the Significance of Brown and Black Residue in Nasogastric Tube Aspirate

The color of the gastric aspirate from a nasogastric tube?

Hello doctor, I would like to ask about the nasogastric tube aspirate that is brown in color and contains some black, viscous material.
What could this indicate?

Jie, 80~89 year old female. Ask Date: 2023/07/16

Dr. Zheng Weijun reply Internal Medicine

Dear commenter, regarding your description of the nasogastric tube aspirating brown fluid with black viscous material, further examination and evaluation may be necessary.
The contents aspirated from the nasogastric tube may be related to ingested foods, such as iron-rich foods like pig's blood or rice blood, or beverages like coffee, which can cause gastric contents to appear brown with undigested black viscous material.
Of course, this phenomenon could also be due to gastric mucosal bleeding or bleeding caused by the friction of the nasogastric tube against the esophagus or stomach.
The bleeding may originate from issues in the stomach, esophagus, or oral cavity, while the black viscous material is a result of blood being broken down by gastric acid during the digestive process.
This condition may be associated with diseases such as oral ulcers, esophageal ulcers, gastric ulcers, gastritis, or esophageal varices.

To determine the cause of the bleeding, further examinations are needed, which may include endoscopy, blood tests, and other relevant imaging studies.
Once a diagnosis is established, the physician will provide an appropriate treatment plan, which may include repositioning the nasogastric tube to alleviate discomfort or address the underlying issue.
However, as a physician, I must adhere to Article 11 of the Medical Practitioners Act, which states that a physician must personally examine a patient before providing treatment, prescribing medication, or issuing a diagnosis; this cannot be delegated to others.
Therefore, if you have a genuine need for consultation, I recommend that you schedule an appointment in person as soon as possible, allowing the physician to personally assess your symptoms, conduct the necessary examinations, and provide appropriate treatment.
Please do not ignore such symptoms; seeking medical attention early can help in the early detection and management of potential issues, ensuring that your health is properly addressed.
If you are unable to visit the hospital for consultation, our affiliated and cooperating physicians are available to assist you: Dr.
Hsiang Kuo-Wei at Hsiang Kuo-Wei Internal Medicine Clinic, No.
141, Chongxue Road, Tainan City; Dr.
Wu Chong-Han at Hankan Clinic, No.
180, Daqiao 2nd Street, Yongkang District, Tainan City; and Dr.
Shih Yi-Cheng at Cheng Yi Internal Medicine Clinic, No.
189, Section 1, Beian Road, North District, Tainan City.
Wishing you good health!

Reply Date: 2023/07/16

More Info

The presence of brown and black residue in nasogastric tube aspirate can be indicative of several underlying conditions, and it is essential to interpret these findings in the context of the patient's overall clinical picture. The brown color often suggests the presence of old blood, which can occur due to bleeding in the upper gastrointestinal (GI) tract. The black, tarry appearance, known as "melena," typically indicates that the blood has been digested, suggesting that it has been in the stomach for some time before being aspirated.

When a nasogastric tube is used, it is often for the purpose of feeding, decompressing the stomach, or administering medications. If the aspirate shows brown or black residue, it raises several clinical considerations:
1. Upper GI Bleeding: The most concerning implication of brown or black residue is the possibility of upper GI bleeding. This could be due to various causes, including peptic ulcers, gastritis, esophageal varices, or malignancies. The presence of blood in the aspirate necessitates further evaluation to determine the source of the bleeding.

2. Gastric Contents: The aspirate may also contain old food particles mixed with bile, which can sometimes appear brown. If the patient has been experiencing nausea, vomiting, or has a history of gastrointestinal issues, this could explain the brown color.

3. Medications: Certain medications can also affect the color of gastric contents. For instance, iron supplements can cause dark stools and may influence the appearance of aspirate. If the patient is on medications that can cause gastrointestinal irritation or bleeding, this should be taken into account.

4. Infection or Inflammation: Conditions such as gastritis or gastroenteritis can lead to changes in gastric secretions. If there is an inflammatory process, it may result in the presence of blood or altered gastric contents.

5. Need for Further Investigation: The presence of brown and black residue in the nasogastric aspirate should prompt further investigation. This may include laboratory tests such as a complete blood count (CBC) to check for anemia, and possibly imaging studies or endoscopy to visualize the upper GI tract and identify any lesions or sources of bleeding.

In summary, the appearance of brown and black residue in nasogastric tube aspirate is a significant finding that warrants careful evaluation. It is crucial to correlate these findings with the patient's symptoms, medical history, and other diagnostic tests to arrive at an accurate diagnosis and appropriate management plan. If there are any signs of hemodynamic instability, such as hypotension or tachycardia, immediate medical attention is required. It is advisable to consult with a healthcare professional for a thorough assessment and to determine the next steps in management.

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