Mallory Weiss Tear

Question 1

What is a Mallory Weiss tear?

Answer 1

• Tear/laceration near gastro-oesophageal junction
• Sudden increased pressure within non-distensible lower oesophagus

Question 2

What causes a Mallory Weiss tear?

Answer 2

• Heavy alcohol use
• Vomiting (gastroenteritis, bulimia, migraine)
• Coughing
• Trauma
• Iatrogenic (NG tube, OGD)

Question 3

What are the symptoms of a Mallory Weiss tear?

Answer 3

• History of predisposing symptoms/condition e.g. vomiting
• Haematemesis
• Epigastric or back pain
• Lightheaded
• Odynophagia
• Dysphagia
• Melaena

Question 4

What are the signs of a Mallory Weiss tear?

Answer 4

• Maybe nothing
• Hypovolaemia - tachycardia and hypotension

Question 5

How do you diagnose a Mallory Weiss tear?

Answer 5

• OGD
• CXR
• FBC (check for blood loss)
• LFTs, PT/INR, PTT (assess for bleeding risk)

Question 6

How do you manage a Mallory Weiss tear?

Answer 6

• Control bleeding - endoscopy with haemoclip or adrenaline injection
• IV - fluids, maybe blood transfusion
• IV PPI bolus and oral PPI for 4-8 weeks
• Antiemetic