Editing Mallory-Weiss tear


Linear mucosal or submucosal lacerations at or near GOJ resulting from forceful retching/vomiting that may lead to UGIB.

* Initially described by     Kenneth Mallory and Soma Weiss in 1929

== Pathophysiology ==

* Results from large gradient     in pressure between stomach and thorax, which occurs at GOJ
* Can result from 'any action     which results in an abrupt increase in intra-abdominal pressure and     gastric herniation'
** Vomiting
** Coughing
** Straining
* Most tears occur below GOJ     (within 2cm), and along lesser curve

== Risk factors ==

* Hiatus hernia (found in 50%     of cases)
* 40-60 year old patients
* Aspirin/alcohol can make     bleeding worse

== Risks for worse outcomes ==

* Older
* Anaemia
* Shock at presentation
* Active bleeding on endoscopy
* Alcoholic patients with     portal hypertension

== Presentation ==

* Non-bloody vomiting followed     by haematemesis is classic
* Seen in 5-15% of patients     with UGIB (behind only PUD in non-variceal UGIB)
* MOSTLY self-limiting






== Treatment approach ==

* Generally identified during     initial endoscopy for UGIB - treat with adrenaline and gold probe, or     haemoclip if gold probe is unavailable
* If patient becomes unstable     again, or there is large bleeding and you are unable to get control     endoscopically, consider transarterial embolisation if available
* If all else fails, operate

== Management options ==

* Medical
** PPI (raises gastric pH to      improve coagulation)
** Anti-emetic
* Endoscopic intervention if     active bleeding
** 90-100% success rate
** Injection therapy
*** Adrenaline 1-3mL of       1:10,000
**** Mix 1mL of 1:1000        adrenaline with 9mL saline
**** Great outcomes but combine        with second therapy
*** Sclerosing agents
** Multipolar      electrocoagulation
** Band ligation
** Haemoclipping
* Interventional embolotherapy
* Surgery
** Very rarely indicated
** High anterior longitudinal      gastrotomy to visualise GOJ mucosa
** Oversew with 2/0 Vicryl to      reappose mucosa

[[Category:UGIS]]