Mallory-Weiss tears are superficial esophageal erosions that may cause a GI bleed. They usually are seen with vomiting and retching (alcoholics and bulimies). Diagnosis and treatment are done endoscopically (sclerose any bleeding vessels). Boerhavc's tears are full-thickness esophageal ruptures; if not iatrogenic (from endoscopy), they are usually due to vomiting or retching (alcoholics and bulimics). Diagnose with endoscopy or barium enema, and treat with immediate surgical repair and drainage.
Note: With suspected GI perforation, never use barium (winch may cause chemical peritonitis). Use water-soluble contrast instead (e.g., Gastrografin). The exception is esophageal perforation because the lungs tolerate barium well but develop chemical pneumonitis from water- soluble contrast.
Gastrointestinal malformations seen, in children: (see table, top of next page)
Tracheoesophageal fistula: the most common variant (85% of cases) has esophageal atresia with a fistula front the bronchus to the distal esophagus (hence, gastric distention; each breath transmits air to the GI tract). Be. able to recognize a sketch, of this most common variant.Treat carii of the following conditions with surgical repair.
Transesophageal'; i .stub :
VOMIT JJESeSIPyiON Noubilioits,. projects te
■ M >>'F; palpable oiiye-shapeil'mass in.epigastrium, low . pot-as« tim,'metabolic alkalosis
■ "Double-bubfelí" fiign, Pów'n syndrome. ■
" Respiratory cbrtfproinise wiUvieedipg', aipirai-iiiii . .pneunionk,1 inability to pass nasogastric tube, gastric, disit-ntiom (air) '
. Abdominal distention; obstipation, gavigto seen on. . rectal biopsy, M >> F ■
. Cyanosis with feeding, 'relieved by crying; inability to pass .'nasogastric, tube
Other gastrointestinal conditions in children:
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