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home - Oesophagus - Miscellaneous - Mallory Weiss Tears Written by Dr Sebastian Zeki
Nausea and Vomiting:
Understands the pathophysiology of vomiting.
Appreciates the gastrointestinal conditions that cause nausea and
vomiting as well as the range of extra-intestinal causes

Recognises the influence of neurological conditions and metabolic
derangements such as diabetes

Understands the physiology of gastric emptying and how this is
affected by disease, toxins and drugs

Abdominal Pain:
Knows the causes of acute and chronic abdominal pain that arise
from upper gastrointestinal, biliary and pancreatic diseases

Understands the clinical presentations of the various conditions
causing pain and the means by which they can be diagnosed and
treated

Weight Loss:
Knows the significance of weight loss as a consequence of upper
gastrointestinal disease, knows those conditions that present with
loss of weight and how they are managed

Skills
Makes a detailed clinical assessment of patients presenting with
symptoms indicating possible upper gastrointestinal disease,
construct a management plan and be aware of the various avenues
of treatment

Behaviours
Evaluates patients in a structured and timely manner, carries out
appropriate investigations and formulates management plan.

Mallory Weiss Tears

Mallory-Weiss syndromePathogenesis Precipitating factors:Vomiting.Straining at stool or lifting.Coughing, epileptic convulsions.Hiccups under anaesthesia.Cosed-chest massage.Blunt abdominal injury.Colonoscopic preparation with polyeth-ylene glycol electrolyte lavage solution.Gastroscopy. Predisposing conditions:Hiatal hernia( in 40-100%).Chronic alcoholism (due to recurrent vomiting).Perhaps increasing age. Endoscopic FeaturesThe tear appears as a red crack sometimes with adherent clot and normal adjacent.Usually heal in 24-48 hours mucosa.Tears are at the GOJ, often within a hiatus hernia.Tears can continue down into the cardia and up into the oesophagus.Lesions can be multiple in 25%. Treatment:Injection therapy of various agents, including epinephrine , ethanol , and other sclerosants- this has been used as monotherapy or in combination with thermal devices.Haemoclips- can be effective.Very occasionally surgery with oversewing of bleeding vessel. Written by Dr Sebastian Zeki

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