Mallory Weis Tear

Question 1

define a mallory- weiss tear?

Answer 1

tearing of the lining of oesophagus around the junction of the stomach as a result of vomit or straining to vomit

Question 2

explain the aetiology of Mallory weiss tears?

Answer 2

Factors such as coughing, retching, vomiting, straining, hiccups, closed-chest pressure or cardiopulmonary resuscitation, acute abdominal blunt trauma, primal scream therapy, alcohol, medications (aspirin or other non-steroidal anti-inflammatory drugs [NSAIDs]), chemotherapeutic agents, and oesophageal instrumentation have been associated with MWT.

Hiatal hernia, which is present in 40% to 100% of people with MWT, is considered by many to be a precipitating factor, causing an oesophageal tear to occur

Question 3

what are the conditions that may induce vomiting that can lead to a mallory weis tear?

Answer 3

Gastrointestinal disease, including food poisoning (particularly when due to Bacillus cereus, in which case vomiting occurs soon after ingestion of contaminated food), infectious gastroenteritis, peptic ulcer disease, malrotation, intussusception, volvulus, gastric outlet obstruction, and gastroparesis

Hepatobiliary disease, including hepatitis, gallstones, and cholecystitis

Associated with hyperemesis gravidarum
Renal disease, including urinary tract infection, nephrolithiasis, renal failure, and ureteropelvic obstruction

Neurological disease, including tumours, hydrocephalus, congenital disease, trauma, meningitis, pseudotumour cerebri, migraine headaches, and seizures

Psychiatric disease, including anorexia nervosa,[17] bulimia,[18] and cyclic vomiting syndrome.

Question 4

describe the pathophysiology of MWT?

Answer 4

not completely understood

result of a sudden rise in abdominal pressure or transmural pressure gradient across the gastro-oesophageal with a corresponding low intrathoracic pressure

when these forces are high enough to cause distension in this poorly distended area, an acute gastro-oesophageal tear or laceration may occur

Question 5

how is a mallory weis tear classified?

Answer 5

single tears

mutiple tears

Question 6

summarise the epidemiology of mallory weis tear?

Answer 6

Quite rare

3-15% of cases of upper GI bleeding

More common in MEN and women of a child-bearing age

Question 7

outline the presenting signs/ symptoms of Mallory- weis tears?

Answer 7

haematemesis- common diagnostic - varies from flecks or streaks of blood mixed with gastric contents and/or mucus, blackish or ‘coffee ground’, to a bright-red bloody emesis after a bout of retching, vomiting, coughing, straining, or blunt trauma, or any other factors that increase pressure at the level of the gastro-oesophageal junction

light headidness- sudden drop in BP

postural/orthostatic hypotension

dysphagia

odynopagia

malaenia

haematochezia-fresh blood when blood loss is considerable
unstable patient with haematochezia and other historical factors suggesting upper GI bleeding requires urgent diagnosis and treatment

shock- hypovolaemic shock due to blood loss

signs of anaemia- Rare in acute MWT. Low Hb at presentation may be indicative of co-existing comorbidities. Signs of anaemia include pallor, tachycardia, dyspnoea, and fatigue.

Question 8

what are the appropriate investigations for MVT?

Answer 8

OGD- see a tear or laceration

bloods

CXR- laceration is not visible normally-> but may be used as initial test to rule if suspected oesophageal perforation

Question 9

Describe bloods when investigating Mallory Weis tear?

Answer 9

○ FBC to check for anaemia but RARE

○ Urea –high if ongoing bleeds

○ LFTs – should be norm but to rule out liver disease which may predispose patient to varices (potential sources of bleeding)

○ PTT/ INR – rule out other causes of bleeding

Always check for blood group as part of a blood work up when loss of blood involved

Question 10

Generate a management plan for Mallory- Weis tears?

Answer 10

• 80-90% of the time, the bleeding from a Mallory-Weiss tear will stop on its own
• Assess haemodynamic stability –> if unstable ABC (may administer phytomenadione if maj bleeding)
• Other measures may be necessary if the bleeding does NOT stop

○ Haemoplacement clip +/- adrenaline injection
OR
○ Thermocoag therapy + adrenaline injection
OR
○ (for big ones) endoloop + haemoplacement clip

• NOTE: transfusions may be required if blood loss has been severe
• Anti-reflux medications may also be prescribed

Question 11

what are the possible complications of a mallory weis tear?

Answer 11

re- bleeding ( low ) - occurs within the first 24 hours

adrenaline- related HT emergency ( low)

hypovolaemic shock/death ( low)

oesophageal perforation ( low)

Question 12

summarise the prognosis of a Mallory- Weis tear?

Answer 12

GOOD