November 14, 2024

42-year-old presenting with acute heatemesis

By Med-Challenger · 1 minute read

A 42-year-old man presents with acute hematemesis. The patient has been having retching and vomiting for about 45 minutes before his admission. He is also complaining of epigastric pain. On physical examination, he is tachycardic and hypotensive. Upper endoscopy reveals the presence of mucosal lacerations in the distal esophagus (see Figure).

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Figure.

The most likely condition associated with Mallory-Weiss tears is which of the following?

puerperium
cirrhosis
alcohol use disorder
anorexia

Educational Objective:

Examine alcohol use disorder as a common trigger of Mallory-Weiss tears.

The correct answer is:

alcohol use disorder

Key Point:

Mallory-Weiss tears are acute lacerations of the distal esophageal mucosa caused by severe vomiting and retching. Alcohol use disorder is the most common cause.

Explanation:

The patient has Mallory-Weiss tears. These are acute lacerations of the distal esophageal mucosa as a consequence of retching and severe vomiting. A history of alcohol use disorder is very common as a trigger.

Hyperemesis gravidarum can cause Mallory-Weiss tears during pregnancy, but gastrointestinal symptoms usually resolve after delivery.

Bulimia can be associated with forced vomiting and may also cause Mallory-Weiss lesions (rather than anorexia).

Liver cirrhosis can be associated with esophageal varices rather than Mallory-Weiss tears.

References:

Biecker E. Diagnosis and therapy of non-variceal upper gastrointestinal bleeding. World J Gastrointest Pharmacol Ther. 2015;6(4):172-182.

Tjwa ET, Holster IL, Kuipers EJ. Endoscopic management of nonvariceal, nonulcer upper gastrointestinal bleeding. Gastroenterol Clin North Am. 2014;43(4):707-719.

This question appears in Med-Challenger Internal Medicine Review with CME

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