Description Surgical Stomach Esophageal

and Duodenal Procedures, Age > 17 with CC

M allory-Weiss syndrome is a tear or laceration, usually singular and longitudinal, in the mucosa at the junction of the distal esophagus and proximal stomach. Esophageal lacerations account for between 5% and 10% of upper gastrointestinal (GI) bleeding episodes. Approximately 60% of the tears involve the cardia, the upper opening of the stomach that connects with the esophagus. Another 15% involve the terminal esophagus, and 25% involve the region across the epigastric junction. In a small percentage of patients, the tear leads to upper GI bleeding. Most episodes of bleeding stop spontaneously, but some patients require medical intervention. If bleeding is excessive, hypovolemia and shock may result. Esophageal rupture (Boerhaave syndrome) is rare but catastrophic when it does occur. If esophageal perforation occurs, the patient may develop abscesses or sepsis.

The most common cause of Mallory-Weiss syndrome is failure of the upper esophageal sphincter to relax during prolonged vomiting. This poor sphincter control is more likely to occur after excessive intake of alcohol. Any event that increases intra-abdominal pressure can also lead to an esophageal tear, such as persistent forceful coughing, trauma, seizure, pushing during childbirth, or a hiatal hernia. Other factors that may predispose a person to Mallory-Weiss syndrome are esophagitis, gastritis, and atrophic gastric mucosa.

Mallory-Weiss syndrome is not currently thought to have a genetic association, although it has been seen in identical twins.

Mallory-Weiss syndrome, first described in people with alcohol dependence, is now recognized across the life span but is most common in men over the age of 40. In women, hyperemesis gravidarum, which in the first trimester of pregnancy causes persistent nausea and vomiting. There are no known ethnic or racial considerations.

HISTORY. The patient may report a history of retching and vomiting, followed by vomiting bright red blood. Ask the patient about the appearance of the vomitus. Hematemesis has a "coffee-ground" appearance if it is of gastric origin and is often a sign of brisk bleeding, usually from an arterial source or esophageal varices. Ask about passage of blood with bowel movements, either a few hours to several days after vomiting. Although vomiting and retching before the onset of bleeding can be indicative of a Mallory-Weiss tear, some patients with Mallory-Weiss

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