Mallory-Weiss Tear

Typical exam question presentation: 20 year old student has been out on a binge with his mates and has vomited a couple of times. He is now noticing blood in his vomit.


Mallory-Weiss Tear

Definition: longitudinal tear in the oesophageal mucosa (at the gastro-oesophageal junction) associated with excessive vomiting

Aetiology/ risk factors:

-Excessive vomiting: e.g. alcohol, gastroenteritis, bulimia, morning sickness

-Also excessive retching, coughing or straining

Other risk factors:

-hiatus hernia

-endoscopy/ other interventions to the oesophagus

Epidemiology:

-more common people aged 30-50 years

-3x more common in men than women

Symptoms:

-haematemesis (blood in vomit)

-small and self-limited episode

-varies from flecks or streaks of blood mixed with gastric contents and/or

-blackish/ “coffee ground” to

-bright-red bloody emesis

Other symptoms

-light-headed/ dizziness

Uncommon symptoms- dysphagia, odynophagia, pain, melaena

Signs:

-postural hypotension (drop in BP due to bleeding)

-signs of intoxication, gastroenteritis, bulimia etc.

Uncommon- signs of shock or anaemia

Investigations:

Endoscopy- Mallory-Weiss tear can be visualised. It is a red longitudinal tear surrounded by normal mucosa. Varies from a few mm to several cm. Tear may not be identified if it has already healed.

Image result for mallory weiss tear endoscopy

Management:

-self-limiting, tear will heal and does not rebleed, so specific treatment not necessary

-massive bleeding is rare

-rarely, will need endoscopic haemostasis (e.g. injection of adrenaline, thermal therapy) or fluid resuscitation

-treat associated disease e.g. reduce alcohol intake to prevent recurrence

Complications:

Very rarely- massive haemorrhage, anaemia, shock

Prognosis: good prognosis, usually stop spontaneously

-The Rockall score is used for prognosis of upper GI bleeds. A Mallory-Weiss tear gives a score of 0 (contributes to a good prognosis).

References: Cheese & Onion, Kumar & Clarke’s

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