Mallory-Weiss Tear Flashcards
def
a tear in the oesophageal mucosa due to persistant vomiting/retching which results in painful haematemesis
what is a common cause of the vomiting associated with a MWT
alcoholism
bulimia
associations/risk factors
hiatus hernia conditions that may induce vomiting: 1 GI disease (B. cereus - rice) 2 alcoholism 2 bulimia 3 in pregnant women (hyperemesis gravidarum - severe morning sickness associated with vomiting + retching) chronic cough
what is the difference between MWT and Boerhaave syndrome
MWT involves tear of mucosa and submucosa
Boerhaave involves all layers (mucosa, submucosa, muscular layers)
epi
30-50yrs
men>women
history + examination
1 haematemesis after recent violent vomiting/retching
OR
2 light-headedness (hypotension)
3 meleana
what % of upper Gi bleeds does a mallory-weiss tear account for
5-15%
aetiology
sudden rise in pressure (vomiting, retching, coughing, straining) causes a tear
investigations
1 oesophagogastroduodenoscopy -for definitive diagnosis 2 bloods -FBC (normal unless severe) -urea (high with ongoing bleeding)
what are common risk factors of MWT
1 condition predisposing to retching, vomiting +/ straining 2 chronic cough 3 hiatus hernia 4 heavy alcohol use 5 retching during endoscopy
management
1 for self-limiting bleeding
-supportive treatment (IV fluids, blood transfusion if indicated)
2 for persistent bleeding
-anti-secretory drugs (PPIs/H2 antagonists with endoscopic procedures)
-anti-emetics (with persistent N+V)
-combination of adrenaline and cauterization
why is a combination of adrenaline and cauterization used
adrenaline causes vasoconstriction which reduces bleeding
cauterization seals the vessels
when is MWT treated with surgery
if endoscopic haemostasis has failed or perforation has occured
sewing of the tear
where does the tear in MWT commonly occur
gastro-oesophageal junction
complications
1 recurrence/re-bleeding
2 oesophageal perforation
3 adrenaline related HTN/VT
