Malaena
Overview
Malaena refers to the passing of jet black, tarry, sticky, foul-smelling stools. This symptom is highly suggestive of upper GI bleeding.
Aetiology
Causes of Malaena
- Oesophageal - varices, AVM, tumour, oesophagitis, Mallory-Weiss tear
- Gastric- gastritis, gastric ulcer, gastric carcinoma, hiatus hernia
- Duodenal - duodenal ulcer, duodenitis
Note that iron and bismuth-containing medications can cause stools with a similar appearance to malaena.
History of Presenting Complaint
Stools
- Ask about the appearance and smell of the stools to ascertain whether they in fact represent malaena.
Onset
Under what circumstances the dark stools began.- Onset after recently commencing iron supplementsUnlikely to represent true malaena
- Onset after protracted vomitingSuggestive of Mallory-Weiss tear
Timing
- How long the patient has noticed the dark stools for.
Associated Symptoms
Whether the dark stools have been associated with any other symptoms.- Coffee-ground vomitingSuggestive of peptic ulceration with slow bleed
- Epigastric painSuggestive of gastritis, peptic ulcer or oesophagitis
- Prolonged heartburnSuggestive of oesophagitis
Extra Credit
Rare Causes of Gastrointestinal Bleeding
- Cameron lesions: linear erosions / ulcerations found at the subdiaphragmatic end of a hiatus hernia
- Dieulafoy leisons: congenitally superficial arteries within the mucosa / submucosa that erode and bleed with minor trauma
- Cancer of the small intestine
- Varices (non-oesophageal)- small intestine, colon, rectum, peristomal, gallbladder, bile duct, pancreasPortal hypertension
- Haemosuccus pancreaticus: bleeding from the pancreas into the ampulla of VaterPancreatitis, malignancy, trauma, arteriovenous malformation
- Haemobilia: bleeding from the biliary systemIatrogenic, trauma, malignancy, hepatic abscess / cyst, arteriovenous malformation
- Aortoenteric fistula
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------