Mallory Weiss tear

Question 1

What is a Mallory Weiss Tear?

Answer 1

Mallory-Weiss tear (MWT), also known as Mallory-Weiss syndrome (MWS), is characterised by a tear or laceration often along the right border of, or near, the gastro-oesophageal junction.

Question 2

What are the risk factors of a mallory weiss tear?

Answer 2

> Chronic Cough
> Hiatus Hernia
> Retching during endoscopy
> Alcohol
> Previous instrumentation

Question 3

What is the epidemiology of a mallory weiss tear?

Answer 3

Admission to hospital for non-variceal upper gastrointestinal (GI) bleeding is common, with an incidence of about 50 to 150 per 100,000 people per year. Mortality ranges between 8% and 14%.

Question 4

What are the signs and symptoms of a mallory weiss tear?

Answer 4

Haematemesis
Light headedness
Postural hypotension
Dysphagia
Odynophagia
Pain
Malaena
Haematochezia

Question 5

What investigations are appropriate for a mallory weiss tear?

Answer 5

FBC (anaemia)
Urea (high if ongoing bleed)
LFTs (normal)
PT/ INR (normal)
PTT (normal)
CXR (normal)
OGD (tear or laceration in mucosa)
X match/ group

Question 6

What is the management plan for a mallory weiss tear?

Answer 6

Fluids/ Blood
Endoscopy with intervention
Antigastric acid therapy
Anti emetic
Somatostatin
Erythromycin
Surgical intervention

Question 7

What are the complications of a mallory weiss tear?

Answer 7

vasopressin infusion-related abdominal pain
re-bleeding
myocardial ischaemia or infarction
adrenaline-related hypertensive emergency
adrenaline-related ventricular tachycardia
hypovolaemic shock/death
oesophageal perforation
gastric ischaemia or infarct
metabolic disturbance

Question 8

What is the prognosis for a Mallory Weiss Tear?

Answer 8

For most patients, bleeding is self-limited, and will have stopped by the time of endoscopy

Re-bleeding occurs in about 8% to 15% of patients. It usually occurs within the first 24 hours and most often in patients with high-risk factors for re-bleeding