Mallory-Weiss syndrome overview: Difference between revisions
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==Overview== | ==Overview== | ||
Mallory-Weiss syndrome refers to bleeding from tears in the [[mucosa]] at the junction of the [[stomach]] and [[esophagus]], usually caused by severe retching, [[cough]]ing, or [[vomiting]]. It is often associated with [[alcoholism]] and [[eating disorders]] and there is some evidence that presence of a [[hiatus hernia|hiatal hernia]] is a required predisposing condition. | Mallory-Weiss syndrome refers to bleeding from tears in the [[mucosa]] at the junction of the [[stomach]] and [[esophagus]], usually caused by severe retching, [[cough]]ing, or [[vomiting]]. It is often associated with [[alcoholism]] and [[eating disorders]] and there is some evidence that presence of a [[hiatus hernia|hiatal hernia]] is a required predisposing condition. | ||
==Historical Perspective== | ==Historical Perspective== | ||
The condition was first described in 1929 by G. Kenneth Mallory and [[Soma Weiss]] in 15 alcoholic patients <ref>Weiss S, Mallory GK. ''Lesions of the cardiac orifice of the stomach produced by vomiting.'' [[Journal of the American Medical Association]] 1932;98:1353-55.</ref>. | The condition was first described in 1929 by G. Kenneth Mallory and [[Soma Weiss]] in 15 alcoholic patients <ref>Weiss S, Mallory GK. ''Lesions of the cardiac orifice of the stomach produced by vomiting.'' [[Journal of the American Medical Association]] 1932;98:1353-55.</ref>. | ||
==Classification== | |||
==Pathophysiology== | |||
==Causes== | ==Causes== | ||
Mallory-Weiss syndrome is caused by severe retching, [[cough]]ing, or [[vomiting]]. It is often associated with [[alcoholism]] and [[eating disorders]] and there is some evidence that presence of a [[hiatus hernia|hiatal hernia]] is a required predisposing condition. | Mallory-Weiss syndrome is caused by severe retching, [[cough]]ing, or [[vomiting]]. It is often associated with [[alcoholism]] and [[eating disorders]] and there is some evidence that presence of a [[hiatus hernia|hiatal hernia]] is a required predisposing condition. | ||
==Differentiating {{PAGENAME}} from Other Diseases== | |||
==Epidemiology and Demographics== | |||
==Risk Factors== | |||
==Screening== | |||
==Natural History, Complications, and Prognosis== | |||
===Natural History=== | |||
===Complications=== | |||
===Prognosis=== | |||
==Diagnosis== | ==Diagnosis== | ||
===History and Symptoms=== | ===History and Symptoms=== | ||
Mallory-Weiss syndrome often presents as an episode of vomiting up blood ([[hematemesis]]) after violent retching or vomiting, but may also be noticed as old blood in the stool ([[melena]]), and a history of retching may be absent. In most cases, the bleeding stops spontaneously after 24-48 hours, but endoscopic or surgical treatment is sometimes required and rarely the condition is fatal. | Mallory-Weiss syndrome often presents as an episode of vomiting up blood ([[hematemesis]]) after violent retching or vomiting, but may also be noticed as old blood in the stool ([[melena]]), and a history of retching may be absent. In most cases, the bleeding stops spontaneously after 24-48 hours, but endoscopic or surgical treatment is sometimes required and rarely the condition is fatal. | ||
=== | |||
===Physical Examination=== | |||
===Laboratory Findings=== | |||
===Imaging Findings=== | |||
===Other Diagnostic Studies=== | |||
Definitive diagnosis is by [[Esophagogastroduodenoscopy|endoscopy]]. | Definitive diagnosis is by [[Esophagogastroduodenoscopy|endoscopy]]. | ||
==Treatment== | ==Treatment== | ||
===Medical Therapy=== | ===Medical Therapy=== | ||
Treatment is usually supportive as persistent bleeding is uncommon. However [[cauterization]] or injection of [[epinephrine]]<ref name="pmid15913474">{{cite journal |author=Gawrieh S, Shaker R |title=Treatment of actively bleeding Mallory-Weiss syndrome: epinephrine injection or band ligation? |journal=Current gastroenterology reports |volume=7 |issue=3 |pages=175 |year=2005 |pmid=15913474 }}</ref> to stop the bleeding may be undertaken during the index endoscopy procedure. Very rarely [[embolization]] of the arteries supplying the region may be required to stop the bleeding. If all other methods fail, high [[gastrostomy]] can be used to ligate the bleeding vessel. It is to be noted that the tube will not be able to stop bleeding as here the bleeding is arterial and the pressure in the balloon is not sufficient to overcome the arterial pressure. | Treatment is usually supportive as persistent bleeding is uncommon. However [[cauterization]] or injection of [[epinephrine]]<ref name="pmid15913474">{{cite journal |author=Gawrieh S, Shaker R |title=Treatment of actively bleeding Mallory-Weiss syndrome: epinephrine injection or band ligation? |journal=Current gastroenterology reports |volume=7 |issue=3 |pages=175 |year=2005 |pmid=15913474 }}</ref> to stop the bleeding may be undertaken during the index endoscopy procedure. Very rarely [[embolization]] of the arteries supplying the region may be required to stop the bleeding. If all other methods fail, high [[gastrostomy]] can be used to ligate the bleeding vessel. It is to be noted that the tube will not be able to stop bleeding as here the bleeding is arterial and the pressure in the balloon is not sufficient to overcome the arterial pressure. | ||
===Surgery=== | ===Surgery=== | ||
Surgical oversewing of the tear is reserved for the occasional bleeding case that is refractory to endoscopic therapy or angiotherapy. | Surgical oversewing of the tear is reserved for the occasional bleeding case that is refractory to endoscopic therapy or angiotherapy. | ||
===Prevention=== | |||
==References== | ==References== | ||
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[[Category:Gastroenterology]] | [[Category:Gastroenterology]] | ||
[[Category:Emergency medicine]] | [[Category:Emergency medicine]] | ||
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{{WikiDoc Sources}} | {{WikiDoc Sources}} | ||
Revision as of 16:14, 30 June 2016
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Mallory-Weiss syndrome refers to bleeding from tears in the mucosa at the junction of the stomach and esophagus, usually caused by severe retching, coughing, or vomiting. It is often associated with alcoholism and eating disorders and there is some evidence that presence of a hiatal hernia is a required predisposing condition.
Historical Perspective
The condition was first described in 1929 by G. Kenneth Mallory and Soma Weiss in 15 alcoholic patients [1].
Classification
Pathophysiology
Causes
Mallory-Weiss syndrome is caused by severe retching, coughing, or vomiting. It is often associated with alcoholism and eating disorders and there is some evidence that presence of a hiatal hernia is a required predisposing condition.
Differentiating Mallory-Weiss syndrome overview from Other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications, and Prognosis
Natural History
Complications
Prognosis
Diagnosis
History and Symptoms
Mallory-Weiss syndrome often presents as an episode of vomiting up blood (hematemesis) after violent retching or vomiting, but may also be noticed as old blood in the stool (melena), and a history of retching may be absent. In most cases, the bleeding stops spontaneously after 24-48 hours, but endoscopic or surgical treatment is sometimes required and rarely the condition is fatal.
Physical Examination
Laboratory Findings
Imaging Findings
Other Diagnostic Studies
Definitive diagnosis is by endoscopy.
Treatment
Medical Therapy
Treatment is usually supportive as persistent bleeding is uncommon. However cauterization or injection of epinephrine[2] to stop the bleeding may be undertaken during the index endoscopy procedure. Very rarely embolization of the arteries supplying the region may be required to stop the bleeding. If all other methods fail, high gastrostomy can be used to ligate the bleeding vessel. It is to be noted that the tube will not be able to stop bleeding as here the bleeding is arterial and the pressure in the balloon is not sufficient to overcome the arterial pressure.
Surgery
Surgical oversewing of the tear is reserved for the occasional bleeding case that is refractory to endoscopic therapy or angiotherapy.
Prevention
References
- ↑ Weiss S, Mallory GK. Lesions of the cardiac orifice of the stomach produced by vomiting. Journal of the American Medical Association 1932;98:1353-55.
- ↑ Gawrieh S, Shaker R (2005). "Treatment of actively bleeding Mallory-Weiss syndrome: epinephrine injection or band ligation?". Current gastroenterology reports. 7 (3): 175. PMID 15913474.