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'''For patient information click [[{{PAGENAME}} (patient information)|here]]'''
{{DiseaseDisorder infobox |
{{DiseaseDisorder infobox |
   Name        = Melena |
   Name        = Melena |
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}}
}}
{{Melena}}
{{Melena}}
{{CMG}}
==[[Melena overview|Overview]]==
==[[Melena historical perspective|Historical Perspective]]==
==[[Melena pathophysiology|Pathophysiology]]==
==[[Melena causes|Causes]]==
==[[Melena epidemiology and demographics|Epidemiology and Demographics]]==


{{CMG}}
==[[Melena risk factors|Risk Factors]]==
==Overview==
'''Melena''' or ''melaena'' refers to the black, "tarry" [[feces]] that are associated with gastrointestinal [[hemorrhage]]. The black color is caused by oxidation of the [[iron]] in [[hemoglobin]] during its passage through the [[ileum]] and [[colon (anatomy)|colon]].


==Melena vs. hematochezia==
==[[Melena natural history, complications and prognosis|Natural History, Complications and Prognosis]]==
Bleeding originating from the lower GI tract (such as the [[sigmoid colon]] and [[rectum]]) is generally associated with the passage of bright red blood, or [[hematochezia]], particularly when brisk.  Blood acts as a [[cathartic]] agent in the intestine, promoting its prompt passage.  Only blood that originates from a high source (such as the [[small intestine]]), or bleeding from a lower source that occurs slowly enough to allow for oxidation, is associated with melena.  For this reason, melena is often associated with [[hemorrhage]] in the [[stomach]] or [[duodenum]] ([[upper gastrointestinal tract]]), for example by a [[peptic ulcer]]. A rough estimate is that it takes about 14 hours for blood to be broken down within the intestinal lumen; therefore if transit time is less than 14 hours the patient will have hematochezia and if greater than 14 hours the patient will exhibit melena. One often-stated rule of thumb is that melena only occurs if the source of bleeding is above the [[ligament of Treitz]].


==Diagnosis==
==Diagnosis==
Patients present with signs of anemia.  The presence of blood must be confirmed with either a positive hemoccult slide on rectal exam, frank blood on the examining finger, or a positive stool guaiac from the lab.  If a source in the upper GI tract is suspected, an [[upper endoscopy]] can be performed to diagnose the cause.  Lower GI bleeding sources usually present with hematochezia or frank blood.  A test with poor sensitivity/specificity that may detect the source of bleeding is the tagged red blood cell scan, whereas mesenteric angiogram is the gold standard. Hence, the commonly referenced quote goes as follows: "when you go the bathroom it spells melana in the toilet."


==Differential diagnosis of causes of melena==
[[Melena history and symptoms|History and Symptoms]] | [[Melena physical examination|Physical Examination]]  | [[Melena laboratory findings|Laboratory Findings]] | [[Melena x ray|X Ray]] | [[Melena CT|CT]] |  [[Melena other imaging findings|Other Imaging Findings]] | [[Melena other diagnostic studies|Other Diagnostic Studies]]
The most common cause of melena is [[peptic ulcer]] disease. Any other cause of bleeding from the upper gastro-intestinal tract, or even the ascending colon, can also cause melena.  Melena may also be a sign of drug overdose if a patient is taking anti-coagulants, such as warfarin. A less serious, self-limiting case of melena can occur in newborns two to three days after delivery, due to swallowed maternal blood.


==Treatment==
==Treatment==
Urgent care however is required.
[[Melena medical therapy|Medical Therapy]] | [[Melena surgery|Surgery]] | [[Melena primary prevention|Primary Prevention]] | [[Melena secondary prevention|Secondary Prevention]] |  [[Melena cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] |  [[Melena future or investigational therapies|Future or Investigational Therapies]]
 
==Case Studies==
[[Melena case study one|Case #1]]


==Related Chapters==
==Related Chapters==

Revision as of 15:37, 5 September 2012

For patient information click here Template:DiseaseDisorder infobox

Melena Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Melena from Other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

X Ray

CT

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

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MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

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Melena in the news

Blogs on Melena

Directions to Hospitals Treating Melena

Risk calculators and risk factors for Melena

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Historical Perspective

Pathophysiology

Causes

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms | Physical Examination | Laboratory Findings | X Ray | CT | Other Imaging Findings | Other Diagnostic Studies

Treatment

Medical Therapy | Surgery | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Case Studies

Case #1

Related Chapters

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