Dark, tarry stools indicate bleeding in which location of the GI tract?
A. Upper colon
B. Lower colon
C. Upper GI tract
D. Small intestine
Correct Answer: C. Upper GI tract
Melena is the passage of dark, tarry stools that contain a large amount of digested blood. It occurs with bleeding from the upper GI tract. The clinical presentation can vary but should be well-characterized. Hematemesis is the overt bleeding with vomiting of fresh blood or clots. Melena refers to dark and tarry-appearing stools with a distinctive smell. The term “coffee-grounds” describes gastric aspirate or vomitus that contains dark specks of old blood.
Option A: UGIB is described as blood loss from a gastrointestinal source above the ligament of Treitz. It can manifest as hematemesis, which can be bright red emesis or coffee-ground emesis, hematochezia, or melena. Patients may also present with symptoms secondary to blood loss, such as syncopal episodes, fatigue, and weakness.
Option B: Gastrointestinal bleeding can fall into two broad categories: upper and lower sources of bleeding. The anatomic landmark that separates upper and lower bleeds is the ligament of Treitz, also known as the suspensory ligament of the duodenum. This peritoneal structure suspends the duodenojejunal flexure from the retroperitoneum.
Option D: Bleeding that originates above the ligament of Treitz usually presents either as hematemesis or melena whereas bleeding that originates below most commonly presents as hematochezia.
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