Differential Diagnosis for Melena
Single Most Likely Diagnosis
- Peptic Ulcer Disease: This is the most common cause of melena, which is characterized by black, tarry stools resulting from upper gastrointestinal bleeding. The bleeding is usually from a duodenal or gastric ulcer.
Other Likely Diagnoses
- Gastritis: Inflammation of the stomach lining can lead to bleeding, resulting in melena. This can be caused by various factors, including non-steroidal anti-inflammatory drugs (NSAIDs), alcohol, or stress.
- Esophageal Varices: Enlarged veins in the esophagus, often due to liver cirrhosis, can rupture and cause significant bleeding, leading to melena.
- Mallory-Weiss Tear: A tear in the mucous membrane or lining of the lower end of the esophagus, where it connects to the stomach, can cause bleeding and melena.
Do Not Miss Diagnoses
- Gastrointestinal Malignancy: Although less common, tumors in the upper gastrointestinal tract can cause bleeding and melena. Missing this diagnosis could lead to delayed treatment and poor outcomes.
- Vascular Malformations: Abnormal blood vessel formations, such as Dieulafoy's lesion, can cause significant bleeding and are important not to miss due to their potential for severe hemorrhage.
- Ingested Foreign Body: Sharp objects ingested can cause perforation or bleeding in the gastrointestinal tract, leading to melena.
Rare Diagnoses
- Hemobilia: Bleeding from the bile ducts into the gastrointestinal tract can cause melena, although this is a rare occurrence.
- Angiodysplasia: Vascular lesions in the gastrointestinal tract can cause bleeding, but they are less common and often found in older adults.
- Intussusception: A condition where a part of the intestine slides into an adjacent part, potentially causing bleeding and melena, is rare in adults but can occur.