mallory weiss tear Flashcards
Differential diagnosis for MWT? (1+4)
Boerhaave’s syndrome
-spontaneous perforation of the oesophagus
-usually due to vomiting
-ruptures all the layers of the oesophageal wall (transmural)
-unlike MWT it’s a surgical emergency
Risk factors of a Mallory Weiss Tear? (7)
-Any condition that predisposes to retching or vomiting: gastroenteritis, bulimia, hyperemesis
- Alcoholism
- chronic cough
- hiatus hernia
- GORD
- Male
- age 40-60
What if a patient has haematemesis and pulmonary hypertension?
oesophageal varices rupture
Investigations to diagnose MWT
Upper GI endoscopy (gold standard) required for all patients depending on the Glasgow Blatchford score
- usually shows a single longitudinal tear (can be multiple) in the mucosa at the gastro-oesophageal junction
Symptoms of MWT (3)
Background of alcohol excess presenting with episodes of violent retching or vomiting
- Haematemesis
(Usually small to moderate volume of bright red blood which is self limiting)
- hypotensive in severe cases but unlikely
Scoring system for upper GI bleeds (3)
Glasgow Blatchford Score
Score >0 means patient require admission for inpatient endoscopy
Score 0 means patient can be discharged
Most accurate in identifying risk patients in need of transfusion
What is the Rockall score?
Calculated after endoscopy to identify patients at risk of adverse outcomes after treatment for an upper GI bleed
What is Mallory Weiss Tear? (2)
Linear lower oesophageal mucosal tear due to sudden increase in intra-abdominal pressure at the border of the gastro-oesophageal junction
Limited to mucosa and submucosa
Treatment for MWT
Most spontaneously heal within 24h!
Typical presentation of Mallory-Weiss Tear? (2)
Presents typically as a young male with acute history of retching and vomiting after a night out eventually causing haematemesis
Causes a laceration resulting in an upper GI bleed that is usually self-limiting.
