Mallory-Weiss syndrome differential diagnosis: Difference between revisions

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__NOTOC__
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{{Mallory-Weiss syndrome}}
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Mallory-Weiss_syndrome]]
{{CMG}} {{AE}}
{{CMG}}; {{AE}} {{DM}}
 
{{PleaseHelp}}


==Overview==
==Overview==
Mallory-Weiss syndrome must be differentiated from other causes of Upper gastrointestinal bleeding such as [[Peptic ulcer|PUD]], [[Variceal bleeding|Esophagogastric varices]], [[Gastritis|Severe or erosive gastritis/duodenitis]], [[Angiodysplasia]].


==Differential Diagnosis==
==Differential Diagnosis==
Mallory-Weiss syndrome must be differentiated from other diseases that cause esophageal ulcers such as:
Mallory-Weiss syndrome must be differentiated from other diseases that cause esophageal ulcers such as:<ref name="pmid7812643">{{cite journal |vauthors=Sutton FM, Graham DY, Goodgame RW |title=Infectious esophagitis |journal=Gastrointest. Endosc. Clin. N. Am. |volume=4 |issue=4 |pages=713–29 |year=1994 |pmid=7812643 |doi= |url=}}</ref>
* [[Reflux esophagitis]]
<small>
* Infectious esophagitis
{|
* Medication-induced esophagitis
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! rowspan="2" |Diseases
! colspan="8" |History and Symptoms
! colspan="4" |Physical Examination
! colspan="3" |Laboratory Findings
! rowspan="2" |Upper endoscopy
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
!Hematemesis
!Epigastric pain
!Light-headedness
!Retching
!Heartburn
!History of medication
!Vomiting
!History of alcoholism
!Tachycardia
!Skin Pallor
!Hypotension
!Weak pulse
!Hemoglobin
!Platelets
!BUN
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Mallory-Weiss syndrome
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | + (with heavy bleeding)
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | + (with heavy bleeding)
| style="background: #F5F5F5; padding: 5px;" | + (with heavy bleeding)
| style="background: #F5F5F5; padding: 5px;" | + (with heavy bleeding)
| style="background: #F5F5F5; padding: 5px;" | + (with heavy bleeding)
| style="background: #F5F5F5; padding: 5px;" |↓
| style="background: #F5F5F5; padding: 5px;" |↓
| style="background: #F5F5F5; padding: 5px;" |↑
| style="background: #F5F5F5; padding: 5px;" |Tears are usually single and located in the esophagogastric junction, usually extends into the cardia and sometimes into the esophagus
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Infectious esophagitis
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |Ulcerations are multiple and usually involve the proximal esophagus
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Medication-induced esophagitis
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |Ulcerations are usually singular and deep
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Reflux esophagitis
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |Ulcerations are usually in distal esophagus, and maybe irregular and multiple
|}
</small>
Mallory-Weiss syndrome must be differentiated from other causes of [[Upper gastrointestinal bleeding]]:<ref name="pmid15173790">{{cite journal |vauthors=Boonpongmanee S, Fleischer DE, Pezzullo JC, Collier K, Mayoral W, Al-Kawas F, Chutkan R, Lewis JH, Tio TL, Benjamin SB |title=The frequency of peptic ulcer as a cause of upper-GI bleeding is exaggerated |journal=Gastrointest. Endosc. |volume=59 |issue=7 |pages=788–94 |year=2004 |pmid=15173790 |doi= |url=}}</ref><ref name="pmid18206878">{{cite journal |vauthors=Enestvedt BK, Gralnek IM, Mattek N, Lieberman DA, Eisen G |title=An evaluation of endoscopic indications and findings related to nonvariceal upper-GI hemorrhage in a large multicenter consortium |journal=Gastrointest. Endosc. |volume=67 |issue=3 |pages=422–9 |year=2008 |pmid=18206878 |doi=10.1016/j.gie.2007.09.024 |url=}}</ref><ref name="pmid21962318">{{cite journal |vauthors=Balderas V, Bhore R, Lara LF, Spesivtseva J, Rockey DC |title=The hematocrit level in upper gastrointestinal hemorrhage: safety of endoscopy and outcomes |journal=Am. J. Med. |volume=124 |issue=10 |pages=970–6 |year=2011 |pmid=21962318 |doi=10.1016/j.amjmed.2011.04.032 |url=}}</ref><ref name="pmid24275716">{{cite journal |vauthors=Wollenman CS, Chason R, Reisch JS, Rockey DC |title=Impact of ethnicity in upper gastrointestinal hemorrhage |journal=J. Clin. Gastroenterol. |volume=48 |issue=4 |pages=343–50 |year=2014 |pmid=24275716 |pmc=4157370 |doi=10.1097/MCG.0000000000000025 |url=}}</ref>
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! rowspan="2" |Diseases
! colspan="6" |History and Symptoms
!
!
! colspan="4" |Physical Examination
! colspan="3" |Laboratory Findings
! rowspan="2" |Upper endoscopy
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
!Hematemesis


Mallory-Weiss syndrome must be differentiated from other causes of [[Upper gastrointestinal bleeding]]:<ref name="pmid15173790">{{cite journal |vauthors=Boonpongmanee S, Fleischer DE, Pezzullo JC, Collier K, Mayoral W, Al-Kawas F, Chutkan R, Lewis JH, Tio TL, Benjamin SB |title=The frequency of peptic ulcer as a cause of upper-GI bleeding is exaggerated |journal=Gastrointest. Endosc. |volume=59 |issue=7 |pages=788–94 |year=2004 |pmid=15173790 |doi= |url=}}</ref><ref name="pmid18206878">{{cite journal |vauthors=Enestvedt BK, Gralnek IM, Mattek N, Lieberman DA, Eisen G |title=An evaluation of endoscopic indications and findings related to nonvariceal upper-GI hemorrhage in a large multicenter consortium |journal=Gastrointest. Endosc. |volume=67 |issue=3 |pages=422–9 |year=2008 |pmid=18206878 |doi=10.1016/j.gie.2007.09.024 |url=}}</ref><ref name="pmid21962318">{{cite journal |vauthors=Balderas V, Bhore R, Lara LF, Spesivtseva J, Rockey DC |title=The hematocrit level in upper gastrointestinal hemorrhage: safety of endoscopy and outcomes |journal=Am. J. Med. |volume=124 |issue=10 |pages=970–6 |year=2011 |pmid=21962318 |doi=10.1016/j.amjmed.2011.04.032 |url=}}</ref><ref name="pmid24275716">{{cite journal |vauthors=Wollenman CS, Chason R, Reisch JS, Rockey DC |title=Impact of ethnicity in upper gastrointestinal hemorrhage |journal=J. Clin. Gastroenterol. |volume=48 |issue=4 |pages=343–50 |year=2014 |pmid=24275716 |pmc=4157370 |doi=10.1097/MCG.0000000000000025 |url=}}</ref>
!Epigastric pain
*  [[Peptic ulcer|PUD]]
!Retching
* [[Variceal bleeding|Esophagogastric varices]]
!History of alcoholism
* [[Gastritis|Severe or erosive gastritis/duodenitis]]
!Light-headedness
* [[Angiodysplasia]]
!history of cirrhosis
!NSAIDs use
!''Helicobacter pylori'' infection
!Tachycardia
!Hypotension
!Skin Pallor
!Weak pulse
!CBC
!Platelets
!BUN
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Mallory-Weiss syndrome
| style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | + (with heavy bleeding)
| style="background: #F5F5F5; padding: 5px;" | + (with heavy bleeding)
| style="background: #F5F5F5; padding: 5px;" | + (with heavy bleeding)
| style="background: #F5F5F5; padding: 5px;" | + (with heavy bleeding)
| style="background: #F5F5F5; padding: 5px;" |<math>\downarrow</math>
| style="background: #F5F5F5; padding: 5px;" |<math>\downarrow</math>
| style="background: #F5F5F5; padding: 5px;" |<math>\uparrow</math>
| style="background: #F5F5F5; padding: 5px;" |Tears are usually single and located in the esophagogastric junction, usually extends into the cardia and sometimes into the esophagus
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |PUD
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | + (with heavy bleeding)
| style="background: #F5F5F5; padding: 5px;" | + (with heavy bleeding)
| style="background: #F5F5F5; padding: 5px;" | + (with heavy bleeding)
| style="background: #F5F5F5; padding: 5px;" | + (with heavy bleeding)
| style="background: #F5F5F5; padding: 5px;" |<math>\downarrow</math>
| style="background: #F5F5F5; padding: 5px;" |<math>\downarrow</math>
| style="background: #F5F5F5; padding: 5px;" |<math>\uparrow</math>
| style="background: #F5F5F5; padding: 5px;" |Discrete mucosal lesions with a punched-out smooth ulcer base with whitish fibrinoid base
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Esophagogastric varices
| style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | + (with heavy bleeding)
| style="background: #F5F5F5; padding: 5px;" | + (with heavy bleeding)
| style="background: #F5F5F5; padding: 5px;" | + (with heavy bleeding)
| style="background: #F5F5F5; padding: 5px;" | + (with heavy bleeding)
| style="background: #F5F5F5; padding: 5px;" |<math>\downarrow</math>
| style="background: #F5F5F5; padding: 5px;" |<math>\downarrow</math>
| style="background: #F5F5F5; padding: 5px;" |<math>\uparrow</math>
| style="background: #F5F5F5; padding: 5px;" |The varices may be in the esophagus and/or the stomach.
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Severe or erosive gastritis/duodenitis
| style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | + (with heavy bleeding)
| style="background: #F5F5F5; padding: 5px;" | + (with heavy bleeding)
| style="background: #F5F5F5; padding: 5px;" | + (with heavy bleeding)
| style="background: #F5F5F5; padding: 5px;" | + (with heavy bleeding)
| style="background: #F5F5F5; padding: 5px;" |<math>\downarrow</math>
| style="background: #F5F5F5; padding: 5px;" |<math>\downarrow</math>
| style="background: #F5F5F5; padding: 5px;" |<math>\uparrow</math>
| style="background: #F5F5F5; padding: 5px;" |Erythema, mucosal erosions, the absence of rugal folds, and visible vessels
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Angiodysplasia
| style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | + (with heavy bleeding)
| style="background: #F5F5F5; padding: 5px;" | + (with heavy bleeding)
| style="background: #F5F5F5; padding: 5px;" | + (with heavy bleeding)
| style="background: #F5F5F5; padding: 5px;" | + (with heavy bleeding)
| style="background: #F5F5F5; padding: 5px;" |<math>\downarrow</math>
| style="background: #F5F5F5; padding: 5px;" |<math>\downarrow</math>
| style="background: #F5F5F5; padding: 5px;" |<math>\uparrow</math>
| style="background: #F5F5F5; padding: 5px;" |small, flat, cherry-red lesions with a fern-like pattern
|}


==References==
==References==

Latest revision as of 22:21, 7 February 2019

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohamed Diab, MD [2]

Overview

Mallory-Weiss syndrome must be differentiated from other causes of Upper gastrointestinal bleeding such as PUD, Esophagogastric varices, Severe or erosive gastritis/duodenitis, Angiodysplasia.

Differential Diagnosis

Mallory-Weiss syndrome must be differentiated from other diseases that cause esophageal ulcers such as:[1]

Diseases History and Symptoms Physical Examination Laboratory Findings Upper endoscopy
Hematemesis Epigastric pain Light-headedness Retching Heartburn History of medication Vomiting History of alcoholism Tachycardia Skin Pallor Hypotension Weak pulse Hemoglobin Platelets BUN
Mallory-Weiss syndrome + + + (with heavy bleeding) + - - + + + (with heavy bleeding) + (with heavy bleeding) + (with heavy bleeding) + (with heavy bleeding) Tears are usually single and located in the esophagogastric junction, usually extends into the cardia and sometimes into the esophagus
Infectious esophagitis - + - - - - - - - - - - Ulcerations are multiple and usually involve the proximal esophagus
Medication-induced esophagitis - + - - - + - - - - - - Ulcerations are usually singular and deep
Reflux esophagitis - + - - + - - - - - - - Ulcerations are usually in distal esophagus, and maybe irregular and multiple

Mallory-Weiss syndrome must be differentiated from other causes of Upper gastrointestinal bleeding:[2][3][4][5]

Diseases History and Symptoms Physical Examination Laboratory Findings Upper endoscopy
Hematemesis Epigastric pain Retching History of alcoholism Light-headedness history of cirrhosis NSAIDs use Helicobacter pylori infection Tachycardia Hypotension Skin Pallor Weak pulse CBC Platelets BUN
Mallory-Weiss syndrome + + + + + - - - + (with heavy bleeding) + (with heavy bleeding) + (with heavy bleeding) + (with heavy bleeding) <math>\downarrow</math> <math>\downarrow</math> <math>\uparrow</math> Tears are usually single and located in the esophagogastric junction, usually extends into the cardia and sometimes into the esophagus
PUD +/- + - +/- - - + + + (with heavy bleeding) + (with heavy bleeding) + (with heavy bleeding) + (with heavy bleeding) <math>\downarrow</math> <math>\downarrow</math> <math>\uparrow</math> Discrete mucosal lesions with a punched-out smooth ulcer base with whitish fibrinoid base
Esophagogastric varices + + +/- + + - - + (with heavy bleeding) + (with heavy bleeding) + (with heavy bleeding) + (with heavy bleeding) <math>\downarrow</math> <math>\downarrow</math> <math>\uparrow</math> The varices may be in the esophagus and/or the stomach.
Severe or erosive gastritis/duodenitis + + +/- - - +/- - + (with heavy bleeding) + (with heavy bleeding) + (with heavy bleeding) + (with heavy bleeding) <math>\downarrow</math> <math>\downarrow</math> <math>\uparrow</math> Erythema, mucosal erosions, the absence of rugal folds, and visible vessels
Angiodysplasia + + - - +/- - - - + (with heavy bleeding) + (with heavy bleeding) + (with heavy bleeding) + (with heavy bleeding) <math>\downarrow</math> <math>\downarrow</math> <math>\uparrow</math> small, flat, cherry-red lesions with a fern-like pattern

References

  1. Sutton FM, Graham DY, Goodgame RW (1994). "Infectious esophagitis". Gastrointest. Endosc. Clin. N. Am. 4 (4): 713–29. PMID 7812643.
  2. Boonpongmanee S, Fleischer DE, Pezzullo JC, Collier K, Mayoral W, Al-Kawas F, Chutkan R, Lewis JH, Tio TL, Benjamin SB (2004). "The frequency of peptic ulcer as a cause of upper-GI bleeding is exaggerated". Gastrointest. Endosc. 59 (7): 788–94. PMID 15173790.
  3. Enestvedt BK, Gralnek IM, Mattek N, Lieberman DA, Eisen G (2008). "An evaluation of endoscopic indications and findings related to nonvariceal upper-GI hemorrhage in a large multicenter consortium". Gastrointest. Endosc. 67 (3): 422–9. doi:10.1016/j.gie.2007.09.024. PMID 18206878.
  4. Balderas V, Bhore R, Lara LF, Spesivtseva J, Rockey DC (2011). "The hematocrit level in upper gastrointestinal hemorrhage: safety of endoscopy and outcomes". Am. J. Med. 124 (10): 970–6. doi:10.1016/j.amjmed.2011.04.032. PMID 21962318.
  5. Wollenman CS, Chason R, Reisch JS, Rockey DC (2014). "Impact of ethnicity in upper gastrointestinal hemorrhage". J. Clin. Gastroenterol. 48 (4): 343–50. doi:10.1097/MCG.0000000000000025. PMC 4157370. PMID 24275716.


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