Bleeding from a Mallory Weiss tear occurs usually from:
Ans. b. Left gastric artery (Ref: Harrison 19/e p277, 18/e p2436; Sabiston 19/e p1167,1222; Schwartz 9/e p875,941; Bailey 26/e p994,25/e p1065; Shackelford 7/e p768)Bleeding from a Mallory- Weiss tear occurs usually from left gastric artery."Mallory-Weiss tears are characterized by arterial bleeding. Most Mallory-Weiss tears stop bleeding spontaneously and supportive treatment is all that is required. If bleeding continues, infusion of vasoactive substances into the celiac artery or into the left gastric artery often obviates the need for operation. "Mallory Weiss SyndromeMallory-Weiss tears are related to forceful vomiting, retching, coughing, or strainingQForceful contraction of the abdominal wall against an unrelaxed cardia. resulting in mucosal laceration of the proximal cardiaQ as a result of the increase in intragastric pressure.Results in disruption of gastric mucosa high on the lesser curve at cardia (just below GE junction)QResults in disruption of gastric mucosa high on the lesser curve at cardia (just below GE junction)Tear is partial thickness, extending through the mucosa & submucosa0Clinical Features:Classically, seen in alcoholic patientsQ after a period of intense retching and vomiting after binge drinking.Cause of up to 15% of all severe upper G1 bleedsQArterial bleeding, usually painless and are rarelyQ associated with massive bleeding.The overall mortality rate is 3-4%, with the greatest risk for massive hemorrhage in alcoholic patients with preexisting portal hypertensionQ.Diagnosis:Usually diagnosed by historyEndoscopy is used to confirm the diagnosisQ.Most tears occur along the lesser curvatureQ.Treatment:Supportive therapy is often all that is necessary because 90% of bleeding episodes are self-limited, and the mucosa often heals within 72 hoursQ.Persistent Bleeding in Mallory Weiss Syndrome is managed byEndoscopic electrocoagulationQ or endoscopic therapy with injectionAngiographic embolizationQSurgery' consists of laparotomy and high gastrotomy with oversewing of the linear tearQ, if above maneuvers fails.Recurrent bleeding from a Mallory-Weiss tear is uncommonQ.Remember: A Sengstaken-Blakemore tube will not stop bleeding in Mallory-Weiss syndrome, as the bleeding is arterial and the pressure in the balloon is not sufficient to overcome the arterial pressure and is contraindicatedQ.
Phrenic vein
Left gastric artery
Short gastric arteries
Coronary vein
Esophageal Perforation