Mallory-Weiss syndrome

What is the underlying cause of Mallory-Weiss syndrome?

A tear in the esophageal mucosa, often caused by a sudden increase in pressure. Summary 1

What are Mallory-Weiss lesions?

A tear in the esophageal mucous membrane, as well as the submucosal arteries and veins Summary 2

What is the primary presenting symptom of Mallory-Weiss syndrome?

Typically presents with hematemesis (vomiting blood). Summary 3

What are the typical treatment steps for patients with a Mallory-Weiss tear?

Hemodynamic support, control of bleeding, and acid suppression. Summary 4

What is the sex predilection for Mallory-Weiss syndrome?

♂ > ♀ (3:1) Epidemiology 5

What percentage of GI bleeding cases are caused by Mallory-Weiss lesions?

Approximately 5%. Epidemiology 6

What is the mechanism of Mallory-Weiss lesions?

A sudden and severe rise in the esophageal intraluminal pressure results in tearing of the esophageal mucous membrane, as well as the submucosal arteries and veins. Etiology 7

What are some precipitating factors for Mallory-Weiss syndrome?

Severe vomiting, blunt abdominal trauma, strained defecation. Etiology 8

What are some predisposing conditions for Mallory-Weiss syndrome?

Alcohol use disorder, bulimia nervosa, hiatal hernia, GERD. Etiology 9

What are some clinical features of Mallory-Weiss syndrome?

May be asymptomatic, epigastric or back pain, hematemesis, possible shock with massive hemorrhage. Clinical features 10

When should you suspect Mallory-Weiss syndrome?

In patients with upper GI bleeding and a history of precipitating factors or predisposing conditions. Diagnosis 11

Why might blood loss be initially concealed in Mallory-Weiss Syndrome?

Because of the large volume of the GI tract. Diagnosis 12

What is the gold standard test for Mallory-Weiss syndrome?

EGD (esophagogastroduodenoscopy). Diagnosis 13

When should EGD be performed for Mallory-Weiss syndrome?

Should be performed in all patients to confirm the diagnosis. Diagnosis 14

What are the typical findings on EGD for Mallory-Weiss syndrome?

Often a single longitudinal tear (but multiple tears are possible) in the mucosa at the gastroesophageal junction or in the cardia of the stomach which are limited to the mucosa and submucosa. Diagnosis 15

What are the typical findings on EGD of a Mallory-Weiss lesion?

A fibrin crust over the split, a clot, or active bleeding may be evident. Diagnosis 16

When is angiography indicated in Mallory-Weiss syndrome?

Signs of active bleeding without successful location of the tear on EGD, EGD unavailable. Diagnosis 17

What are the typical findings on angiography for a Mallory-Weiss lesion?

Contrast extravasation at the site of active bleeding. Diagnosis 18

What are some differential diagnoses for Mallory-Weiss syndrome?

Boerhaave syndrome, esophagitis, esophageal ulcers, peptic ulcer disease. Differential diagnoses 19

What is the initial approach to a patient with Mallory-Weiss syndrome?

Start initial management of overt GI bleeding, potentially including immediate hemodynamic support, emergency blood transfusion and correction of coagulopathy, empiric medical therapy for GI bleeding. Treatment 20

What is the goal of pharmacological treatment in Mallory-Weiss Syndrome?

To promote mucosal recovery. Treatment 21

What acid suppression medications are used in Mallory-Weiss syndrome?

IV PPI therapy: e.g., esomeprazole, Oral PPI therapy (e.g., omeprazole or pantoprazole). Treatment 22

When is anticoagulant reversal considered?

Consider for life-threatening bleeding. Treatment 23

What antiemetic medications are used for Mallory-Weiss syndrome?

Ondansetron, promethazine. Treatment 24

Does pharmacological therapy delay endoscopy?

No, Initiation of pharmacological therapy should not delay endoscopy. Treatment 25

When is conservative treatment sufficient for Mallory-Weiss syndrome?

Conservative treatment with PPI therapy alone is usually sufficient for patients without active bleeding. Treatment 26

When is endoscopic treatment indicated for Mallory-Weiss syndrome?

First-line treatment for actively bleeding Mallory-Weiss tears. Treatment 27

What are some endoscopic treatment techniques for Mallory-Weiss syndrome?

Injection of an epinephrine solution or a fibrin sealant, Electrocoagulation or argon plasma coagulation, Endoscopic band ligation, Hemoclip placement. Treatment 28

When is angiographic treatment indicated for Mallory-Weiss syndrome?

Second-line treatment for actively bleeding Mallory-Weiss tears if EGD is unsuccessful, Alternative to EGD in patients at high risk for endoscopic complications or if EGD is unavailable. Treatment 29

What are some angiographic treatment techniques for Mallory-Weiss syndrome?

Embolization of the left gastric artery, Vasopressin infusion. Treatment 30

When is surgical treatment considered for Mallory-Weiss syndrome?

Only considered if EGD and angiographic treatment are unsuccessful and bleeding is ongoing. Treatment 31

What is the surgical treatment for Mallory-Weiss syndrome?

Surgical ligation of bleeding vessels. Treatment 32