Monday, December 28, 2009

EtOH 1

This week is alcohol week.

A 35 year old alcoholic presents with coffee ground emesis and black tarry stools. "My stomach has been killing me too," he says, "but that's probably from all the vomiting." He notes that when he started vomiting, there was no blood; he only noticed blood after a few hours of retching. He says he's just a binge drinker during the holidays.

Labs show anemia. Upper GI endoscopy shows a hiatal hernia and this:

Challenge: What's your diagnosis?

Image shown under fair use.

4 comments:

tree said...

Mallory-Weiss Tear

Suheil said...

Mallory weiss syndrome? my only other differential is hours ago and be's syndrome.. though since the patient has melena, the condition occured atleast 18 hours ago and a patient of boerhaave's syndrome should have deteriorated by now because of mediastinitis.. i'm really bad at endoscopy so if u dont mind, when you post the reply, could you highlight the site of the lesion in the given image please?

Elden said...

Diverticula, esophageal erosion, ulcer, and some kind of varice. I have no clue hehe I'm still a premed student.

Craig Chen said...

Hi! Yes it's a Mallory-Weiss :). Esophageal erosion is not a bad guess. For the image, you are looking down the esophagus, and the tear is a longitudinal mucosal tear extending from the distal esophagus to the gastric cardia. It is important when you're doing endoscopy to do a retroflexed view of the gastric cardia to make sure you don't miss anything.
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EtOH 1

Mallory-Weiss syndrome is longitudinal mucosal lacerations in the distal esophagus and proximal stomach due to forceful retching leading to bleeding from submucosal arteries.

Source: UpToDate; eMedicine from WebMD.