Posted by sinagayusuf pada 28/04/2009
Mild to massive and usually painless bleeding due to a tear in the mucosa or submucosa of the cardia or lower esophagus characterizes Mallory-Weiss syndrome. Such a tear, usually singular and longitudinal, results from prolonged or forceful vomiting. About 60% of these tears involve the cardia; 15%, the terminal esophagus; and 25%, the region across the esophagogastric junction. Mallory-Weiss syndrome is most common in men older than age 40, especially alcoholics.
The direct cause of a tear in Mallory-Weiss syndrome is forceful or prolonged vomiting, probably when the upper esophageal sphincter fails to relax during vomiting. This lack of sphincter coordination is more common after excessive intake of alcohol. Other factors and conditions that may also increase intra-abdominal pressure and predispose to esophageal tearing include coughing, straining during bowel movements, trauma, seizures, childbirth, hiatal hernia, esophagitis, gastritis, and atrophic gastric mucosa.
CLINICAL TIP à Patients with portal hypertension are at a higher risk for continuous or recurerrent bleeding. Monitoring for signs of hemorrhage is advised.
Signs and symptoms
Typically, Mallory-Weiss syndrome begins with the vomiting of blood or the passing of large amounts of blood rectally a few hours to several days after normal vomiting. This bleeding, which may be accompanied by epigastric or back pain, may range from mild to massive but is generally more profuse than in esophageal rupture.
In patients with Mallory-Weiss syndrome, the blood vessels are only partially severed, preventing retraction and closure of the lumen. Massive bleeding – most likely when the tear is on the gastric side, near the cardia – may quickly lead to fatal shock.
Identifying esophageal tears by fiberoptic endoscopy confirms Mallory-Weiss syndrome. These lesions, which usually occur near the gastroesophageal junction, appear as erythematous longitudinal cracks in the mucosa when recently produced and as raised, white streaks surrounded by erythema when older. Other helpful diagnostic measures include the following:
Angiography (selective celiac arteriography) can determine the bleeding site but not the cause; this is used when endoscopy isn’t available.
Gastrotomy may be performed at the time surgery
Hematocrit helps quantify blood loss.
Appropriate treatment varies with the severity of bleeding. Usually, GI bleeding stops spontaneously, requiring supportive measures and careful observation but no definitive treatment. However, if bleeding continues, treatment may include:
- Angiographic infusion of a vasoconstrictor (vasopressin) into the superior mesenteric artery or direct infusion into a vessel that leads to the bleeding artery.
- Transcatheter embolization or thrombus formation with an autologous blood clot or other hemostatic material (insertion of artificial material, such as a shredded absorbable gelatin sponge or, less commonly, the patient’s own clotted blood through a catheter into the bleeding vessel to aid thrombus formation).
- Surgery to suture each laceration (for massive recurrent or uncontrollable bleeding).
- Evaluate respiratory status, monitor arterial blood gas measurements, and administer oxygen as necessary.
- Assess the amount of blood loss, and record related signs, such as hematemesis and melena (including color, amount, consistency, and frequency).
- Monitor hematologic status (hemoglobin level, hematocrit, red blood cell count). Draw blood for coagulation studies (prothrombin time, partial thrombloplastin time, and platelet count) and typing and crossmatching.
- Try to keep three units of matched whole blood on hand at all times. Until blood is available, insert a large-bore (14G to 18G) I.V. line, and start a temporary infusion of normal saline solution.
- Monitor the patient’s vital signs, central venous pressure, urine output, and overall clinical status.
- Avoid giving the patient medications that may cause nausea or vomiting. Administer an antiemetic, as necessary, to prevent postoperative retching and vomiting.
- Advise the patient to avoid alcohol, aspirin, and other irritating substances.
Taken from “Handbook of DISEASES” Third Edition, Lippincott Williams & Wilkins
Maaf klo isinya in english…Tapi klo perlu versi indonesianya hubungin aja saya…nti saya bantu translate sebisanya ^^
S’moga bisa sedikit menambah pengetahuan teman2 🙂