Mallory–Weiss tear

Question 1

What is a MWT?

Answer 1

MWT = tear/laceration of mucosa at/near the gastro-oesophageal junction

Arterial bleeding
Tear - longitudinal

Question 2

What is the aetiology of MWT?

Answer 2

Factors causing increased thoracic/intragastric pressure
Vomiting

Coughing - Whooping cough, bronchitis, bronchiectasis,
emphysema, COPD, LC

Retching/vomiting - Alcohol excess, GI: Food poisoning, PUD, volvulus,Hepatobiliary: Hepatitis, gallstones, Hyperemesis gravidum, Renal: UTI, RF, Neurological, Psychiatric: Anorexia nervosa, bulimia, Toxins: Chemotherapy, Post-anaesthesia

Straining

Hiccups

CPR

Acute abdominal blunt trauma

Hiatus hernia

Transoesophageal echocardiogram

Medications

Question 3

What are the risk factors for MWT?

Answer 3

• Hiatus hernia (present in 40-100%)
• Condition predisposing to retching/vomiting
• Chronic cough
• Retching during endoscopy
• Male
• Middle age

Question 4

What is the epidemiology of MWT?

Answer 4

3-15% of upper GI bleeding

Less common in children
More common in men

In women of child bearing age, the most common cause is hyperemesis gravidarum

Question 5

What are the symptoms of MWT?

Answer 5

• Haematemesis (vomit normal, then blood streaked)
• Light-headedness
• Dysphagia
• Odynophagia
• Melena

Question 6

What are the signs of a MWT?

Answer 6

• Postural hypotension

Question 7

What are appropriate investigations for MWT?

Answer 7

Bloods
FBC
Usually unremarkable
May show low HB
Urea - High (if ongoing bleeding)

Flexible OGD - DIAGNOSTIC
Red, longitudinal defect with normal surrounding mucosa
From few mm to several cm

CXR
Normal

Question 8

What is management for MWT?

Answer 8

Urgent evaluation and monitoring: ABCDE + resuscitation

Commonly – self limits in 12-24 hours before OGD

OGD – if active bleeding (Cauterization or epinephrine injection may be used)

Anti-emetic
PPI (IV) - Anti-gastric acid therapy

If altered respiratory/mental status = endotracheal intubation

IF endoscopic haemostasis fails - Surgical intervention,
Senstaken-Blakemore tube

Question 9

What is the prognosis of MWT?

Answer 9

Bleeding usually self-limited and stopped by the time of the OGD

Prognosis is excellent without associated disease

Re-bleeding occurs in 8-15% - Usually within first 24 hours

High risk patients = old age, haematemesis at presentation, haemodynamic instability, alcoholism, SID use, comorbidities