Melena (Dark Stools) Treatment in Delhi, India

Melena's stools are black, tar-like, and sticky. This black appearance is due to the breakdown and digestion of blood by an enzyme in the GI tract. A nasty smell is frequently associated with this hue. Melena can cause various symptoms based on the severity of internal bleeding and the location.

Symptoms Of Severe Blood Loss Are As Follows:

• Marked reduction in blood volume
• Anaemia
• Shock
• Lack of strength
• Dyspnea
• Pale skin
• Lightheadedness
• Fast heart rate

Mild Blood Loss Symptoms Are As Follows:

• Bleeding in the small intestine can cause stomach aches
• Bleeding in the mouth, oesophagus, or abdomen
• Discomfort while swallowing
• Pain in the upper abdomen
• Hematemesis (vomiting blood)
  
  

Causes of Melena

Melena occurs due to injury to the mucosa of the upper gastrointestinal tract, inflammation of the blood vessels, or bleeding problems. Melena can be caused by a peptic ulcer, characterised by acute ulcers or blisters that form in the stomach and small intestine.

Damage To The Gastrointestinal Tract

• Mallory-Weiss syndrome
• High stomach acid
• Gastroesophageal reflux disease can progress to inflammation of the oesophagus lining that can lead to blistering & bleeding.
• Tumour development

Upper Gastrointestinal Bleeding Also Can Be Caused By Swollen Veins

• Portal hypertension is the most prevalent cause of this. Liver diseases like liver fibrosis can obstruct blood flow via the liver, causing portal hypertension.

Blood Disorders In Which There Is Excessive Bleeding And Ecchymosis (Bruising)

• Hemophilia and Thrombocytopenia

The physician will obtain a medical history from the person, including any prior bleeding, perform a physical examination, and request tests.

The following tests doctor can perform to diagnose:

• Blood tests- The doctor may ask the patient to have a complete blood count test to evaluate how quickly a person's blood clots,their platelet count, & liver function test, to name a few.
• Stool tests- The reason for gastrointestinal bleeding can be determined by analysing the patient's faeces.
• Nasogastric lavage- Lavage helps remove the stomach's contents; a tube is inserted through the nose and into the stomach. This method helps determine the source of the bleeding.
• Upper endoscopy- This technique involves passing a long tube via the patient's mouth with a tiny camera attached to assist the doctor in checking the upper gastrointestinal tract.
• Colonoscopy- In this method, a long tube is passed into the rectum with a tiny camera attached to it through which the doctor inspects the patient's big intestine & rectum.
• Capsule endoscopy- A capsule, the size of a vitamin, containing a tiny camera, is given to the patient. The camera inside the capsule takes thousands of photographs as it goes through the patient’s digestive tract & sends them to a recorder attached to a band around the patient's waist. The doctor will be able to view the small intestine with this procedure.
• Flexible sigmoidoscopy- A tube with a camera and light is inserted to examine the rectum.
• Balloon-assisted enteroscopy- A specialist scope examines sections of the small intestine which aren't accessible with an endoscope. Throughout this examination, the site of bleeding may be managed or addressed.
• Angiography- In this method, an artery is injected with dye, and then X-rays are taken to search for and treat bleeding blood vessels and other problems.
• Imaging tests- To locate the source of bleeding, imaging tests are used. The doctor may order imaging tests like CT scans for the abdomen.

The underlying reason will determine treatment:

• Medication may be prescribed to lessen the quantity of acid produced by the stomach. In case melena is due to ulceration, this may assist. If the patient has a tear or injury, medication to stop blood from flowing to an injury or tear may also be given. If Melena is due to the patient's medication, the healthcare practitioner may modify it. NSAIDs & blood thinners are two examples. It is advisable not to discontinue taking any medications without consulting a doctor.
• Endoscopy can help treat the cause of bleeding. To close a tear, sometimes, a healthcare practitioner may use heat to close an incision. They may use clips to hold tissue together as it heals. Bands can be wrapped across swollen varices to halt the bleeding.
• The doctor may order a blood transfusion if a person loses a considerable amount of blood.
• Surgery may be required if severe bleeding occurs or other therapies have failed. A tear in the stomach or intestine wall may require surgery to repair. The doctor may also order surgery in case of blockage or tumour.

If the location of gastrointestinal bleeding is not recognized and treated, significant consequences can occur, specifically in individuals who are bleeding excessively or for an extended period. Gastrointestinal bleeding can lead to the following complications:

• Anaemia- prolonged bleeding can lead to anaemia due to a shortage of haemoglobin and RBC. Chest discomfort, vertigo, exhaustion, tiredness, palpitations, breathlessness, and inability to concentrate are symptoms.
• Hypovolemia- When a person loses blood due to a severe GI bleed, their heart may struggle to circulate sufficient blood throughout the body. All symptoms include sweating excessively, disorientation, agitation, reduced urine output, weakness, pale complexion, fast breathing, & unconsciousness.
• Shock- GI bleeds that occur suddenly and abruptly can result in a lack of blood supply to the rest of the body, triggering organ damage & organ failure. Shock can intensify without therapy, resulting in permanent injury or death. Dangerously low blood pressure, blue lips & fingernails, chest pain, altered mental state, dizziness, anxiety, pale complexion, low urine output, rapid yet weak pulse, chest breathing, & unconsciousness are all signs & symptoms of shock.

Some factors that make individuals more susceptible to gastrointestinal bleeding are:

• Liver diseases like advanced liver cirrhosis (CLD)
• Cancer
• Use of aspirin or other nonsteroidal anti-inflammatory medications
• Dieulafoy lesion is a rare, life-threatening condition.
• Inflammation in the oesophagus
• Erosive gastritis
• Intestinal ischemia
• Gastric ulcer
• Mallory-Weiss tear
• Varices in the oesophagus or stomach

The prognosis for Melena is determined by the source & place of the bleeding, the severity of the bleeding at the time of consultation, and any pre-existing medical issues that may impair the patient's rehabilitation.

Reviewed byDr. Vibhor Pareek, Consultant, Gastroenterology, Hepatology & Endoscopy on 19-Dec-2022.