Mallory-Weiss Tear

Question 1

Define a Mallory-Weiss Tear

Answer 1

Mallory-Weiss tear/syndrome, is characterised by a tear or laceration often near, the GOJ usually as a result of forceful or recurrent retching, vomiting, coughing, or straining.

Question 2

Explain the aetiology/risk factors for Mallory-Weiss Tears

Answer 2

Haematemesis follows any event that provokes a sudden rise in pressure gradient across GOJ, such as retching, vomiting, coughing, or straining

• Conditions predisposing to retching/vomiting
  
  • Hyperemesis Gravidarum (in pregnant women)
  • Bulimia
  • Chronic/Significant alcohol use (leading to vomiting)
  • Food poisoning
  • Gastroenteritis
• Hiatus Hernia (current or previous)
• Chronic Intense coughing
• Iatrogenic (endoscopy)

Question 3

Summarise the epidemiology of a Mallory-Weiss Tear

Answer 3

• Most patients are between the ages of 30 and 50 years
• More common in males 3:1
• Quite a rare condition
• In women of childbearing age, the most common cause is hyperemesis gravidarum.

Question 4

Recognise the presenting symptoms of Mallory-Weiss Tear?

Answer 4

• Can be ASYMPTOMATIC
• PAINFUL Haematesis (self-limiting & rarely massive bleed)
  
  • Blood ranges from fresh, coffee-ground, mixed with gastric contents ± mucus
• Light-headedness & Postural hypotension
• Melaena

Question 5

Recognise the signs of a Mallory-Weiss tear on physical examination

Answer 5

• Melaena
• The physical findings are linked to the underlying disorder causing the vomiting, retching, coughing, and/or straining.

Question 6

Identify appropriate investigations for a Mallory-Weiss tear and interpret the results

Answer 6

• Oesophageogastoduodenoscopy (endoscopy)
  
  • OGD is contraindicated in acute perforation, Peritonitis, severe shock, acute MI
  • Assess need for endoscopy using Glasgow-Blatchford and/or Rockall Score
• FBC - to check for anaemia and platelets
• U & E - Elevated urea in the absence of renal failure indicated upper GI bleed

Question 7

Generate a management plan for a Mallory-Weiss tear

Answer 7

• MWT is usually self-limiting
• Whilst waiting for endoscopy consider giving PPIs, orally if not actively bleeding - IV otherwise
• Endoscopic treatment with adrenaline injection
  
  • If actively bleeding use haemoclip and adrenaline
• If actively bleeding, carry out fluid resuscitation

Question 8

Identify the possible complications of a Mallory-Weiss tear and its management

Answer 8

• Boerhaave’s perforation (spontaneous perforation of the oesophagus) –

Question 9

Summarise the prognosis for patients with a Mallory-Weiss tear

Answer 9

• For most patients, bleeding is self-limited, and will have stopped by the time of endoscopy.
• Prognosis is excellent in patients without associated disease or complications.
• A routine second endoscopic evaluation is not recommended unless the patient remains symptomatic after initial treatment.