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Mallory Weiss tear (Risk factors (Alcohol excess, Gastroenteritis,…
Mallory Weiss tear
Risk factors
Alcohol excess
Gastroenteritis
Hyperemesis gravidarum
Bulimia
Raised ICP
Chemo
Biliary disease
Hiatus hernia
Complications
Aspiration pneumonia
Hypovolemic shock
Electrolyte disturbance
Rebleeding
Perforation
Diagnosis
Examination
Abdo - often nil
Investigations
Bedside
Obs - any infection/shock
ECG
Bloods
FBC - likely normal, high WCC if gastroenteritis
CRP - raised if gastroenteritis
LFTs (liver disease), U+Es, clotting
Crossmatch 4u
Blood cultures (infection)
Imaging
CXR - exclude perf (air in mediastinum)
Endoscopy (diagnostic)
History
PC - onset, other symptoms
PMH - liver disease, coagulation
DH - anticoagulants, NSAIDs, steroids, allergies
FH - GI disorder, malignancy
SH - alcohol, smoking, diet, travel
Classification
Rockall Score for GI bleeds
Pathophysiology
Violent retching/vomiting,
often after alcohol
Tear in mucosa of oesophagus
and bleeding
Not a perforation (Boorhave's)
Clinical
presentation
Haematemesis
Malaena
Syncope
Epidemiology
5% of upper GI bleeds
Alcohol
Typically 30-50y
Management
Definitive
Medical
IV PPI e.g. omeprazole
Blood if profuse
Correct clotting (FFP, platelets, vit K)
Conservative
Information, advice, support
Monitoring (obs, bloods)
Refer to gastro ASAP for endoscopy
Surgical
Banding/clipping
Adrenaline injection
Thermocoagulation
Initial ABCDE
Definition
Gastrointestinal disorder of haematemesis
due to oesophageal trauma from vomiting
Prognosis
Most patients stop bleeding spontaneously,
few will need surgical intervention