A 43 year old patient comes to emergency with chest pain. He is a chronic alcoholic and he had a episode of vomiting with bright red colour blood. Endoscopy shows partial thickness tear in distal oesophagus. What is the diagnosis
**Core Concept**
The patient's presentation of chest pain, chronic alcoholism, and an episode of vomiting with bright red blood, along with an endoscopic finding of a partial thickness tear in the distal oesophagus, suggests a diagnosis related to oesophageal mucosal injury. This is a classic presentation of a specific condition that occurs due to prolonged and excessive alcohol consumption.
**Why the Correct Answer is Right**
The patient's symptoms and endoscopic findings are consistent with a diagnosis of Mallory-Weiss syndrome. This condition is characterized by a mucosal tear at the junction of the oesophagus and stomach, often resulting from intense or prolonged vomiting, retching, or coughing. The tear is typically partial thickness and can be accompanied by bleeding, which is evident in this case. The pathophysiology involves the sudden increase in intra-abdominal pressure during vomiting, which leads to a shearing force on the mucosal lining of the oesophagus, causing a tear.
**Why Each Wrong Option is Incorrect**
**Option A:** This option is incorrect because it does not accurately describe the patient's presentation and endoscopic findings. While oesophageal varices can be a complication of chronic liver disease, the patient's symptoms and endoscopic findings are more consistent with Mallory-Weiss syndrome.
**Option B:** This option is incorrect because it does not account for the patient's history of chronic alcoholism and the episode of vomiting with bright red blood. While oesophageal cancer can present with bleeding, the patient's symptoms and endoscopic findings are not typical for this condition.
**Option C:** This option is incorrect because it does not accurately describe the patient's presentation and endoscopic findings. While gastroesophageal reflux disease (GERD) can cause oesophageal mucosal injury, the patient's symptoms and endoscopic findings are more consistent with Mallory-Weiss syndrome.
**Option D:** This option is incorrect because it does not account for the patient's history of chronic alcoholism and the episode of vomiting with bright red blood. While oesophageal ulcers can be a complication of chronic alcoholism, the patient's symptoms and endoscopic findings are more consistent with Mallory-Weiss syndrome.
**Clinical Pearl / High-Yield Fact**
Mallory-Weiss syndrome is a classic example of a condition that occurs due to the shearing force on the mucosal lining of the oesophagus, resulting from intense or prolonged vomiting, retching, or coughing. This condition can be prevented by avoiding prolonged and excessive vomiting, retching, or coughing, especially in patients with a history of chronic alcoholism.
**Correct Answer:** D. Oesophageal tear due to intense vomiting is a common cause of Mallory-Weiss syndrome.