# Melaena (Black Tarry Stools) - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - 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 date: 2026-08 ## Verified against - No dose - referral pathway, no medicine given in primary care ## Treatment metadata - No drug therapy in primary care (Referral & Advice) ## Complete treatment card ```text MELAENA (BLACK TARRY STOOLS) 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/ Review status: REVIEWED against the source listed above (2026-08) 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 Score Glasgow-Blatchford score - Does this upper-GI bleed need admission and treatment? Source StatPearls "Upper Gastrointestinal Bleeding" - disease-level clinical article Status traced to the source above 1. NO DRUG THERAPY IN PRIMARY CARE (REFERRAL & ADVICE) [1st line] Adult 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 Peds Children follow the same pathway: recognise and refer. No primary-care medicine is implied. 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. Caution 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. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)