Mallory Weiss tear

Question 1

define it

Answer 1

DEFINITION: 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

Mallory weiss vs boerhaave syndrome?

Answer 2

boerhaave - transmural tear. takes longer to present? also chest pain
Mackler’s triad (severe vomiting combined with dyspnoea and chest pain of sudden onset)

Mallory - not transmural

Question 3

risk factors?

Answer 3

Caused by prolonged violent vomiting

Risk Factors

Chronic alcohol abuse

Bulimia

Other causes: trauma, intense coughing, gastritis

Question 4

presenting symptoms?

Answer 4

Most cases do not cause any symptoms

Abdominal pain
Severe vomiting
Haematemesis

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

varies from flecks or streaks of blood mixed with gastric contents and/or mucus, blackish or ‘coffee ground’, to a bright-red bloody emesis

Question 5

Management?

Answer 5

80-90% of the time, the bleeding from a Mallory-Weiss tear will stop on its own

1. Phytomenadione
   1b. Endoscopy + intervetion eg adrenaline injected
2. Surgery may be necessary if the bleeding does NOT stop

Question 6

ivx for boerhaave?

Answer 6

1st - CT contrast swallow is the investigation of choice for suspected Boerhaave’s syndrome

Question 7

Mx boerhave?

Answer 7

Treatment is with thoracotomy and lavage, if less than 12 hours after onset then primary repair is usually feasible,

surgery delayed beyond 12 hours is best managed by insertion of a T tube to create a controlled fistula between oesophagus and skin.