Mallory-Weiss Syndrome Clinical Presentation

Updated: Jun 27, 2016
  • Author: Carmen Cuffari, MD; Chief Editor: Carmen Cuffari, MD  more...
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Presentation

History

Presenting symptoms of Mallory-Weiss syndrome include hematemesis, melena, light-headedness, dizziness, syncope, and abdominal pain.

  • Hematemesis: Hematemesis is the presenting symptom in all patients diagnosed with a Mallory-Weiss tear. [5] The diagnosis does not depend on the amount of hematemesis because it can vary from blood flecks or streaks of blood mixed with gastric contents or mucus to several ounces of bright red bloody emesis. In most children, hematemesis is preceded by one or more episodes of nonbloody emesis; however, hematemesis secondary to a Mallory-Weiss tear has been reported to occur during the first bout of vomiting.

  • Melena: Melena has been reported to occur in as many as 10% of patients who have been diagnosed with a Mallory-Weiss tear.

  • Light-headedness, dizziness, or syncope: Patients with severe vomiting can develop light-headedness or dizziness. These symptoms usually occur secondary to dehydration from the underlying cause of vomiting and are not secondary to blood loss from the Mallory-Weiss tear. Only in rare cases does a Mallory-Weiss tear lead to anemia requiring transfusions.

  • Abdominal pain, dyspepsia: As many as 40% of patients may experience epigastric pain or symptoms of heartburn. These symptoms are often related to the underlying cause of vomiting and not specifically to the Mallory-Weiss tear.

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Physical

No specific physical findings can be linked to the diagnosis of a Mallory-Weiss tear. Physical findings are linked to the underlying disorder causing the vomiting and retching.

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Causes

Many underlying disorders that cause vomiting and retching result in a Mallory-Weiss tear.

  • GI disease

  • Pregnancy: Some women develop hyperemesis gravidarum, a syndrome characterized by persistent severe vomiting and retching, in the first trimester of pregnancy. Gastric dysrhythmias and prolonged small-bowel motility cause the development of hyperemesis gravidarum. Some women lose as much as 10% of their body weight during this period.

  • Hepatitis: Acute inflammation of the liver causes vomiting in 10-20% of patients.

  • Biliary tract disease: Although rare in children, these conditions can cause vomiting typically associated with meals.

  • Renal disease: Vomiting is often associated with diseases affecting the kidneys, including the following:

  • Increased intracranial pressure: Intracranial lesions that cause hydrocephalus or increased intracranial pressure may lead to vomiting in children. Most common causes of hydrocephalus include tumors, cysts, and congenital abnormalities. Other causes of increased intracranial pressure consist of trauma, infections (eg, meningitis), medications, and pseudotumor cerebri.

  • Iatrogenic causes: Complications of endoscopy may cause esophageal tears (< 0.01% in children) and are almost always associated with a patient who is retching or struggling during the procedure. The use of polyethylene glycol lavage, when used for ingestions, severe constipation, or preparation for colonoscopy, may cause severe vomiting.

  • Other causes

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