Mallory Weiss Tear

Question 1

What is a mallory weiss tear?

Answer 1

longitudinal laceration in mucosa and submucosa near GOS

Question 2

Does a mallory weiss tear ever self resolve?

Answer 2

Usually self-limiting, resolving spontaneously in 80-90%

Question 3

What are RF for a mallory weis tesr?

Answer 3

1. Persistent retching, coughing, vomiting or straining
2. Alcoholics
3. Bulimics

Question 4

What is usually presentation of a mallory weiss tear?

Answer 4

1. Haematemesis is the most common
2. Lightheaded/dizziness
3. Postural hypotension
4. May experience dysphagia, odynophagia, melaena

Question 5

What is the gold standard investigation for a mallory weiss tear?

Answer 5

Upper GI endoscopy to visualise tears

Question 6

What scoring systems can be used for mallory weiss tear?

Answer 6

1. Points to note: Risk assements
2. Rockall score
3. Glasgow-Blatchford score

Question 7

What other investigations are used for a mallory weiss tear and why?

Answer 7

1. FBC- may show anaemia
2. Urea- elevation may indicate Upper GI bleed
3. CXR- to rule out perforation

Question 8

What is the first line management for a mallory weiss tear?

Answer 8

With the endoscopy inject adrenaline or conduct band ligation to stop bleeding

Question 9

What adjuncts can be used in treatment of a mallory weiss tear?

Answer 9

1. Give anti-secretory therapy (PPI) before endoscopy- seems to reduce re-bleed
2. Give anti-emetics to prevent recurrence

Question 10

What is the second line treatment of a mallory weiss tear?

Answer 10

Sengstaken-Blakemore tube

Question 11

Why is urea high in gastric bleeding?

Answer 11

haemoglobin reabsorbed and breakdown into urea

Question 12

What are complications of mallory weiss?

Answer 12

• rebleeding

- Boerheeav’s perforation