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.
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:
-endoscopy/ other interventions to the oesophagus
-more common people aged 30-50 years
-3x more common in men than women
-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
Uncommon symptoms- dysphagia, odynophagia, pain, melaena
-postural hypotension (drop in BP due to bleeding)
-signs of intoxication, gastroenteritis, bulimia etc.
Uncommon- signs of shock or anaemia
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.
-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
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