Mallory-Weiss syndrome differential diagnosis
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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 | CBC | Platelets | BUN | ||
| Mallory-Weiss syndrome | + | + | + (with heavy bleeding) | + | - | - | + | + | + (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 |
| 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]
Preferred Table
| 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
- ↑ Sutton FM, Graham DY, Goodgame RW (1994). "Infectious esophagitis". Gastrointest. Endosc. Clin. N. Am. 4 (4): 713–29. PMID 7812643.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.