Our topic now, back in the esophagus
is Mallory Weiss Syndrome.
Mallory Weiss Syndrome;
what is your patient doing?
Your patient could be the following: male or female, in
the fashion industry, or high pressure image okay, image.
Maybe a poster child for Vogue.
You know one of these… or maybe a model for Victoria
Secret or model for Calvin Klein would have you. Okay.
Your patient, might be a med
student such as yourself.
Patient may be a law student,
a highly stressful situation.
And every single weekend they find themselves
binge drinking, binge drinking, binge drinking.
So I’ll give you two
major populations here.
Binge drinkers where every weekend, every weekend they’ve
taken high stress exams and such, you know what that is?
But then they have to
find relief, and outlets.
And so therefore, they binge drink every weekend
and when they do so, [gags twice], right?
They’re doing that
quite a bit - retching.
I gave you the fashion industry, high
pressure to maintain image of the
body to the point where psychologically
it becomes very, very draining.
So now they feel guilty about
everything that they’re eating.
They had two fries, they run to the
bathroom, [gags], you get the point.
So there’s quite a bit of increased
pressure in the lumen of the esophagus.
Retching, or maybe vomiting.
When this occurs, then you’re worried about a tear taking
place in your lower portion of your esophagus, posterolateral.
It’s the weakest portion.
This tear is then referred to as
being your Mallory Weiss tear.
Mucosal laceration of the gastroesophageal
junction, accounts for all 10% of your GI bleeds.
That’s pretty high isn’t it?
75% of the cases have history of recent retching, meaning
increased interluminal pressure within the esophagus.
Repeated emesis, emesis, emesis.
Many of your patients
actually have a hiatal hernia.
What does that mean again?
The hiatus at T10 of the diaphragm becomes widened, you have
herniation of the fundus perhaps sliding into the thoracic.
Imagine a lot of bit of retching
and emesis taking place.
in 75% of your cases.
Endoscopic cautery; so now
what do you want to do?
Literally you’re going to go in
there and ‘sew the tear together’.
But the ‘sewing’ will be taking
place through cauterization.
So endoscopy not only is going to give you… will help you
diagnose, but then also here, helps you with management.
Clipping, injection of
epinephrine stops the bleeding.
Mallory Weiss, you might be looking
at vomiting but then it would
be your hematemesis, vomiting up of blood because of a tear.
Keep in mind, this is a
tear and not a rupture.
This is a tear, not a rupture.
Why do I keep repeating that?
Two different diagnoses.
And the prognosis changes completely when you go from
a tear to a… boring a hole through your esophagus.
Why’d I say it like that?
Boerhaave Syndrome is boring a
hole through your esophagus.
Your patient’s dead, high mortality.
Let’s go ahead and look at a
tear here, on upper endoscopy.
On your left, where the arrow’s pointing to would be
literally because of a recent history of a patient who had
body dysmorphic syndrome, who then retched, retched,
retched every time he ate something, resulting in a tear.
You’ll notice around it that there’s
erythema because of the bleeding.
After endoscopic cauterization,
you put the lesion back together.
In other words, you sewed it up.