MALLORY-WEISS SYNDROME

DEFINITION:
  • A Mallory -Weiss tear (MWT) is a longitudinal tear in the mucous membrane of the esophagus at the stomach junction (Gastric cardia).
ETIOLOGY:
  • Alcoholism
  • Eating disorders 
  • Hiatal hernia 
  • Forceful vomiting causes tearing of the mucosa at the junction.
  • NSAID abuse 
  • The tear involves the mucosa and submucosa but not the muscular layer (contrast to Boerhaave syndrome which involves all the layers).
  • The mean age is more than 60 and 80% are men.
  • Hyperemesis gravidarum, which is severe morning sickness associated with vomiting and retching in pregnancy, is also a known cause of Mallory-Weiss tear
CLINICAL PRESENTATION:
  • Episode of vomiting up blood (hematemesis) after violent retching or vomiting
  • Old blood in the stool (melena), and a history of retching may be absent.
  • In Mallory-Weiss syndrome the majority (75-90%) of tear is located below the gastroesophageal junction, entirely within the gastric cardia.
  • Only a few of the tears involve the gastro-esophageal junction.
  • In most cases, the bleeding stops spontaneously after 24–48 hours, but endoscopic or surgical treatment is sometimes required and the condition is rarely fatal.
DIAGNOSIS:
  • EGD
  • Hemoglobin and hematocrit values are checked to determine amount of bleeding.

TREATMENT:
  • Tears usually self heal without any intervention in several days and bleeding stops within a few hours.
  • Medications such as a PPI and an antiemetic
  • Avoid alcohol use.
  • Blood transfusion, if there is excessive bleeding.
  • Bleeding is treated with epinephrine injection and during endoscopy hemaclips can be placed.
  • Monitor for the signs of bleeding and to report them to prevent complications from hemorrhage.
  • If excessive bleeding occurs, shock symptoms may occur and require prompt interventions
  • Teach about medications and avoidance of alcohol use.
Exam Question
  • Mallory - Weiss syndrome is seen in alcoholics
  • A male executive, 50 year of age is seen in casualty with hematemesis & forceful retching with history of alcohol intake is diagnosed with Mallory - Weiss syndrome
  • Esophagogastroduodenoscopy is the BEST method to diagnose a case of Mallory weiss tear
  • Superficial mallory weiss tear heals completely within 48 hours
  • 26 year old women in the first trimester of preg­nancy with retching and re­peated vomiting with large hematemesis. Her pulse rate is 126/minute and blood pressure is 80 mm Hg systolic. The most likely diagnosis is Mallory - Weiss syndrome
  • Mallory weiss Syndrome is caused due to tear in Gastro esophageal junction.
  • Mallory weiss syndrome is partial thickness rupture occurs at Gastric cardia
  • Mallory weiss syndrome often occurs in Patient who abuse analgesics & pregnant females
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