Mallory-Weiss Tear

Question 1

Define Mallory-Weiss Tear

Answer 1

Tear or laceration along the border of the Gastro-Oesophageal junction, often the right border

Question 2

Aetiology of Mallory-Weiss Tear

Answer 2

Increased pressure (coughing, retching, vomiting, straining, hiccups, cardiopulmonary resuscitation, alcohol, aspirin + NSAIDs)

Hiatus hernia

GI disease (poisoning, gastroenteritis, peptic ulcers)

Hepatobiliary disease (hepatitis, gallstones, cholecystitis)

Hyperemesis gravidarum (childbearing women)

Renal (UTI, nephrolithiasis, renal failure)

Psychiatric (Anorexia nervosa, bulimia)

Toxins

Post-anaesthesia or surgery

Chronic cough (bronchiectasis, COPD, cancer)

Question 3

Symptoms of Mallory-Weiss Tear

Answer 3

Haematemesis (preaching nausea and vomiting)
Light-headedness
Dysphagia 
Odynophagia 
Pain 
Melaena or haematochezia

Question 4

Signs of Mallory-Weiss Tear on examination

Answer 4

Orthostatic hypotension
Shock
Anaemia: pallor, cyanosis, SOB

Question 5

Investigations for Mallory-Weiss Tear

Answer 5

OGD: tear or laceration (red longitudinal defect + normal mucosa surrounding)

FBC: usually normal, may show anaemia
Renal function: Urea is high
LFTs: normal unless liver disease is the cause
Clotting studies: Normal, assess bleeding risk
X-match: in need of transfusion
Cardiac enzymes + ECG: rule out MI

CXR: normal, exclude oesophageal perforation

Question 6

Management for Mallory-Weiss Tear

Answer 6

1. ABCDE
2. Bilateral large bore IV access
3. Fluid rests with crystalloid fluid
4. Major bleed -> phytomenadione
5. Assess transfusion need
6. Haematemesis or altered respiratory. -> intubation
7. PPI or H2 antagonist
8. Anti-emetic e.g. promethazine
9. Endoscopy: Haemoclip placement + adrenaline OR band ligation with+ adrenaline
10. Laparascopic surgery if no improvement

Sengastaken-Blakemore tube for bleeding cessation while waiting for endoscopy

Question 7

Complications of Mallory-Weiss Tear

Answer 7

Re-beleeding
MI 
Hypovolaemic shock 
Death 
Oesophageal perforation
Gastric ischaemia/infarct
Metabolic disturvance

Question 8

Prognosis for Mallory-Weiss Tear

Answer 8

Bleeding is usually self-limited and stopped by the time endoscopy is performed
Excellent in patients without associated disease or complications