WBR0525

Author	[[PageAuthor::Mugilan Poongkunran M.B.B.S [1]]]
Exam Type	ExamType::USMLE Step 3
Main Category	MainCategory::Emergency Room
Sub Category	SubCategory::Gastrointestinal
Prompt	[[Prompt::A 40 yr old male comes to the emergency department with an episode coffee-ground colored vomiting. He denies any abdominal pain, dizziness and black stools. His past history is insignificant with no similar episodes. He occasionally smokes and consumes alcohol. On examination pulse is 92/min and BP is 110/80 mmHg. Abdomen is soft and non-tender. Cardiovascular and respiratory examinations are normal. The patient underwent an endoscopy and results shows a small tear at the gastroesophagel junction with no active bleeding. What is the most likely condition associated with the patient’s disease?]]
Answer A	AnswerA::Esophageal varices
Answer A Explanation	AnswerAExp::''' Incorrect ''' : Esophageal varices may be seen in chronic alcoholics who present with this syndrome and per se it is not a predisposing factor.
Answer B	AnswerB::Peptic ulcer
Answer B Explanation	[[AnswerBExp:: Incorrect  : Peptic ulcer disease may present with dyspeptic or other gastrointestinal symptoms or may be completely asymptomatic, sometimes until complications such as hemorrhage or perforation occur. This is not a predisposing factor.]]
Answer C	AnswerC::Hiatal hernia
Answer C Explanation	[[AnswerCExp:: Correct  : Hiatal hernia has been found in 40 to 100 percent of patients with Mallory-Weiss tears and has been considered by some to be a necessary predisposing factor as a higher pressure gradient develops in the hernia compared with that in the rest of the stomach during retching, thereby increasing the potential for mucosal laceration.]]
Answer D	AnswerD::Hepatomegaly
Answer D Explanation	[[AnswerDExp:: Incorrect  : A history of heavy alcohol use may lead to alcoholic liver disease and portal hypertension with hepatomegaly. It leads to heavy vomiting that has been noted in 40 to 80 percent of patients with Mallory-Weiss syndrome in most series but hiatal hernia is more common.]]
Answer E	AnswerE::Epilepsy
Answer E Explanation	[[AnswerEExp:: Incorrect  : Mallory-Weiss tears are usually secondary to a sudden increase in intraabdominal pressure and precipitating factors include epilepsy. But it is not a common predisposing factor.]]
Right Answer	RightAnswer::C
Explanation	[[Explanation::Mallory-Weiss syndrome is characterized by longitudinal mucosal lacerations (intramural dissections) in the distal esophagus and proximal stomach, which are usually associated with forceful retching. Mallory-Weiss tears are usually secondary to a sudden increase in intraabdominal pressure. Precipitating factors include vomiting, straining at stool or lifting, coughing, epileptic convulsions, hiccups under anesthesia, closed-chest massage, blunt abdominal injury, colonoscopic preparation with polyethylene glycol electrolyte lavage solution, and gastroscopy. Predisposing conditions to Mallory-Weiss tears include hiatal hernia, chronic alcoholism, and perhaps increasing age. Educational Objective: References: ]]
Approved	Approved::Yes
Keyword	WBRKeyword::Mallory-Weiss syndrome, WBRKeyword::Hiatal hernia
Linked Question	Linked::
Order in Linked Questions	LinkedOrder::