Laceração de Mallory-Weiss
Summary
Definition
History and exam
Key diagnostic factors
- hematêmese
Other diagnostic factors
- vertigem/tontura
- hipotensão postural/ortostática
- disfagia
- odinofagia
- dor
- melena
- hematoquezia
- choque
- sinais de anemia
Risk factors
- afecções que predispõem ao esforço para vomitar, vômitos e/ou esforços
- tosse crônica
- hérnia hiatal
- esforço para vomitar durante endoscopia ou outra intervenção
- consumo significativo de bebidas alcoólicas
- instrumentação prévia
- idade entre 30 e 50 anos
- sexo masculino
- uso de aspirina ou outros anti-inflamatórios não esteroidais
- soluços
- trauma abdominal contuso
- ressuscitação cardiopulmonar
Diagnostic tests
1st tests to order
- Hemograma completo
- ureia
- creatinina e eletrólitos
- testes da função hepática
- tempo de protrombina (TP)/razão normalizada internacional (INR)
- tempo de tromboplastina parcial (TTP)
- prova cruzada/tipagem sanguínea
- endoscopia digestiva alta (EDA) flexível
Tests to consider
- tomografia computadorizada (TC) do tórax
- radiografia torácica
- angiografia
Treatment algorithm
todos os pacientes
Contributors
Authors
Douglas G. Adler, MD, FACG, AGAF, FASGE
Professor of Medicine
Center Director
Center for Advanced Therapeutic Endoscopy (CATE)
Advent Health
Porter Adventist Hospital
Denver
CO
Disclosures
DGA is a consultant for Merit Medical, Cook Endoscopy, Olympus America, and Boston Scientific.
Acknowledgements
Dr Douglas Adler would like to gratefully acknowledge Dr Shilpa Reddy and Dr Juan Carlos Munoz, the previous contributors to this topic.
Disclosures
SR and JCM declare that they have no competing interests.
Peer reviewers
Joseph Sung, MD
Professor of Medicine
Department of Medicine and Therapeutics
Director
Institute of Digestive Disease
The Chinese University of Hong Kong
Hong Kong
Disclosures
JS declares that he has no competing interests.
Imtiyaz Mohammed, MD
Consultant Gastroenterologist
Sandwell General Hospital
Lyndon
West Bromwich
UK
Disclosures
IM declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Alali AA, Barkun AN. An update on the management of non-variceal upper gastrointestinal bleeding. Gastroenterol Rep (Oxf). 2023 Mar 20;11:goad011.Full text Abstract
Laine L, Barkun AN, Saltzman JR, et al. ACG clinical guideline: upper gastrointestinal and ulcer bleeding. Am J Gastroenterol. 2021 May 1;116(5):899-917.Full text Abstract
Barkun AN, Almadi M, Kuipers EJ, et al. Management of nonvariceal upper gastrointestinal bleeding: guideline recommendations from the International Consensus Group. Ann Intern Med. 2019 Dec 3;171(11):805-22.Full text Abstract
American College of Radiology. ACR appropriateness criteria: nonvariceal upper gastrointestinal bleeding. 2024 [internet publication].Full text
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Esofagite
- Perfuração espontânea do esôfago (síndrome de Boerhaave)
- Erosões de Cameron
More DifferentialsGuidelines
- ACR appropriateness criteria: nonvariceal upper gastrointestinal bleeding
- Management of anticoagulants and antiplatelets during acute gastrointestinal bleeding and the periendoscopic period
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