Mallory-Weiss Tear (MWT) Flashcards
Define MWT
Upper GI bleeding caused by tears in the mucous membrane at or near the gastro-oesophageal junction
What is the pathophysiology of MWT?
Sudden and severe rise in oesophageal intraluminal pressure → tearing of the oesophageal mucous membrane and the submucosal arteries and veins
What is the aetiology of MWT?
Things which increase oesophageal intraluminal pressure:
- Vomiting (can be secondary to GI, neuro or renal disease)
- Retching
- Coughing (can be secondary to lung conditions)
- Blunt abdominal trauma (non-penetrating)
- Strained defecation
- Hiatus hernia
Most commonly caused by repeated retching and vomiting which could be due to:
- Binge drinking (alcoholism)
- Bulimia nervosa
- Severe morning sickness during pregnancy
What are the risk factors for MWT?
- Condition predisposing to retching, vomiting, and/or straining
- Chronic cough
- Hiatus hernia
- Retching during endoscopy or other instrumentation
- Excessive alcohol
What is the epidemiology of MWT?
- Tends to affect people aged in their 30s-50s, although it can occur at any age
- More common in men than in women
What are the presenting symptoms of MWT?
- Haematemesis - main symptom
(most people just have small streaks of blood but sometimes there can be a lot of blood loss) - Epigastric pain
- Light-headedness due to blood loss
- Severe blood loss → hypovolaemic shock (rare)
What are the signs of MWT?
- Melaena (due to upper GI bleeding)
- Haematemesis
- If severe → signs of hypovolaemic shock
(e.g. hypotension, tachycardia, weak pulse,
cold extremities, slow capillary refill)
What investigations would you do if you were suspecting MWT and what would you expect to see?
Bloods - 1st investigation:
- FBC (Hb – anaemia may range from mild to severe in rare cases)
- Urea (digested blood → increased protein → high urea)
- LFT (should be normal unless underlying liver disease)
- Prothrombin time/INR (should be normal unless underlying coagulopathy)
LFT and PT done to exclude other problems
OGD - diagnostic test:
- Can see if a tear is present and its location
What is the management of MWT?
Bleeding usually stops on its own, so patient needs to be monitored to make sure they are haemodynamically stable
If bleeding does NOT stop on its own:
- Therapeutic OGD - 1st line
Therapeutic OGD:
- Adrenaline injection (causes vasoconstriction of bleeding vessels)
- Band ligation (to tie off bleeding vessel)
- Electrocoagulation
- Thermocoagulation
- Haemoclipping (repairing tear using metal clips)
In rare cases that therapeutic OGD doesn’t stop bleeding:
- Angiography with embolisation
- Surgical repair
What are the complications of MWT?
- Re-bleeding
- Hypovolaemic shock (could lead to myocardial ischaemia and infarction, death)
Severe vomiting could lead to:
- Hypokalaemia
- Boerhaave syndrome (spontaneous oesophageal perforation)
What is the prognosis of MWT?
- Prognosis generally excellent
- Most patients usually stop bleeding spontaneously and the tears heal rapidly (usually within 48-72 hours)
