Mallory-Weiss tear: Difference between revisions
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==Background== | ==Background== | ||
[[File:Gray1032.png|thumb|Posterior view of the position and relation of the esophagus in the cervical region and in the posterior mediastinum.]] | |||
[[File:Layers of the GI Tract english.svg|thumb|Layers of the GI track: the mucosa, submucosa, muscularis, and serosa.]] | |||
[[File:Illu esophagus.jpg|thumb|Esophagus anatomy and nomenclature based on two systems.]] | |||
*Longitudinal lacerations through mucosa and submucosa | *Longitudinal lacerations through mucosa and submucosa | ||
*75% in proximal stomach, rest in distal esophagus | *75% in proximal stomach, rest in distal esophagus | ||
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===History=== | ===History=== | ||
*Classic presentation: [[Hematemesis | *Classic presentation: [[Hematemesis]] following vomiting or retching | ||
**As few as 30% of patients present this way | **As few as 30% of patients present this way | ||
*Coffee ground emesis | *Coffee ground emesis | ||
*Melena | *[[Melena]] | ||
*Hematochezia | *Hematochezia | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{UGIB DDX}} | |||
==Evaluation== | ==Evaluation== | ||
[[File:Mallory Weiss Tear.png|thumb|Mallory–Weiss tear affecting the esophageal side of the gastroesophageal junction.]] | |||
*Approach as any GI bleed | *Approach as any GI bleed | ||
**CBC | **CBC | ||
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**Type and screen | **Type and screen | ||
**Guiac | **Guiac | ||
**CXR | **[[CXR]] | ||
*Definitive diagnosis by endoscopy | *Definitive diagnosis by endoscopy | ||
==Management== | ==Management== | ||
*Most Mallory-Weiss tears are minor and resolve on their own, but up to 3% of | *Most Mallory-Weiss tears are minor and resolve on their own, but up to 3% of upper gastrointestinal bleeding deaths are a result of Mallory-Weiss tears | ||
*Endoscopy only for active and on-going bleeding<ref>Gyawali CP. The Washington Manual Gastroenterology Subspecialty Consult 2ed. 2008. Washington University School of Medicine.</ref> | *Endoscopy only for active and on-going bleeding<ref>Gyawali CP. The Washington Manual Gastroenterology Subspecialty Consult 2ed. 2008. Washington University School of Medicine.</ref> | ||
*Treat as undifferentiated | *Treat as [[undifferentiated upper GI bleed]] | ||
**Many of these patients are alcoholics and have cirrhosis; consider esophageal varices | **Many of these patients are alcoholics and have cirrhosis; consider esophageal varices | ||
**History of vomiting/retching; consider [[boerhaave]] | **History of vomiting/retching; consider [[boerhaave]] | ||
===Treatments Not Supported by the Literature=== | ===Treatments Not Supported by the Literature=== | ||
*No evidence to support octreotide use | *No evidence to support octreotide use | ||
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==See Also== | ==See Also== | ||
*[[Gastrointestinal bleeding]] | |||
*[[Upper gastrointestinal bleeding]] | *[[Upper gastrointestinal bleeding]] | ||
Revision as of 22:32, 7 February 2024
Background
- Longitudinal lacerations through mucosa and submucosa
- 75% in proximal stomach, rest in distal esophagus
- Due to sudden increase in intrabdominal pressure
- Typically in the setting of forceful vomiting or retching
Clinical Features
Risk Factors
- Hiatal hernia
- Alcoholism
- Anything that increases intrabdominal pressure: blunt abdominal trauma, CPR, etc.
History
- Classic presentation: Hematemesis following vomiting or retching
- As few as 30% of patients present this way
- Coffee ground emesis
- Melena
- Hematochezia
Differential Diagnosis
Upper gastrointestinal bleeding
- Peptic ulcer disease (most common cause)
- Gastritis/esophagitis
- Gastric/esophageal varices
- Mallory-Weiss tear
- Malignancy
- Aortoenteric fisulta
- Boerhaave
- Dieulafoy's lesion
- Angiodysplasia
- Hemobilia
- Hemorrhagic gastritis, EtOH
- Celiac disease
- Dengue
- Other intrabdominal bleeds
- Lower GI bleeding
- Hemorrhagic pancreatitis
- Splenic rupture
- Subcapsular cavernous hemangiomas
- Peliosis hepatis
Mimics of GI Bleeding
- Hemoptysis
- Vaginal/Urethra bleeding
- ENT bleeding
- Dietary (Iron, bismuth, beets)
- Swallowed maternal blood (in neonate)
Evaluation
- Approach as any GI bleed
- CBC
- BMP
- Type and screen
- Guiac
- CXR
- Definitive diagnosis by endoscopy
Management
- Most Mallory-Weiss tears are minor and resolve on their own, but up to 3% of upper gastrointestinal bleeding deaths are a result of Mallory-Weiss tears
- Endoscopy only for active and on-going bleeding[1]
- Treat as undifferentiated upper GI bleed
- Many of these patients are alcoholics and have cirrhosis; consider esophageal varices
- History of vomiting/retching; consider boerhaave
Treatments Not Supported by the Literature
- No evidence to support octreotide use
Disposition
- Anticipate admission
See Also
External Links
References
- ↑ Gyawali CP. The Washington Manual Gastroenterology Subspecialty Consult 2ed. 2008. Washington University School of Medicine.