[heights]

So both of these can cause hematemesis and possibly lead to death in alcoholics. How can you differentiate between them based on the question stem/ vignette? Would appreciate some feedback!
Thanks

 

[khanar]

How to differentiate variceal bleeding from Mallory Weiss

This is a common tricky question in the USMLE and it's usually difficult to distinguish.

Always look for clues, they love to give clues in USMLE:

Clues going with Mallory Weiss Tear:

• Sudden onset (like the last few hours)
• Severe retching (very important buzzword), so it's actually the retching and vomiting that produces the tear and the bleeding.
• Patient might be bulimic not alcoholic.
• Usually a trivial problem and requires no treatment.

Clues going with variceal bleeding:

• End-Stage-Liver-Disease (Cirrhosis) Stigmata, such as spider nevi, palmar erythema, ascitis, ..etc
• No immediate warning signs before (I mean no retching or something, it just comes all of a sudden.
• Large volume of bleeding (to the point of shock usually) and a recipe for impending death in alcoholics.

Note that both of them are usually painless vomiting.

The real dilemma is when Mallory Weiss progresses to Boerhaave Syndrome which is like varices is also lethal

 

[sunny]

This is a common tricky question in the USMLE and it's usually difficult to distinguish.

Always look for clues, the love to give clues in USMLE:

Clues going with Mallory Weiss Tear:

• Sudden onset (like the last few hours)
• Severe retching (very important buzzword), so it's actually the retching and vomiting that produces the tear and the bleeding.
• Patient might be bulimic not alcoholic.
• Usually a trivial problem and requires no treatment.

Clues going with variceal bleeding:

• End-Stage-Liver-Disease (Cirrhosis) Stigmata, such as spider nevi, palmar erythema, ascitis, ..etc
• No immediate warning signs before (I mean no retching or something, it just comes all of a sudden.
• Large volume of bleeding (to the point of shock usually) and a recipe for impending death in alcoholics.

Note that both of them are usually painless vomiting.

The real dilemma is when Mallory Weiss progresses to Boerhaave Syndrome which is like varices is also lethal

Hi.. Esophageal varices are "painless" bleeding of submucosal veins in lower one third of esophagus and MW syndrome if painful as u said due to mucosal laceration at the gastroesophageal junction due to severe vomiting. Usually seen in bullimics and alcoholics.

 

[omarm]

In addition to what mentioned above, please notice the following:
- Esophageal varices: although PainLESS, but is life threatening.
- MW syndrome: PAINFUL but almost never life threatening.. so although there will be painful hematemesis from lacerations but it is not life threatening.

Based on UW.
good luck

 

[khanar]

In addition to what mentioned above, please notice the following:
- Esophageal varices: although PainLESS, but is life threatening.
- MW syndrome: PAINFUL but almost never life threatening.. so although there will be painful hematemesis from lacerations but it is not life threatening.

Based on UW.
good luck

Mallory Weiss tear is not painful. The condition might be associated with abdominal pain in small number of patients. Most patients presents with hematemesis after vomiting and/or retching and that's it. Even some patients presents with melena only.

Good luck!

 

[heights]

Thanks for all the feedback everyone! You were all right on...I got a question in my Qbank today about a man who had been vomiting all day and thinks he may have been poisoned, and presents to the ED with hematesis. I got it right this time...it was a Mallory Weiss tear. I think the key for me was the all day vomitting, not very severe, etc.
Thanks!