Mallory Weiss tear

Question 1

Define Mallory Weiss tear

Answer 1

Tear or laceration along the right border or around the gastro-oesophageal junction
->non variceal GI bleed
usually self limiting and caused by short spurt of lots of abdominal strain

Question 2

Aetiology and risk factors of Mallory Weiss tear

Answer 2

Pathophysio not to understood, but related to excessive, chronic, raised abdominal pressure-vomiting, coughing, straining, hiccups
Very linked with hiatal hernia

Risk factors-
age 30-50
Male>women
Previous MWT
Lots of alcohol
Hiatal hernia (40-100%)
Chronic vom (Food poisoning, Cholestatic disease, Renal, neurological, psych
Chronic cough (bronchiectasis, COPD, cancer)
Chronic strain (constipation)

Question 3

Epidiemology of Mallory Weiss tear

Answer 3

Common, 50-150 per 100000 a year

MWT is about 10% of upper GI bleeding

Question 4

Signs and Sx of Mallory Weiss tear

Answer 4

Main sign-Hematemasis
Light headedness/dizzy/postural hypotension

GI bleed with NO other sign or Sx (unlike variceal-usually with sign of portal hyper)

Question 5

Investigations of Mallory Weiss tear

Answer 5

FBC-maybe aneamia if long lasting
Urea-high in bleeding patients
LFT-normal (difference with variceal)
INR/PT-fine
CXR-fine
OGD-see the red tear

Question 6

Mangement of Mallory Weiss tear

Answer 6

Main goal is control initial acute bleed
IV fluids/Blood
PPI
Correct any INR change with VitK or FFP

Endoscopy and clip placement (with adrenaline )
Endoscopic band ligation
Vasopressin

Question 7

Complications of Mallory Weiss tear

Answer 7

High risk of rebleeding in 24h
Acute bleed related to MI
Shock
Oesophageal Perforation-> sepsis and death

Question 8

Prognosis of Mallory Weiss tear

Answer 8

usually self limning-stops by the time of endoscopy
excellent prog in uncomplicated disease

rebleeding in 10% of pt in those with risk factors (old, high INR)-they need hospital admission