Boerhaave's syndrome vs Mallory–Weiss syndrome
Boerhaave's syndrome
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Mallory–Weiss syndrome
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Site : Lower thoracic oesophagus
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Site: Vertical tear in cardia of stomach , may extend to distal
oesophagus.
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There is vertical perforation, and all gastric content goes into
mediastinum.
No history of foreign body.
Mackler's triad may be seen :
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Mucosa and submucosa are involved, NOT a complete perforation.
Presentation : Hematemesis (Not pain) |
Reason : Vomiting / Retching against closed cricopharynx. i.e
barotrauma
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Reason : Vomiting , Increased LES (Lower esophageal sphincter) pressure. – can cause tear.
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Sign : Air in mediastinum
Hamman’s Sign (seen with any
cause of pneumomediastinum.) – On auscultation , because of air around heart.
Investigation of Choice : Water soluble contrast study ( DO NOT USE
BARIUM)
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Diagnosis : Upper GI endoscopy.
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Treatment : Immediate surgery
(via LEFT thoracotomy )
If >24-48 hrs – Let heal with secondary intention , do not suture
, Just put a drain.
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Treatment : Conservative (95 % cases)
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MedicoNotebook - Founder : DrShiviMudgal , Co-Founder : DrAyushGoel
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