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Q: I am a 52 year old woman and have recently been told by my physician that my hematocrit is 26. I have occasionally noticed that my stools are black but otherwise do not have any symptoms. My physician referred me to a gastroenterologist, but I do not understand why, as I feel well.
A: It is of the outmost importance to be carefully evaluated by a gastroenterologist ( a doctor specialized in diseases of the digestive system) in the presence of the symptoms and findings above. In fact, the presence of black stools suggests the presence of bleeding in the upper part of the intestinal tract. When bleeding here occurs, there is a chemical reaction between certain chemicals in the upper intestinal tract and the blood, thus leading to the characteristic back color of the stool. These black stools are usually referred to as melena. Furthermore, because of bleeding, the hematocrit of the blood, which is a measure of the number of red blood cells per unit volume of blood, is also decreased. Hence, in the case being discussed it is imperative to visit a gastroenterologist so that he or she can do an upper endoscopy. An upper endoscopy is a test in which a flexible tube is inserted through the mouth and moved within the upper intestinal tract. The flexible tube contains a suitable optical system in order to permit evaluation of the upper intestinal tract as this tube is passed through its various portions. Furthermore, by use of this flexible tube, it is also possible to perform a biopsy of diseased areas, so as to obtain a histologic diagnosis, i.e., a precise diagnosis obtained by evaluation of the excised tissue by use of a microscope.
Updated: 12/21/98
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