Dawaa Reference

chronic

Melaena (Black Tarry Stools)

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources3 sources

ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class DS15 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care · Upper Gastrointestinal Bleeding - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK470300/

Verified against1 document
  • No dose - referral pathway, no medicine given in primary care

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (7)

  • Melaena means black, sticky, tarry stool with a smell of its own [melaena]
  • Vomiting fresh blood or clots is haematemesis; coffee-ground vomit is dark specks of older blood [vomiting · vomiting blood]
  • Bright red blood or clots from the back passage usually means a lower gut source, but brisk upper bleeding can do the same [bleeding]
  • Red flag: fainting or a blood pressure that drops on standing means the bleed is heavy enough to destabilise [syncope]
  • Ask directly about NSAIDs, antiplatelet drugs, aspirin, anticoagulants and herbal remedies, which can interfere with anticoagulant metabolism and increase bleeding [bleeding]
  • Ask about other illnesses, previous endoscopy and previous abdominal operations
  • Alcohol and drug use flag up liver disease, and ask about gut cancers and bleeding disorders in the family [bleeding]

Signs — what you find (3)

  • Have the patient describe exactly what came out, and confirm it with a rectal examination
  • Red flag: abdominal tenderness with rebound or guarding suggests the gut has perforated [abdominal tenderness · guarding · rebound tenderness]
  • Look for chronic liver disease: red palms, spider naevi, breast tissue in men, jaundice and ascites, which point to bleeding varices [ascites · bleeding · jaundice]

Tests (8)

  • Full blood count for haemoglobin, haematocrit and platelets; a small red cell volume points to slow chronic loss with iron deficiency
  • A urea to creatinine ratio above 30 points to an upper gut source of the bleeding
  • Clotting screen with INR, particularly with liver disease, on anticoagulants, or with a known bleeding tendency
  • Upper endoscopy is the reference test, both to find the cause and to treat it
  • Guidelines put endoscopy within 24 hours of admission, after the patient has been resuscitated
  • When variceal bleeding is suspected, endoscopy is brought forward to within 12 hours, because delay costs lives in cirrhosis
  • CT angiography localises the bleed when endoscopy finds nothing, is unavailable or unsuitable, or when surgery has changed the anatomy
  • CT angiography picks up bleeding at about 0.1 mL a minute but cannot treat, so a positive scan is followed by endoscopy or catheter angiography

If not this — what else fits (6)

  • Black stool that is not blood at all: iron tablets, bismuth, licorice and a range of foods all mimic it
  • Bismuth compounds taken for diarrhoea, and iron supplements, blacken the stool without any bleeding
  • Red flag: an aortoenteric fistula is rare and lethal, and melaena can be the warning bleed before a torrential one
  • Suspect that fistula in someone whose aorta has had an endovascular graft that has worn through into the bowel, or after aortic infection
  • Hemosuccus pancreaticus, an aneurysm bursting into the pancreatic duct, and haemobilia, bleeding from the bile ducts: both bleed out through the ampulla and are easily missed
  • Depending on the history, a hidden upper gut cancer or a deposit from elsewhere must be excluded

Scores

  • Glasgow-Blatchford score — Does this upper-GI bleed need admission and treatment?

SourceStatPearls "Upper Gastrointestinal Bleeding" - disease-level clinical article

Presentation findings are traced to the source above.

1

NO DRUG THERAPY IN PRIMARY CARE (REFERRAL & ADVICE)

1st line
Adult dose and duration

Black tarry stools signal bleeding from the upper digestive tract, a medical emergency; a GP recognises it, may start empiric acid suppression, and arranges urgent hospital transfer rather than managing it alone. - Refer, with advice

Paediatric dose

Children follow the same pathway: recognise and refer. No primary-care medicine is implied.

Dose source

No dose - referral pathway, no medicine given in primary care

Why

Black tarry stools signal bleeding from the upper digestive tract, a medical emergency; a GP recognises it, may start empiric acid suppression, and arranges urgent hospital transfer rather than managing it alone.

Cautions
  • No medicine is prescribed for this in primary care - this entry is for recognition and referral. Anything given is decided by the service it is referred to.
  • RED FLAG - Hemodynamic instability (low blood pressure, fast pulse), ongoing or large-volume bleeding, or known liver disease or varices with the risk of a variceal bleed requires emergency hospital referral.

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.