Haematemesis with or without Melaena

CLINICAL DIAGNOSTIC MANUAL

Haematemesis, defined as vomiting blood, and melaena, characterised by black, tarry stools due to the presence of digested blood, are clinical signs indicating upper gastrointestinal bleeding.

These manifestations can vary in severity, from mild blood loss to life-threatening haemorrhage. Identifying the underlying cause is crucial to providing appropriate treatment and preventing serious complications.

Pathology	Symptoms and Clinical Signs	Suspected Diagnosis	Confirmatory Diagnosis
Bleeding duodenal ulcer	Haematemesis, melaena, epigastric pain, nausea, vomiting, anaemia	History of epigastric pain relieved by food, physical examination	Upper endoscopy, H. pylori testing
Bleeding gastric ulcer	Haematemesis, melaena, epigastric pain worsened by food, nausea, vomiting, anaemia	History of epigastric pain, physical examination	Upper endoscopy, H. pylori testing
Gastric erosion	Haematemesis, melaena, epigastric pain, dyspepsia, nausea, vomiting	History of NSAID use, alcohol, stress, physical examination	Upper endoscopy
Oesophageal varices	Massive haematemesis, melaena, signs of liver disease, splenomegaly	History of liver cirrhosis, physical examination	Upper endoscopy, liver ultrasound
Mallory-Weiss syndrome	Haematemesis, epigastric pain, history of severe vomiting, alcoholism	History of repeated vomiting or retching, physical examination	Upper endoscopy
Oesophageal carcinoma	Haematemesis, progressive dysphagia, weight loss, chest pain	History of dysphagia, physical examination	Endoscopy with biopsy, chest and abdominal CT scan
Gastric carcinoma	Haematemesis, melaena, weight loss, epigastric pain, anorexia	History of chronic gastrointestinal symptoms, physical examination	Endoscopy with biopsy, abdominal CT scan
Gastroesophageal reflux disease (GERD)	Mild haematemesis, heartburn, regurgitation, epigastric pain	History of reflux symptoms, physical examination	Upper endoscopy, oesophageal pH monitoring
Hiatal hernia	Haematemesis, heartburn, regurgitation, epigastric pain	History of reflux and heartburn symptoms, physical examination	Upper endoscopy, barium swallow X-ray
Corrosive agent ingestion	Haematemesis, chest and abdominal pain, dysphagia, odynophagia, oral lesions	History of corrosive substance ingestion, physical examination	Upper endoscopy, respiratory function tests
Meckel’s diverticulum	Melaena, abdominal pain, vomiting, anaemia, rectal bleeding	History of recurrent pain and bleeding episodes, physical examination	Technetium-99m pertechnetate scan, laparoscopy
Pseudohaematemesis	Apparent haematemesis without gastrointestinal source, possible nasal or oral bleeding	History of recent nasal or oral bleeding, physical examination	Detailed physical examination, endoscopy to exclude GI bleeding
Other causes	Symptoms vary depending on underlying pathology, haematemesis, melaena	Detailed medical history, physical examination	Specific tests based on clinical suspicion