Mallory Weiss Tear

Question 1

What is a Mallory Weiss tear?

Answer 1

Tearing of the lining of the oesophagus around the junction with the stomach as a result of violent vomiting or straining to vomit.

Question 2

How does a Mallory Weiss tear differ to Boerhaves perforation?

Answer 2

MWT: linear mucosal tears at gastrooesophageal junction

Boerhaave’s: transmural perforation of the oesophagus

Question 3

List 7 risk factors for Mallory Weiss tear

Answer 3

Chronic alcohol abuse  
Bulimia 
Retching  
Vomitting 
Straining 
Chronic cough  
Hiatal hernia

Question 4

Describe the epidemiology of Mallory Weiss tears

Answer 4

Quite rare
3-15% of cases of upper GI bleeding
More common in MEN + women of a child-bearing age

Question 5

How do Mallory Weiss tears usually present?

Answer 5

Most cases are ASYMPTOMATIC

Question 6

List 4 symptoms of Mallory Weiss tear

Answer 6

Chest/ Abdo pain
Involuntary retching
Black/ tarry stools
Sx of hypovolaemia if SEVERE blood loss (e.g. light-headedness)

Question 7

Give 2 signs of Mallory Weiss tear

Answer 7

Severe vomiting

Haematemesis

Question 8

What bloods are taken in patients with Mallory Weiss tears?

Answer 8

FBC: to identify anaemia (RARE)
Urea: high if ongoing bleeds
LFTs: should be norm but to exclude liver disease which may predispose to varices (potential sources of bleeding)
PT/ INR: exclude other causes of bleeding
Group + save

Question 9

What is the gold standard investigation used for Mallory Weiss tears?

Answer 9

OGD: can see a tear or laceration

Question 10

Describe the management of Mallory Weiss tears in which bleeding does not stop spontaneously

Answer 10

Haemoclip placement +/- adrenaline injection
OR
Thermocoag therapy + adrenaline injection
OR
Endoscopic band ligation + adrenaline injection
OR
Endoloop + Haemoclip placement

Question 11

Describe management of Mallory Weiss tears

Answer 11

Assess haemodynamic stability (ABC)
Replace fluids +/- blood
Phytomenadione if high INR (Vit K)

Question 12

Describe the nature of bleeding in Mallory Weiss tears

Answer 12

In 80-90% cases bleeding will stop spontaneously

Question 13

What drugs may be prescribed pre-endoscopy?

Answer 13

Anti-gastric acid
Anti-emetics
Somatostatin analogues (reduce portal venous blood flow)

Question 14

List 4 complications of Mallory Weiss tear

Answer 14

Re-bleeding (low)
Adrenaline-related HTN emmergency (low)
Hypovol shock/ death (low)
Boerrhaave’s perforation (low)

Question 15

What is the prognosis for Mallory Weiss tears?

Answer 15

Good

Question 16

What procedure may be used if an endoscopic intervention is not available for patients with a Mallory Weiss tear?

Answer 16

Sengstaken-Blakemore tube

balloon tamponade

Question 17

What is Boerhavees perforation?

Answer 17

spontaneous perforation of the oesophagus

Rare but high mortality

Question 18

List 9 signs and symptoms of a Boerhaaves perforation

Answer 18

Sudden-onset chest pain immediately after episode of vomiting.
SOB + pleuritic pain due to subsequent pleurisy + effusion.
Signs of pleural effusion after some hours (dull percussion, absent breath sounds, dec vocal resonance)
Abdominal rigidity
Sweating
Fever
Tachycardia
Hypotension
Pneumomediastinum.