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Malaena refers to the passing of jet black, tarry, sticky, foul-smelling stools. This symptom is highly suggestive of upper GI bleeding.


  • 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
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