About Mallory Weiss syndrome true is –
Correct Answer: Seen in alcoholics
Description: Mallory - Weiss syndrome is characterized by a mucosal tear at the gastroesophageal junction following a bout of forceful retching (or vomiting, coughing or straining.
- The tear is partial thickness, extends through the mucosa and submucosa, but not through the muscular layer (compare this with Boerhaave syndrome in which the tear is full thickness penetrating completely through all the layers of esophageal wall with spillage of contents into the mediastinum)
The clinical picture consists of acute upper gastrointestinal bleeding following bouts of retching or vomiting
"The mean age of patients is older than 60 years. 80% are men" - Sabiston 17/e, p 1254.
Majority of patients are alcoholics
Other frequent associations with Mallory-Weiss tears are
A hiatal hernia
NSAIDs abuse
Disease-related bleeding diathesis.
Management
In the majority (-90% of patients the bleeding stops spontaneously and only supportive therapy is required.
Persistent bleeding is managed by
Endoscopic electrocoagulation
if fails
Angiographic techniques (embolization)
if fails
Surgery: Laparotomy with high gastrotomy with oversewing of the linear tear.
It is important to rule out the diagnosis of variceal bleeding in cases of failed endoscopic therapy by a thorough examination of the GE junction. Recurrent bleeding from a Mallory-Weiss tear is uncommon.
Note that the Sengstaken - Blakemore tube will not be able to stop the bleeding in Mallory-Weiss syndrome as the bleeding is arterial and the pressure in the balloon is not sufficient to overcome the arterial pressure.
Category:
Surgery
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