MALLORY-WEISS SYNDROME

Mallory – Weiss syndrome is characterized by a mucosal tear at the gastroesophageal junction following a bout of forceful retching (or vomiting, coughing, or straining).

Mallory-Weiss tear consists of a 1- to 4-cm longitudinal tear in the gastric mucosa near the esophagogastric junction.

The majority of patients are alcoholics, but the tear may appear after severe retching for any reason.

Typically, the patient first vomits food and gastric contents. This is followed by forceful retching and then bloody vomitus.

In about 90% of patients, the bleeding stops spontaneously after ice-water lavage of the stomach.

Mallory-Weiss Tear

Mallory-Weiss tears 

• Mucosal or submucosal lacerations that occur at the gastroesophageal junction.
• Patients present with hematemesis or coffee-ground emesis.
• All will have a history of recent non-bloody vomiting followed by hematemesis.
• The tear is due to increased intra-abdominal pressure, in combination with a shearing effect caused by negative intrathoracic pressure.
• The bleeding is self-limited and mild.
• Superficial Mallory-Weiss tears can heal completely within 48 hours. 

Ans. is a Mallory weiss syndrome

Upper gastorintestinal bleeding :

“Occasionally, persistent vomiting may be accompanied by worrisome upper gastrointestinal bleeding. The obvious concern is that there is a bleeding peptic ulceration, however, most of these women have minute linear mucosal tears near the gastroesophageal junction. Women with these co called Mallory-Weiss tears usually respond promptly to conservative measures.”

Ans. is ‘d’ i.e., Gastroesophageal junction

Mallory –Weiss syndrome

o Is characterized by mucosal tear at the gastroesophageal junction following a bout of forceful retching (or vomitting, coughing or straining).

o The tear is partial thickness, extends through the mucosa and submucosa, but not through the muscular layer (compare this with Boerhave syndrome in which the tear is full thickness penetrating complete through all the layers of esophageal wall with spillage of contents into the mediastinum).

o The clinical picture consists of acute upper gastrointestinal bleeding following bouts of retching or vomitting.

• The mean age of patients is older than 60 years. 80% are men” – Sabiston 17th/e p. 1254.

o Majority of patients are alcoholics

o Other frequent associations with Mallory – Weiss tears are —> Hiatal hernia, NSAIDs abuse, Disease related bleeding diathesis.

Ans. is ‘a’ i.e., Gastric Cardia 

• In Mallory-Weiss syndrome the majority (75-90%) of tear is located below the gastroesophageal junction, entirely within the gastric cardia.
• Only a few of the tears involve the gastro-esophageal junction.

Ans. Three options are correct i.e.,’a, c ‘ (Patient who abuse analgesics, Pregnant females )

Ans. is ‘a’ i.e. Gastro-esophageal junction 

Ans. is ‘a’ i.e., Mallory-Wesis syndrome

“Mallory Weiss syndrome, characterized by acute upper gastrointestinal bleeding following repeated vomiting, is considered to be the cause up to 15% of all severe upper gastrointestinal bleeds”.

Answer is D (Mucosal tear)

Mallory-Weiss Syndrome is associated with a tear of the gastric mucosa near the squamocolumnar mucosa! junction

Mucosal Tear (Mallory-Weiss Syndrome)

• The tear usually involves the gastric mucosa near the squamocolumnar mucosal junction near cardia
• This tear is usually caused by vomiting, retching, or vigorous coughing.
• The tear is usually linear.
• Patients present with upper gastrointestinal bleeding (Hemetemesis)
• Association with alcoholism and hiatus hernia
• In most patients, bleeding ceases spontaneously
• (Continued bleeding may respond to vasopressin therapy or angiographic embolization. Surgery is rarely needed)

Ans: A i.e. Mallory Weiss syndrome

Esophagus disorders & presentation

• In Mallory Weiss syndrome, vigorous vomiting produces a vertical split in gastric mucosa, immediately below the squamo-columnar junction at the cardia in 90% of cases. The condition presents with haematemesis
• Most oesophageal neoplasms presents with mechanical symptoms, principally dysphagia, but sometimes also regurgitation, vomiting, odynophagia & weight loss
• Achalsia cardia presents with dysphagia, although pain (often mistaken for reflux) is common in the early stages.
• In Boerhaave’s syndrome, vomiting occurs against a closed glottis, and pressure builds up in the oesophagus

The condition shown in the picture above represents Mallory Weiss tears.

Severe and prolonged vomiting can result in tears in the lining of the esophagus. The esophagus is the tube that connects throat to stomach. Mallory-Weiss syndrome (MWS) is a condition marked by a tear in the mucous membrane, or inner lining, where the esophagus meets the stomach. Most tears heal within 7 to 10 days without treatment, but Mallory-Weiss tears can cause significant bleeding. Depending on the severity of the tear, surgery may be necessary to repair the damage.