Mallory Weiss Syndrome

University:
Western Sydney University
Course:
MEDI 2003 | Clinical Sciences 2
Academic year:

2024
Views:

331

Pages:

4
Author:

Mariam A. A.

Mallory Weiss Syndrome Definition Characterised by non-transmural longitudinal mucosal lacerations at GEJ Usually confined to the mucosa and submucosa -> distinguishes them from full thickness rupture e.g. Boerhaave syndrome Usually after forceful retching, vomiting or other causes of abrupt increases in intraabdominal pressure Happens due to sudden rise in intraabdominal pressure transmitted at the GEJ Risk Factors Excessive alcohol consumption Most common Hyperemesis grandeur Bulimia nervosa Hital hernia NSAIDs Anticoagulants Cirrhosis with portal hypertension Endoscopy, TEE or other transoesophageal procedures (iatrogenic) CPR associated gastric insufflation and pressure injuries Blunt abdominal trauma Key Info Tears usually at the GEJ of the gastric side of the lesser curvature (most common) or distal oesophagus Clinical features Haematemesis Bright red (more common) or coffee ground In 85% of patients Most common Melena Dizziness Syncope when there is severe blood loss Epigastric or retrosternal pain Investigations Vitals and orthostatic hypotension Features of shock CBC: Hb and haematocrit Assess severity of bleed Renal function BUN/Cr Upper GI bleed may elevate BUN Coagulation profile ECG and troponin If syncope or cardiac risk Upper oesophageal endoscopic Definitive diagnosis and gold standard Both diagnostic and therapeutic Management 90% are self-limited and resolve without intervention If patient is unstable DRSABCD Stabilize airway, breathing and circulation Obtain IV access – don’t forget group and hold IV fluids with or without transfusions NGT tube and NPO Continuous vital monitoring Admit to ICU Pharmacological therapy PPI Enough for patients with no active bleed? IV PPI E.g. pantoprazole Reduce gastric acid and clot stabilisation If coagulopathy is present – correct it Endoscopic therapy For active bleeding and high-risk lesions Epinephrine injection Thermal coagulation MPEC, bipolar probe Haem clip application Band ligation for some DDx Boerhaave syndrome Oesophageal varices Peptic ulcer Gastric or oesophageal malignancy Complications GI bleed via hematemesis Most common Haemorrhage Anaemia Hypovolemia -> shock Melena and hematemesis Severe blood loss -> MI Death Prognosis Usually, good and bleeding do not re-occur