A 35-year-old man with a history of alcohol use disorder is brought to the ER with hematemesis. Prior to this, he has had three episodes of vomiting. His BP is 110/80 mmHg and pulse is 98/min. He has no jaundice. Lungs are clear to auscultation. Abdomen is soft, non tender, and non-distended. There is no hepatomegaly. Endoscopy shows longitudinal mucosal tears at the gastroesophageal junction. This patient's condition is most likely related to which of the following?

Question

A 35-year-old man with a history of alcohol use disorder is brought to the ER with hematemesis.  Prior to this, he has had three episodes of vomiting.  His BP is 110/80 mmHg and pulse is 98/min.  He has no jaundice.  Lungs are clear to auscultation.  Abdomen is soft, non tender, and non-distended.  There is no hepatomegaly.  Endoscopy shows longitudinal mucosal tears at the gastroesophageal junction.  This patient's condition is most likely related to which of the following?

Quizplus · Accepted Answer

Longitudinal mucosal tears at the esophagogastric-squamocolumnar junction describe Mallory-Weiss syndrome. Most commonly, these tears occur secondary to rapid increase of intraabdominal and intraluminal gastric pressure, as when happens during retching and vomiting. Other precipitating factors include coughing, hiccupping, other repeated abdominal straining, and abdominal trauma. Additionally, hiatal hernias are found in about half of patients with Mallory-Weiss syndrome and are considered a strong predisposing factor. Mallory-Weiss syndrome is very commonly associated with chronic alcohol use. Mallory-Weiss tears can be asymptomatic or can lead to gastrointestinal hemorrhage that manifests as hematemesis. About 10% of all upper gastrointestinal bleeds are from Mallory-Weiss syndrome. The intensity of hemorrhage and amount of blood loss varies widely according to the length and depth of the tears, but is almost never life-threatening. (Choice B) Increased venous pressure is associated with potentially life-threatening hemorrhage from esophageal varices. Esophageal varices occur in patients with cirrhosis who often have other symptoms of chronic liver disease−such as jaundice, spider nevi, palmar erythema, gynecomastia, and a history of chonic alcohol use. Endoscopy is diagnostic. (Choices C and D) Local inflammation plays a role in the development of chronic gastritis and esophagitis. Acid reflux is characteristic of gastrointestinal reflux disease (GERD). Neither condition is known for significant upper GI bleeding. (Choice E) Diminished blood perfusion to the small bowel and colon may result from arterial occlusion by embolus, thrombosis of the venous system, or low cardiac output. Ischemic bowel is the result, and it is a very dangerous condition. Ischemic bowel occurs most often in older patients. Educational objective: Mallory-Weiss tears account for about 10% of cases of upper GI hemorrhage. They occur due to increased intraluminal gastric pressure due to retching, vomiting, or other abdominal straining.

A 35-Year-Old Man with a History of Alcohol Use Disorder