the body, blood clotting is reduced, so the likelihood of bleeding increases. Vitamin K should be supplied to the baby from the mother, but not enough is supplied through the placenta.

Premature babies, as well as children born as a result of pregnancy complicated by gestosis, are at particular risk. To avoid this, mothers are given vitamin K some time before birth. The same is done to newborn children for preventive purposes if the birth was difficult or premature. With hemorrhagic disease, not only gastrointestinal but also pulmonary bleeding is detected, as well as effusions of blood into other organs.

Bleeding from the upper gastrointestinal tract, unspecified

Version: MedElement Disease Directory

Melena (K92.1)

Gastroenterology

general information

Short description

Melena(Latin melaena, from Greek melas, melanos - “dark”, “black”) - tarry stools, unformed black tarry stools with a fetid odor.
Melena is a characteristic sign of bleeding mainly in the upper gastrointestinal tract. Sometimes observed with bleeding from the right colon with slow intestinal transit.

Note. Neonatal melena is covered under P54.1 (Melena of the newborn) and P78.2 (Haematemesis and melena due to ingestion of maternal blood).

Period of occurrence

Minimum period of occurrence (days): 1

Maximum period of occurrence (days): not specified

As a rule, it develops no earlier than 8 hours after the start of bleeding. With rapid passage through the gastrointestinal tract and a bleeding volume of more than 100 ml, the time from the onset of bleeding to the appearance of melena may be reduced. In this case, melena may contain an admixture of scarlet blood.

Etiology and pathogenesis

Melena can be a consequence of swallowing blood, for example, with nosebleeds or pulmonary bleeding. Such a cause can be excluded through a thorough history taking, as well as a physical examination of the oropharynx and nasal cavity.

Most common causes of bleeding from the upper gastrointestinal tract (GIT):
- peptic ulcer;
- erosive gastritis;
- phlebeurysm;
- Mallory-Weiss syndrome.
These causes account for more than 90% of all cases of bleeding from the upper gastrointestinal tract, when the location of the lesion can be accurately determined.

Peptic ulcer
It is perhaps the most common cause of upper gastrointestinal bleeding. In the majority of cases, ulcers are detected in the duodenum (duodenum). The risk of significant bleeding is present in approximately 20-30% of patients with documented ulcers. If there is no history typical of a peptic ulcer, it should nevertheless be kept in mind, since hemorrhage can also be the initial manifestation of a peptic ulcer.

Gastritis
The development of gastritis may be caused by recent consumption alcoholic drinks or taking anti-inflammatory drugs (acetylsalicylic acid, indomethacin).
Erosions or symptomatic ulcers in patients with gastritis often occur as a result of major trauma, surgical interventions for severe systemic diseases, especially in burn victims and with increased intracranial pressure.
Gastritis is suspected based on appropriate clinical findings, since the typical physical signs of gastritis are unknown.
Gastroscopy is usually performed to confirm the diagnosis. Gastroscopy is a method of studying the condition of the gastric mucosa, which consists of examining it using a gastroscope (a medical endoscope for examining the cavity and inner surface of the stomach and performing various manipulations)
(X-ray examination usually does not reveal gastritis).

Bleeding from varicose veins
Features- sudden onset and massive blood loss. Bleeding from the veins of the esophagus or stomach may result portal hypertensionPortal hypertension is venous hypertension (increased hydrostatic pressure in the veins) in the portal vein system.
for cirrhosis of the liver Liver cirrhosis is a chronic progressive disease characterized by degeneration and necrosis of the liver parenchyma, accompanied by its nodular regeneration, diffuse proliferation of connective tissue and deep restructuring of the liver architectonics.
.
It should be kept in mind that any condition that causes portal hypertension, even in the absence of liver disease (for example, portal vein thrombosis or idiopathic portal hypertension), can lead to bleeding from varices.
In addition, varicose veins can sometimes be caused by acute hepatitis or severe fatty infiltration of the liver. This expansion spontaneously disappears when the corresponding defect in the liver is eliminated.
Although upper gastrointestinal bleeding in patients with cirrhosis suggests varicose veins, in approximately half of patients the bleeding is due to other causes (eg, gastritis, ulcers). Thus, it is necessary to rule out these causes in order to prescribe the correct treatment.

Mallory-Weiss syndrome
This syndrome is increasingly being identified as a cause acute bleeding from the upper gastrointestinal tract using esophagogastroduodenoscopy. Mallory-Weiss syndrome involves a rupture of the mucous membrane at the junction of the esophagus and the stomach, which often manifests as retching or a history of non-bloody vomiting, followed by hematemesis.

Other pathologies

Esophagitis Esophagitis is inflammation of the mucous membrane of the esophagus.
And carcinoma Cancer (syn. carcinoma, malignant epithelioma) - malignant tumor, developing from epithelial tissue
are less common causes of esophageal bleeding. They mainly cause chronic blood loss and rarely lead to massive bleeding.

Chronic gastrointestinal bleeding may be caused by cancer stomach. In rare cases, lymphoma causes bleeding Lymphoma is the general name for tumors arising from lymphoid tissue
, polyps and other tumors of the stomach and small intestine. Leiomyoma and leiomyosarcoma are rare but can cause massive bleeding.
Bleeding from diverticula is relatively rare. A diverticulum is a protrusion of the wall of a hollow organ (intestine, esophagus, ureter, etc.), communicating with its cavity.
duodenum and jejunum.
Bloody diarrhea may accompany mesenteric vascular insufficiency The mesentery is a fold of the peritoneum through which the intraperitoneal organs are attached to the walls of the abdominal cavity.
, including occlusive and non-occlusive processes.

Possible rupture atherosclerotic aortic aneurysms into the lumen of the small intestine, which almost always ends in the death of the patient. A similar rupture can also occur after reconstructive surgery on the arteries with the formation of a fistula between the synthetic prosthesis and the intestinal lumen. Sudden massive bleeding from an aortointestinal fistula may be preceded by slight bleeding. Sudden bleeding may occur after an injury that ruptures the liver, allowing blood to enter the liver. bile ducts(i.e. hemobilia).

Severe gastrointestinal bleeding may be due to primary dyscrasias Dyscrasia - improper mixing or change in the composition of body fluids (juices)
blood, including leukemia, thrombocytopenic state, hemophilia and disseminated intravascular coagulation.

Polycythemia vera can be combined with an increased incidence of peptic ulcers with the occurrence of gastrointestinal bleeding caused by thrombosis of the mesenteric and portal veins.
Gastrointestinal bleeding may be accompanied by periarteritis nodosa, hemorrhagic Hemorrhagic - bleeding, accompanied by bleeding, leading to bleeding
and other vasculitis. Sometimes such bleeding occurs in arteriovenous malformations, amyloidosis, Osler-Rendu-Weber syndrome, Turner syndrome, elastic pseudoxanthoma, intestinal hemangiomas, neurofibromatosis, Kaposi's sarcoma and Peutz-Jeghers syndrome.
Gastrointestinal bleeding may occur as a result of uremia Uremia is a pathological condition caused by retention of nitrogenous wastes in the blood, acidosis and disturbances of electrolyte, water and osmotic balance in renal failure; usually manifested by weakness, apathy, stupor, hypothermia, arterial hypertension
; its most common manifestation is chronic, hidden bleeding from diffusely altered mucous membrane of the stomach and small intestine.
You should also keep in mind Meckel's diverticulum, hemobilia (bleeding into the bile ducts), gastropathy with portal hypertension.

The black color of stool is a secondary process in relation to intestinal bleeding. It is formed as a result of blood contact with hydrochloric acid, leading to the formation of hematin. Melena is characterized by tar-like (“sticky”) stool. This property distinguishes them from those of black or dark color after the patient has taken iron, bismuth or licorice.
Stools may turn red after eating beets or intravenous administration sulfobromophthalein.
For a single appearance of black stool, approximately 60 ml of blood is required; acute blood loss, in which a larger amount of blood is released, can cause melena within 3 days. Test for occult blood may remain positive for another week or more after the color of the stool has normalized.

Gastrointestinal bleeding is a sign of a potentially serious illness (even if it can only be identified based on positive test feces for occult blood), so additional studies are required.

Epidemiology

Upper gastrointestinal bleeding accounts for approximately 70-80% of all cases of gastrointestinal bleeding.

Clinical picture

Symptoms, course

Clinical manifestations gastrointestinal bleeding depend on concomitant diseases, on the speed and extent of hemorrhage.
If less than 500 ml of blood is lost, systemic signs rarely appear, except in cases of bleeding in elderly patients or people suffering from anemia. Loss of even less blood may cause hemodynamic changes in these patients.
Rapid hemorrhage, accompanied by the loss of large amounts of blood, leads to a decrease in its venous return to the heart, cardiac output and an increase in peripheral resistance, which is caused by reflex vasoconstriction.
Orthostatic hypotension Orthostatic hypotension ( orthostatic collapse, syn. - postural hypotension) is a human condition in which when sudden change body position when standing up or standing for long periods of time, insufficient blood flow to the brain due to decreased blood pressure
more than 10 mm Hg. Art. usually indicates a decrease in total blood volume of 20% or more. Associated symptoms: dizziness, nausea, fainting, thirst, sweating.
In case of critical blood loss - 40% of the total blood volume, a state of shock often occurs with severe tachycardia and hypotension. Patients are very pale, with skin that is cold to the touch.

Diagnostics

Diagnosis is carried out only after hemodynamic parameters improve Hemodynamics - 1. A section of circulatory physiology that studies the causes, conditions and mechanisms of blood movement in the cardiovascular system based on the use of the physical laws of hydrodynamics. 2. The set of processes of blood movement in the cardiovascular system
(see section "Treatment").

1. Anamnesis:
- taking medications (high risk of bleeding from the upper and lower gastrointestinal tract while taking aspirin and NSAIDs);
- ulcer and/or bleeding in the past;
- heredity;
- symptoms of cirrhosis, vasculitis;
- drinking alcohol.
History or symptoms that suggest a primary peptic ulcer may be helpful in diagnosis. Data on previous gastrointestinal bleeding and family history data also help in making a diagnosis. intestinal diseases or hemorrhagic diathesis.
If there is evidence of alcohol abuse or taking anti-inflammatory drugs in the recent past, the development of erosive gastritis seems most likely. In this case, it is necessary to exclude recent trauma and associated systemic diseases, since bleeding caused erosive gastritis, often accompanies precisely these conditions.
With evidence of long-term alcohol abuse, the source of bleeding may be varicose veins of the esophagus.
Acetylsalicylic acid can also cause gastroduodenitis, peptic ulcers and bleeding.
If the patient has had pain and retching followed by hematemesis in the recent past, Mallory-Weiss syndrome may be suspected.
With the acute onset of bloody diarrhea, inflammatory bowel disease or infectious colitis may be present.

2. Physical examination is carried out to identify symptoms of the underlying disease after determining orthostatic changes in heart rate and blood pressure, as well as after restoring circulating blood volume.
When examining the oral cavity and nasopharynx, it is necessary to exclude an extraintestinal source of bleeding.

An examination by a dermatologist can help identify the following signs:
- telangiectasia Telangiectasia is local excessive expansion of capillaries and small vessels.
- typical for Osler-Rendu-Weber syndrome (not visible in severe anemia);
- pigmentation around the mouth - characteristic of Peutz-Jeghers syndrome;
- dermatofibromas Dermatofibroma is a benign connective tissue tumor of the skin in the form of a slowly growing dense painless node, poorly demarcated from the dermis
- characteristic of neurofibromatosis;
- steatomas and osteomas - typical of Gardner's syndrome;
- palpable purpura Purpura - multiple small hemorrhages in the skin and mucous membranes
- often occurs with vasculitis;
- diffuse pigmentation - observed with hemochromatosis.

In the presence of characteristic features chronic liver disease (spider hemangiomas, gynecomastia Gynecomastia - enlargement of the mammary glands in men
, testicular atrophy, jaundice, ascites Ascites - accumulation of transudate in the abdominal cavity
and hepatosplenomegaly) the possibility of portal hypertension, which causes bleeding from esophageal or gastric varices, should be considered.
Palpable formations in it and a noticeable enlargement of the lymph nodes can indicate a hidden malignant process in the abdominal cavity.

Digital examination of the rectum is necessary procedure, since it allows you to exclude local pathology of the rectum as a source of bleeding and determine the color of stool.

3. Aspiration of gastric contents through a nasogastric tube And blood test are carried out if bleeding from the upper gastrointestinal tract is suspected (a false negative result is possible when the bleeding stops).
If there is a history of melena or bloody vomiting or if bleeding from the upper gastrointestinal tract is suspected, a tube is inserted into the stomach through the nose and the stomach contents are aspirated. This allows you to determine whether the bleeding is actually coming from the upper gastrointestinal tract.
If the first portion of the sucked contents is transparent, the probe is left in the stomach for several hours, since, despite this, active bleeding from the duodenum (duodenum) may be present.
When, during a period of active bleeding, there is no blood in the contents aspirated from the stomach, it is assumed that the bleeding is not coming from the stomach or duodenum. However, if there are no signs of active bleeding while the tube is in the stomach, endoscopy may be required, since it cannot be definitively stated that the bleeding is not from the stomach or duodenum.
If the gastric contents aspirated through the tube are stained with red blood or the color of coffee grounds, immediate gastric lavage with saline solution is required. It allows the clinician to assess the intensity of bleeding and clears the stomach of blood clots that have accumulated in it before possible endoscopy.
Further diagnostic measures depend on whether bleeding continues or not. The assessment is made based on changes in vital signs important functions, according to the need for blood transfusion and the number of bowel movements and consistency of stool.

4. Endoscopy allows you to assess the source of bleeding and the possibility of therapeutic intervention with an accuracy of more than 90%. Endoscopy is mandatory if varicose veins or aortointestinal shunt are suspected. Using this study, it is possible to identify the affected artery in the crater of the ulcer, which is a sign of a high risk of rebleeding (50%).
If bleeding from the veins of the esophagus is suspected, an emergency EGD should be performed. FGDS - fibrogastroduodenoscopy ( instrumental study esophagus, stomach and duodenum using a fiberoptic endoscope)
within less than 4 hours from the onset of bleeding; if bleeding from the stomach or duodenum is suspected, within no more than 12-24 hours.

5.X-ray examination upper gastrointestinal tract with barium sulfate identifies the lesion with 80% accuracy, although the source of bleeding cannot always be determined. This study serves as an alternative to endoscopy for chronic intense bleeding.

6. Selective mesenteric arteriography Arteriography is an X-ray examination of arteries after the introduction of a contrast agent into their lumen
performed in cases where bleeding interferes with adequate endoscopy.

7. Radionuclide scanning(99mTc-labeled red blood cells or albumin) is used as a screening test to assess the feasibility of arteriography in intermittent bleeding from an unknown source.

Laboratory diagnostics

Any laboratory parameters must be assessed over time.

1. General blood analysis:
- hematocrit number;
- hemoglobin level;
- assessment of erythrocyte morphology (hypochromic, microcytic erythrocytes may indicate chronic bleeding);
- counting the number of leukocytes and platelets, determining the leukocyte formula.

It should be kept in mind that the hematocrit value, determined immediately after the onset of bleeding, may not accurately reflect its volume. This is due to the fact that to balance the volume of extravascular fluid and hemodilution Hemodilution (syn. hydremia) - increased water content in the blood.
it takes several hours.
Common results laboratory research include mild leukocytosis and thrombocytosis, which develop within 6 hours from the onset of bleeding.

2. Blood chemistry: Blood urea nitrogen levels may be slightly elevated (especially with upper gastrointestinal bleeding). This result is due to the destruction of blood proteins to urea. intestinal bacteria, as well as a slight decrease in glomerular filtration rate.

3.Coagulogram: multidirectional shifts are noted in different phases bleeding, which depends on the etiology and volume of blood loss. Prothrombin time is determined (to exclude primary or secondary blood coagulation disorders), partial thromboplastin time, and other studies are performed to evaluate the blood coagulation system.

Differential diagnosis

1. Melena when swallowing blood (bleeding from the mouth, lungs).
2. Melena of newborns. For more details, see subheadings P54.1 - “Melena of the newborn” and P78.2 - “Hematemesis and melena due to ingestion of maternal blood.”
3. Coloring the stool with food or dyes (the issue is resolved by performing a stool test for occult blood).

Complications

- hypovolemic shock Hypovolemic shock is a condition caused by a decrease in circulating blood volume. Characterized by a mismatch in tissue oxygen demand, metabolic acidosis (increased acidity)
;
- anemia;
- DIC syndrome Consumptive coagulopathy (DIC syndrome) - impaired blood clotting due to massive release of thromboplastic substances from tissues
.

Treatment

The treatment algorithm depends on the presence or absence of signs of shock.

Clinical signs of shock:
- signs of peripheral circulatory disorders;
- tachycardia (pulse more than 100 beats/min.);
- hypotension - systolic blood pressure less than 100 mmHg. (BP during gastroduodenal bleeding against the background arterial hypertension may remain normal or high);
- orthostatic collapse (drop in blood pressure when changing body position);
- oliguria (diuresis rate less than 30 ml/hour).

Treatment algorithm for patients with shock:
- ensuring airway patency, oxygen therapy;
- providing venous access (installation of two peripheral venous catheters 14-16G);
- intravenous administration of blood substitutes (starting dose 500-1000 ml), determination of blood group and Rh factor, calculation of the required dose donated blood;
- catheterization central vein, measurement of central venous pressure;

Continue infusion/transfusion until hemodynamic stabilization;
- correction of blood coagulation disorders (fresh frozen plasma, vitamin K, platelet mass - according to indications);
- regular (at least hourly) monitoring of hemodynamic parameters until it stabilizes;
- catheterization of the bladder and hourly monitoring of diuresis;
- ECG, X-ray examination abdominal organs, blood gas examination;
- urgent endoscopy and/or consultation with a surgeon;
- determination of the risk of rebleeding using the Rockall scale;
- biochemical blood test, coagulogram;
- monitoring of hemodynamics during its stabilization - every 4 hours;
- correction of anemia - blood transfusion (target hemoglobin level of at least 10 g/l);
- ban on food and drink for 24 hours; next 24 hours - drink only clear liquids, light diet after 48 hours (in the absence of re-bleeding);

Consider treatment with PPIs (damage to the stomach and duodenum), octreotide and glypressin (for bleeding from esophageal varices) or other pathogenetic therapy (for bleeding of other etiologies).

Forecast

Mortality reaches, according to various sources, 15-20%. With repeated bleeding - up to 40%.

Hospitalization

As an emergency, go to the surgery or intensive care unit.

Prevention

Timely detection and adequate treatment of etiologically significant diseases.

Information

Sources and literature

Current Medical Diagnosis & Treatment 2009, Forty-Eighth Edition /Editors Stephen J. McPhee, Maxine A. Papadakis
The Merk manual. Guide to Medicine. Diagnostics and treatment /ed. Beers Mark H./trans. from English edited by Chuchalina A.G., M.: Litterra, 2011
Internal illnesses by Tinsley R. Harrison /ed. Fauci E., Braunwald Y., Isselbacher K., Wilson J., Martin J., Kasper D., Hauser S. and Longo D.: in 7 vols., M.: Praktika - McGraw Hill, 2005
Longmore M., Wilkinson Y., Rajagopalan S. Oxford Handbook of Clinical Medicine / ed. prof. Doctor of Medicine Sciences Shustova S.B. and Ph.D. honey. Sciences Popova I.I., M.: Binom, 2009

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Feces (stool) is the end result of the absorption of essential nutrients from the food we eat and the elimination of what is left. The color, smell, composition and consistency of feces are true indicators of our health.

Normal stool color is determined by
bile pigments (hemoglobin metabolites of old red blood cells),
food composition (presence of colored foods, protein, fats and carbohydrates),

intestinal transit rate.

Brown stool (or any shade of brown) is considered normal. On a dairy diet, yellow stool also reflects normal bowel function. In pathological conditions of the intestines, the color of the stool changes and is used to diagnose specific diseases. Black stools require special concern. WITH tul turn black as a result of the reaction of hemoglobin in red blood cells with hydrochloric acid, stomach acid

therefore, the appearance of black stool should be regarded as an SOS signal. But before you worry about black stools, you need to analyze what was recently eaten and what medications were taken. Stool staining caused by foods, supplements, medications or minerals is a

physiological black stool or false melena. Melena is black stool.

red beets, salads with red beets, berries (blueberries, blueberries), black licorice: red or black grapes, pomegranate, prunes, chokeberries, currants, blackberries, coffee, red wine, liver, blood sausage and other meat products with blood. Juices made from vegetables and fruits that have the ability to turn stool black should also be remembered. Preparations containing bismuth (De-Nol, Novbismol) and a series of drugs containing divalent and trivalent iron.
Foods and medications that turn stool black:

Gastritis as a cause of black stool - the gastric mucosa is either inflamed or eroded.

Esophagus - a long passage between the throat and stomach. The stomach and esophagus are connected by a mucous membrane, which in some people is damaged by excessive coughing over a long period and persistent vomiting. The site of damage to the mucous membrane bleeds. This condition is called Mallory's tear -Weiss and manifests itself as black stools.

Black stools may be caused by bleeding from varicose veins. dilated veins of the esophagus A. Varicose veins of the esophagus are associated with circulatory disorders in the liver (hepatitis, cirrhosis), which is manifested by the reverse flow of blood and its accumulation in the veins of the esophagus. The veins can eventually become damaged and become a source of bleeding. Blood from the veins of the esophagus passes all the way through the intestines, mixes with the stool, which becomes not just black, but gummy view. This tarry stool .

Diverticulitis - inflammation of diverticula. Diverticula are abnormal protrusions of the intestinal wall. With bacterial infections, diverticula become inflamed and may rupture. rupture of diverticula is accompanied by bleeding and black stools. Crohn's disease and black stools : Crohn's disease is typically characterized by inflammation of the gastrointestinal tract. The inflammation is not superficial, but penetrates deeply into the intestinal tissue. The exact cause of Crohn's disease is unclear, but smokers and people with a family history of Crohn's disease have an increased risk of developing this inflammatory bowel condition.

Colon cancer and black stool . The development of colon tumors that become malignant (malignant) may be one of the causes of black stool. A tumor is nothing more than an abnormally protruding mass of tissue formed as a result of uncontrolled cell division. In most cases, tumors in the colon bleed and cause painful black stool. Colon cancer is a serious problem and requires urgent treatment I. The causes of colon cancer are not known, but experts identify certain risk factors that include smoking, poor diet, lack of physical activity and chronic intestinal problems such as Crohn's disease and ulcerative colitis.

Anal fissures and black feces. Anal fissures are a painful condition associated with the anal canal. The anal canal is located between the anus and the rectum and has a length of 2.5 to 4 cm. The anal canal is the place where stool is expelled from the body. Hard stool (type 1,2, 3, 6 on the scale of stool shapes of gastroenterologists from the hospital in Bristol, England) can damage the anal canal and rupture it. This can lead to bleeding and appear as black stools. The main cause of anal fissures is constipation.

Hemorrhoids and black stool. Dilation of the veins in the anal canal is called hemorrhoids. When you have a bowel movement, stool can rupture a vein. Causes of hemorrhoids: constipation, pregnancy and the habit of spending a lot of time on the toilet.