Mallory Wiess Tear

Question 1

Definition

Answer 1

Haematemesis from longitudinal lacerations limited to the mucosa and submucosa, at the border of the gastro-oesophageal junction

Question 2

Epidemiology

Answer 2

Male
40-60 years

Question 3

Risk factors

Answer 3

Any condition that predisposes to retching or vomiting: such as gastroenteritis, bulimia, hyperemesis gravidarum
Alcoholism: damages the gastric mucous membrane and also causes vomiting
Chronic cough: often due to COPD, asthma, bronchiectasis
Hiatus Hernia
GORD

Question 4

What is hyperemesis gravidarum

Answer 4

pregnancy complication of SEVERE N+V (much worse than morning sickness), weight loss, dehydration

Question 5

Typical presentation

Answer 5

Young male with acute history of retching (e.g. after night out) eventually causing haematemesis
NO HISTRORY OF LIVER DISEASE + PUL HTN (that’s oesophageal varices)

Question 6

Signs

Answer 6

Features of shock = UNCOMMON
- hypotensive

Question 7

Symptoms

Answer 7

Preceding retching and vomiting
Vomiting blood: usually a small to moderate volume of bright red blood, which is self limiting
Melaena: rare
Epigastric pain

Question 8

Diagnosis

Answer 8

GOLD STANDARD: Oesophago-gastro-duodenoscopy (endoscopy)

Question 9

Severity score

Answer 9

ROCKALL SCORE
- age, blood pressure, comorbidities, and endoscopic findings
- identify patients at risk of adverse outcomes following endoscopic treatment of an upper GI bleed

Question 10

Treatment

Answer 10

Usually self limiting in 24 hours
FIRST LINE:
- upper GI endoscopy: clipping +/- adrenaline. thermal coagulation, sclerotherapy
- High-dose IV PPI AFTER endoscopy
- Manage contributing factors
SECOND LINE:
- surgical repair or interventional radiology: only done if endoscopic haemostasis has failed or transmural oesophageal perforation is present = VERY RARE

Question 11

Complications

Answer 11

Rebleed
Hypovolaemic shock
Oesophageal perforation