Black Stools / Melena

First actions / assessment

• Assess ABCDE first and look for shock or occult haemorrhage. Clarify whether the stool is truly melaena: black, tarry, sticky, and foul-smelling, versus merely dark stool. Ask about duration, number of episodes, associated haematemesis, coffee-ground vomiting, abdominal pain, NSAID use, anticoagulants, antiplatelets, alcohol excess, chronic liver disease, prior peptic ulcer disease, reflux symptoms, weight loss, dysphagia, iron tablets, bismuth, activated charcoal, and foods that may darken stool. Examine vitals, capillary refill, postural symptoms where safe, abdominal tenderness or distension, stigmata of liver disease, and PR if needed to confirm stool appearance. Initial investigations commonly include CBC, U&E, LFTs, coagulation profile, group and screen/crossmatch if significant bleed suspected, and urea which may rise in upper GI bleed. In adults with suspected acute UGIB, calculate a Glasgow-Blatchford score at first assessment.