Mallory-Weiss Tear

Question 1

Define Mallory-Weiss tear

Answer 1

A tear or laceration at the gastro-oesophageal junction, leading to non-varcieal GI bleeding. It is self-limiting in 90% of cases

Question 2

What are the causes/risk factors of Mallory-Weiss tears?

Answer 2

It is caused by prolonged, violent vomiting. The cause of vomiting can be:
• Trauma, especially blunt trauma.
• GI disease including food poisoning, gastroenteritis and obstruction.
• Hyperemesis gravidarum
• Chronic Alcohol abuse
• Liver Disease
• Renal disease e.g. UTI
• CNS disorders and disorders of balance
• Anorexia and Bulimia
• Primal scream therapy (a psychological therapy).
• Hiatal Hernia – precipitate a MWT
• Medications e.g. NSAIDs and chemotherapy
• Chronic cough

Question 3

What are the symptoms of a Mallory-Weiss tear?

Answer 3

• Presence of risk factors
• Most cases are asymptomatic
• Self-limiting haematemesis: This can vary from having specks of blood in the vomit to being coffee-ground to being bright red.
• Light-headedness due to bleeding –hypovolaemia.
• Postural hypotension due to fluid loss –hypovolaemia.
• Black tarry stool
• Vomiting
• Involuntary retching

Question 4

What are the signs of a Mallory-Weiss tear?

Answer 4

• often no signs of examination
• upon examination of stool, could discover
• signs of hypotension and hypovolaemiaalaena

Question 5

What investigations are carried out for a Mallory-Weiss tear?

Answer 5

• FBC - may show signs of anaemia if chronic or severe
• U&Es - urea may be elevated on its own, marking dehydration and hypovolaemia
• LFTs - usually normal, unless there is an underlying hepatobiliary pathology
• Coagulation screen - usually normal, unless the patient has a coagulation disorder or is on warfarin etc…
• Cross- Match - if blood loss is severe, blood transfusions may be required
• CXR - typically normal if no complications are there
• OGD - a tear or laceration typically appears as a red longitudinal defect with normal surrounding mucosa; the lesions vary from a few millimetres to several centimetres

Question 6

What is the management for a Mallory-Weiss tear?

Answer 6

• An ABCDE approach.

Conservative/ Monitoring: 
• Blood transfusions 
• Treat underlying cause 
• Correct electrolyte abnormalities 
• Monitor bleeding time and adjust warfarin accordingly 
*90% will self-resolve. 

Medical:
• Anti-emetics
• Anti-reflux medications

Surgical: Indicated in non-resolving, persistent bleeding, or if complications arise.
• Injection sclerotherapy
• Coagulation therapy
• Arteriography

Question 7

What are the complications of a Mallory-Weiss tear?

Answer 7

• Recurrence
• Hypovolaemic shock
• Boerhaave syndrome (rupture of oesophageal wall secondary to Mallory-Weiss tears