MALLORY-WEISS TEAR/BOERHAAVE SYNDROME Flashcards
Pertinent Anatomy of a patient with Mallory- Weiss Tear / Boerhaave Syndrome.
(1) Esophagus
(a) GE Junction
The esophagus functions to promote
motility, via peristalsis, to introduce ingested food to the stomach
Characterized by a nonpenetrating mucosal tear at the gastroesophageal
junction that is hypothesized to arise from events that suddenly raise transabdominal pressure, such as lifting, retching or vomiting. The laceration
often lead to bleeding from submucosal arteries.
Mallory-Weiss
– A history of heavy alcohol use leading to vomiting has been
noted in 40 to 80 percent of patients with Mallory-Weiss syndrome in case
series. The bleeding is usually more severe when Mallory-Weiss tears are
associated with portal hypertension and esophageal varices
Just read it
a spontaneous
perforation of the esophagus that results from a sudden increase in
intraesophageal pressure combined with negative intrathoracic pressure (e.g.,
severe straining or vomiting)
Boerhaave Syndrome
Signs and Symptoms
(1) Hematemesis with or without melena
(2) HX of retching, vomiting, or straining is obtained in about 50% case
(3) Boerhaave: often present with excruciating retrosternal chest pain due to an intrathoracic
esophageal perforation
Differential Diagnosis
(1) Peptic Ulcer disease
(2) Erosive gastritis
(3) Esophageal varices
(4) Acute pancreatitis
(5) Aortic dissection
(6) Esophageal rupture
(7) Acute myocardial infarction
Lab
(1) CBC to evaluate for anemia
RAD
Upper Endoscopy
Treatment
Most patients stop bleeding spontaneously and require no therapy
Initial Care
(1) Fluid resuscitation and blood transfusions if hemodynamically unstable.
(2) Boerhaave: mortality rate is with esophageal rupture is high, ICU admission is
considered with patients with hemodynamic instability
(3) NPO
(4) IV broad spectrum ABX
(5) IV PPI
(6) Debridement of infected and necrotic tissue
Complications
Esophageal rupture
