Day 49 : To find out the cause of Black tarry stools (Melena)

Saturday , Adarsha Hospital,Kundapura

The day started well with an RTA skid and fall case which was then reffered to KMC,Manipal.

Then finished Dr. Adarsh Sir rounds and followed by his OPD. 

In the evening almost at 4:00PM a case came to casuality reffered by a local doctor.

The patient was Mr.Channayya Poojari, middle aged man k/c/o HTN  came with c/o Black tarry stools since 3 days with generalised weakness,myalgia. He was having multiple episodes of loose stools since 3 days. He is a chronic smoker and Old Alcoholic (Left 10-15 years back). He had Haemorroids few years back and had undergone haemorroidectomy two years back.He had Icteus+ . On examination his vitals and systems were normal. On P/R examination some blood was seen which looked like recent bleed.

source : Osmosis.org

We sent some lab investigations like CBC,RBS,RFT,LFT,Serum Electolytes till sir had to come. Had thought of sending for stool for occult blood once sir examined the patient.

Primary Treatment given was

Inj Tranexa 500mg Slow IV STAT

IVF NS at 70ml/hr.

Few minutes later we got a call from Lab that his Hb was low i.e, almost 7 mg/dl.As my duty finished at 4:00pm I left the hospital.

I've to see tomorow what is the provisional and final diagnosis of the patient and what is the line of treatment.

Some more details about Melena.

Melena refers to black stools that occur as a result of gastrointestinal bleeding. This bleeding typically originates from the upper gastrointestinal (GI) tract, which includes the mouth, esophagus, stomach, and the first part of the small intestine. In some cases, bleeding in the ascending colon of the large intestine, which is located in the lower GI tract, can also result in melena.

For detailed discussion, refer this page : Melena by Osmosis.org

Update on Mr Channayya Poojari 

He has been admitted in ICU due to sudden fall of blood pressure. He was advised two pints of PRBC transfusion yesterday. His all other blood tests were normal yesterday like RFT,LFT,Serum Electrolytes,RBS and Urine Routine.

Today he looked good. Vitals were stable. He was adviced two pints of PRBC transfusion today. I performed Foley's Catheterization to him and his urine output was adequate.

Still we have no proof on the cause of melena and blood loss. Need to wait and see.