OVERVIEW
Overview
Puerperal tarry stools are black stools that occur within 6 weeks after delivery.
Hazards
1. Non-hemorrhagic tarry stools caused by diet or medication are usually harmless;
2. The presence of tarry stools caused by gastrointestinal hemorrhage may affect the absorption of nutrients and the recovery of the mother. In addition, this symptom may indicate the presence of digestive disorders, which may be life-threatening in severe cases.
Common Diseases
Gastric and duodenal ulcers, acute gastric mucosal lesions, ruptured esophagogastric fundus varices, reflux esophagitis, etc.
Causes
Common causes
1. Diseases of the upper gastrointestinal tract
(1) Esophageal diseases and injuries: e.g., reflux esophagitis, e.g., esophageal cardia mucosal tear syndrome, instrumentation.
(2) Gastric and duodenal diseases and injuries: peptic ulcer, acute erosive hemorrhagic gastritis, chronic gastritis, gastric cancer.
(3) Diseases of the jejunum: jejunal ulcer after gastrointestinal anastomosis, jejunal Crohn’s disease.
(2) Rupture of esophagogastric fundic varices or portal hypertensive gastropathy caused by portal hypertension
3. Diseases of neighboring organs or tissues of the upper gastrointestinal tract
(1) Biliary tract bleeding: gallbladder or bile duct stones or cancer, liver cancer, ruptured hepatic aneurysm bleeding from the biliary tract into the duodenum.
(2) Pancreatic diseases: pancreatic cancer, acute pancreatitis complicating abscess ulceration into the duodenum.
(3) Others: thoracic or abdominal aortic aneurysm, hepatic or splenic aneurysm rupture into esophagus, stomach or duodenum, mediastinal tumor or abscess rupture into esophagus.
4. Systemic diseases
(1) Blood diseases: leukemia, aplastic anemia, thrombocytopenic purpura, hemophilia, disseminated intravascular coagulation and other coagulation mechanism disorders.
(2) Uremia.
(3) Vascular diseases: atherosclerosis, anaphylactic purpura, etc.
(4) Rheumatic diseases: polyarteritis nodosa, systemic lupus erythematosus, etc.
(5) Stress-related gastric mucosal injury: severe infection, shock, trauma, mental stimulation, acute respiratory distress syndrome, severe heart failure, etc.
(6) Acute infectious diseases: renal syndrome hemorrhagic fever, dengue fever, etc.
Other causes
Non-hemorrhagic black stools caused by diet and drugs.
Examination
Physical examination
Including general examination and abdominal examination, to clarify the presence of signs and symptoms related to digestive and hematologic diseases, and to provide a basis for the next step of examination and diagnosis.
Laboratory examination
1. Blood test: including routine blood test, coagulation function test, etc. Patients with blood in stools may be accompanied by blood system diseases, and this test can assist in diagnosis.
2. Fecal occult blood test: in addition to assisting in the diagnosis of a variety of digestive tract diseases, it can also be used to distinguish between true and false black stools.
Imaging examination
1. Endoscopy: it is an important means to check the cause of gastrointestinal bleeding, and hemostatic treatment can be carried out at the same time of examination.
2. Gastrointestinal X-ray examination: mostly barium meal X-ray examination, usually carried out after the bleeding has stopped or the condition has stabilized for several days, generally used for patients who suspect upper gastrointestinal bleeding and are not suitable for gastroscopy.
3. Angiography: it is used for gastrointestinal bleeding whose bleeding site and cause are not clear.
Diagnosis
Diagnostic principles
After clarifying the puerperal state, the diagnosis is made according to the patient’s medical history, drug history, diet and relevant examination results.
Differential diagnosis
1. Gastroduodenal ulcer: most patients have a history of ulcer, characterized by chronic, rhythmic pain, often accompanied by vomiting of blood. Most of the patients can have precursor symptoms such as fullness and discomfort in the epigastric region and increasing pain a few days before bleeding, and the epigastric pain can be relieved rapidly after bleeding in some patients. Auxiliary examination is mainly endoscopy, X-ray examination and fecal examination can also be used to support the diagnosis.
2. Acute gastric mucosal lesions: patients have a history of taking non-steroidal anti-inflammatory drugs (such as aspirin, pau d’arco, indomethacin), high-dose corticosteroid drugs, alcoholism and so on. Clinical manifestations are dominated by black stools, manifested by sudden bleeding without obvious antecedent symptoms, and some patients may have epigastric pain, epigastric burning sensation, nausea, vomiting and other symptoms, and a few may have fever and other symptoms. Endoscopy should be carried out within 24h of bleeding, which can improve the positive rate of diagnosis.
3. Rupture of esophagogastric fundal varices: most patients have a history of chronic hepatitis, or schistosomiasis and long-term alcoholism. Patients usually vomit blood suddenly, often bright red or dark red, with a large amount of bleeding and a feeling of fullness in the epigastrium before vomiting blood. After vomiting blood for a certain period of time, there may be tarry stools. Auxiliary tests include routine blood test, emergency gastroscopy, X-ray examination, ultrasound examination, and so on.
4. Reflux esophagitis and esophageal ulcer: patients often have symptoms 1h after meals, which can be induced by forward bending of the torso or strenuous exercise. In addition to black stools, patients mostly have burning pain behind the sternum, heartburn, acid reflux and other concomitant symptoms, but also the performance of swallowing pain, later due to the formation of scarring and narrowing of dysphagia. Auxiliary means of examination include endoscopy, biopsy, esophageal manometry, lower esophageal pH measurement and so on.
5. Pseudo-black stools: Generally, it is necessary to rule out the possibility of gastrointestinal bleeding in combination with relevant examinations. Mothers are usually taking medicines (such as iron, bismuth, biochar, and certain herbs) or food (such as pig’s liver and animal’s blood), and are not accompanied by other uncomfortable manifestations.
Seek medical attention
In the following cases, call 120 or go to the emergency room immediately.
1. If tarry stools are accompanied by severe dizziness, pallor or even shock, call 120 immediately.
2. If tarry stools are accompanied by vomiting of blood, go to the emergency room as soon as possible.
In the following cases, it is necessary to go to an outpatient clinic
If the cause of tarry stools is not clear, you should go to a gastroenterologist for examination.
Suggestions for home treatment
1. Relax your mind and do not be over-stressed;
2. Rest in bed if accompanied by physical discomfort;
3. Recall whether you have eaten iron, bismuth, Chinese herbs, pig liver, animal blood, etc;
4. If there are no other symptoms, eat more fruits and vegetables, keep the bowels clear, and observe whether the tarry stools are relieved.