True about Mallory Weiss tear
MALLORY WEISS SYNDROME is seen in adults with severe prolonged vomiting, causing a longitudinal tear in the mucosa of the stomach at and just below the cardia, leading to severe haematemesis.Violent vomiting often may be due to a migraine or veigo or following a bout of alcohol.* Presents with severe vomiting and later haematemesis, with features of shock. * It is common in one O'clock position.* Only 10% of cases involve lower oesophageal mucosa. Investigations employed mainly includes * Gastroscopy, Hb%, PCV, blood grouping.* During gastroscopy, if the stomach is not inflated properly, 50% cases may be missed.Differential diagnosis -* Bleeding peptic ulcer * Oesophageal varices * Erosive gastritis * Carcinoma stomachTreatment is* Conservative, as it is only a mucosal tear. * Blood transfusion. * IV fluids. * Sedation. * Haemostatic agents like vasopressin.* Endoscopic injection therapy is used if required. * Surgery is rarely required. Ref: SRB's manual of surgery,3 rd ed, pg no 750
Hamman mediastinum
Esophagus perforates at all layers
Auscultation - Crunching sound
Symptoms improves after conservative Mx
G.I.T