Oesophageal tears Flashcards
What is the most common thing that tears in the oesophagus are associated with?
Prolonged and/or intense vomiting
Broadly what is the aetiology of Mallory Weiss tears?
Rapid increases in intra-abdominal pressure
What can cause a rapid increase in intra-abdominal pressure and thereby cause Mallory Weiss tears?
Straining, lifting, coughing, epileptic convulsions, hiccups under anaesthesia, blunt abdominal injury, gastroscopy
Is there an association between hiatus hernia and Mallory Weiss tears?
Yes
40-100% of Mallory Weiss tear pts have been found to also have a hiatus hernia
What is the major clinical manifestation of Mallory Weiss tear?
GIT bleeding, esp haematemesis
Usually the patient will report non-bloody vomiting prior to onset of haematemesis, but not always
Do Mallory Weiss tears always lead to bleeding?
No
Can be small and subclinical, even when iatrogenic secondary to gastroscopy
When a Mallory Weiss tear bleeds, is the amount of bleeding usually insignificant or is it dangerous like a varix?
Normally insignificant, but can of course be significant in some cases
Do Mallory Weiss tears normally require intervention?
No
Only when the patient is displaying signs of massive blood loss, when they might need transfusion and other interventions
What is the normal place where Mallory Weiss tears occur?
At the lower oesophageal sphincter – so the tear will be part in the oesophagus, and part in the stomach
How can you distinguish Mallory Weiss tears from other ulcerative lower oesophagus diseases like reflux oesophagitis?
Mallory Weiss tears will normally be surrounded by normal looking mucosa on endoscopy
What are some patient related factors that make it more likely that someone will have to be hospitalised for Mallory Weiss tears?
Coagulopathy
Portal HTN
What percentage of patients with Mallory Weiss tears require blood transfusions?
40-70%
What is first line treatment for a Mallory Weiss tear that requires intervention?
Endoscopic
Usually haemostatic agents such as adrenaline or ethanol, or electric cauterization
When should you avoid electric cauterization in Mallory Weiss tear treatment?
When the pt is at risk of varices for any reason, because cauterization can worsen them, or precipitate their rupture
Also when the tear is deep, as there is no serosa for the oesophagus, and this could perforate it
What is the average prognosis for Mallory Weiss tears?
5% mortality, mostly in pts of advanced age
