Mallory Weiss Tear is a longitudinal laceration tear that can affect mucosa only, typically occurring at the gastroesophageal junction (GEJ) due to increase intra-abdominal or intragastric pressure. However, in cases when it becomes serious or persistent, a transmural tear can occur, causing perforation. When perforation occurs, this is known as boerhaave syndrome.
Etiology and associations:
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The most common cause of mallory wiss tear is severe vomiting/retching (repeatedly) usually due to chronic alcoholism (binge drink) or bulimia. Other conditions like hiatal hernia is also another risk factor for developing Mallory Weiss tear.
Symptoms and Clinical Presentation of Mallory weiss tear
Mallory Weiss tear can present with upper GI bleeding. The upper GI Bleed are usually painful with hematemesis. This is different from esophageal varices which cause painless hematemesis). Patient with Mallory Weiss tear have bright red hematemesis OR melenic stool. In addition, patient also present with typical epigastric pain and metabolic Alkalosis (due to gastric acid (HCl) loss from vomiting)
The diagnosis of mallory weiss tear can only be made through visualization with upper endoscopy.
Risk of Boerhaave syndrome is the most lethal complication. Rupture of esophagus leading to air in the mediastinum and subcutaneous emphysema.
Treatment and Management:
Most mallory weiss tear usually resolve spontaneously, however, doctor can give injection of Epinephrine or Cauterization if necessary. Proton pump inhitor (PPI) are usually given to enhance healing.