A Mallory-Weiss tear is a lengthwise tear in the lining where the esophagus meets the stomach, caused by forceful retching or vomiting. It often follows heavy alcohol use, and most bleeds stop on their own within a day or two.
Key symptoms
- Vomiting bright red blood after repeated retching
- Streaks of blood in the vomit
- Mild upper belly or chest discomfort
- Sometimes black stools or lightheadedness
What you find on exam
- Vital signs: heart rate, blood pressure, orthostatic changes
- Signs of liver disease that suggest varices instead
- Abdomen usually soft
- Feel for air under the skin of the neck (points to esophageal rupture)
Tests
- Blood count, type and crossmatch, coagulation tests
- BUN, creatinine and liver tests
- Glasgow-Blatchford score to estimate risk
- Upper endoscopy within 24 hours to confirm and treat
Treatment basics
- Two large IV lines, fluids, and transfusion if hemoglobin is under 7
- Proton pump inhibitor IV or by mouth
- Antiemetics such as ondansetron to stop the retching
- Endoscopic clips or epinephrine injection for active bleeding
- Address alcohol use and the cause of vomiting
Red flags
- Ongoing large-volume bleeding or signs of shock
- Severe chest pain, fever or crackling in the neck (Boerhaave rupture)
- Known cirrhosis, where varices may be the source
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Sources: NASEMSO National Model EMS Clinical Guidelines; NCCPA PANCE Content Blueprint; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.