Stomach_Mallory_Weiss_Tears Flashcards
Define what a Mallory-Weiss tear is
Linear disruption of the mucosa of the distal esophagus, usually due to prolonged violent retching/vomiting
What is the difference between a Mallory-Weiss tear and Boerhaave syndrome?
Boerhaave syndrome is perforation of the distal esophagus 2/2 to vomiting. Mallory-Weiss tear is only disruption of the mucosa from vomiting/retching.
Mallory-Weiss syndrome is thought to cause what % of UGI bleeds?
5-15%
How does vomiting cause Mallory-Weiss tears?
The pylorus closes when the stomach and abdominal wall contract violently-> large pressure gradient between the stomach and esophagus-> elevation of GEJ into thoracic cavity-> rapid pressure increase in distal esophagus stretches and tears the mucosa
What is the first step in managing a GI bleed 2/2 to Mallory-Weiss tears?
2 large-bore IVs, get CBC, coags, type and crossmatch. Resuscitation (crystalloid and blood if necessary).
On endoscopy, where are Mallory-Weiss tears often found?
Below GEJ on the lesser curve.
Where are the more uncommon sites of Mallory-Weiss tears found on endoscopy?
2nd most common site: greater curve below GEJ. Then posterior and anterior sites.
Do most Mallory-Weiss tears require surgical intervention?
No. Bleeding is often self-limited (80-90% of pts).
How long does it take a Mallory-Weiss tear to heal?
In as little as 2-3 days after diagnosis
When is surgery indicated for Mallory-Weiss tears?
When endoscopy failed (more than one scope can be done prior to the conclusion of failure)
Describe the surgical approach for Mallory-Weiss tears?
Longitudinal gastrotomy near but not through the GEJ. Tear is sutured with abdorbably suture. Close gastrotomy in 2 layers. Post-op NGT not necessary.
Surgery is required in what % of Mallory-Weiss tear patients?
1%
