Mallory-weiss tear (extra)

Question 1

What is a Mallory-Weiss tear?

Answer 1

Longitudinal mucosal tear in gastroesophageal junction/ gastric cardia.

Present with non-variceal upper GI bleeding.
Self-limiting in 80%-90%

Question 2

Describe mucosa at gastro-oesophageal junction?

Answer 2

Stratified squamous epithelium of oesophagus→ single layer of columnar cells

Question 3

How is a Mallory-Weiss tear classified?

Answer 3

Classified by number of tears (single/ multiple) and endoscopically

Question 4

Aetiology/ risk factors of Mallory-Weiss tear?

Answer 4

• Persistent coughing/ retching/ vomiting/ straining
• Cardiopulmonary resuscitation
• Acute abdominal blunt trauma
• Alcohol
• NB: no cause identified in approx 40% patients

Question 5

Signs and symptoms of Mallory-Weiss tear?

Answer 5

Haematemesis, presence of risk factors, light-headedness/ dizziness, postural hypotension

Question 6

Investigations for Mallory-Weiss tear?

Answer 6

Upper GI endoscopy

FBC (may have anaemia but not common), U&Es (elevated urea in patients w ongoing bleeding)

LFT: need to be done in patients w haemorrhage; typically normal

Question 7

Managements for Mallory-Weiss tear?

Answer 7

Resuscitation and supportive care (IV fluids, ABCDE)

Endoscopic treatment

Consider PPI (omeprazole) post-endoscopy to patients with stigmata of recent haemorrhage (visible vessel/ adherent blood clot)

Question 8

Endoscopic management types for Mallory-Weiss tear?

Answer 8

• Mechanical method (e.g: clips) w/ wo adrenaline
• Thermal coagulation w adrenaline
• Fibrin or thrombin injection w adrenaline