Mallory-Weiss Syndrome Workup
- Author: Carmen Cuffari, MD; Chief Editor: Carmen Cuffari, MD more...
No specific laboratory tests are indicated for determining the etiology of a Mallory-Weiss tear.
- Obtain a CBC count to determine the severity of bleeding.
- Coagulation parameters should be assessed.
No specific imaging studies exist that can positively identify an esophageal tear. Several retrospective studies have demonstrated that barium esophagraphy may reveal small esophageal hematomas or thick streaks where the barium becomes trapped in the tear. However, only 20% of patients with a Mallory-Weiss tear had positive radiologic findings, and, in all cases, an upper endoscopy was performed for definitive diagnosis.
See the list below:
- Upper endoscopy is the diagnostic tool for esophageal tears.
- Visual inspection of the esophagus, stomach, and duodenum is essential in the evaluation of a child presenting with hematemesis.
- The hallmark of a Mallory-Weiss tear is the visual appearance of one or more linear bleeding lesions at or just proximal to the esophagogastric junction.
- Perform endoscopy within 24 hours of the bleeding episode.
- Tears visualized within 24 hours usually have a soft, fresh, mounded, brownish-red appearance on the surface of the mucosa.
- After 48-72 hours, the tear looks like a mucosal cleft that may be surrounded by erythematous mucosa.
- By 96 hours, most Mallory-Weiss lesions are well-healed and may be difficult to visualize.
- In cases of severe bleeding with hemodynamic instability, the patient should be stabilized prior to performing endoscopy.
- Mallory-Weiss tears can heal quickly after the cessation of vomiting and retching and may not be diagnosed if performance of the upper endoscopy is delayed.
Predictive factors for recurrent bleeding include the following:
- Initial presentation of shock: In a study of 159 patients treated for Mallory-Weiss tears with recurrent bleeding post therapy were in shock at initial manifestation and had active bleeding on endoscopic evaluation.
- Liver cirrhosis
- Decreased hemoglobin and platelet count: In a study of 93 patients who were managed for Mallory-Weiss tears, 9 had a fatal outcome. In that study, multivariant analysis showed that advanced age, a low hemoglobin level at clinical presentation, and the presence of tarry stool were associated with an increased risk of dying.
- Need for blood transfusion
- Intensive care management
- Active bleeding noted at the time of endoscopy
Future studies are necessary to validate these clinical observations, and they may perhaps lead to the development of a measure tool for clinical risk among patients presenting with Mallory-Weiss tears.
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