If we talk about Digestive Hemorrhage, the area of Surgery makes feasts with Mallory-Weis Syndrome. And today, it is time for us to understand it in a simple way to learn.
But, first things first:
What are Digestive Hemorrhages?
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The literature points out that digestive hemorrhages are a form of hemorrhage that can occur along the entire gastrointestinal tract, from the esophagus to the rectum. And regardless of the amount of blood, its micro or macroscopic visibility, or its anatomical location, there are classifications that will allow us to separate all these hemorrhagic expressions in order to know how to direct the most accurate diagnosis, to achieve a prompt and frank recovery.
In the midst of all this, it is necessary to take into account the presence of signs that lead us to this effective diagnosis. Among them, we have certain semiological expressions such as:
a) Hematemesis: Presence of blood in vomiting.
b) Melenas: Black fecal matter, fetid, product of the degradation of Hemoglobin in Hematin and the action of the enteric microbial flora.
c) Enterorrhagia: intestinal hemorrhage.
And the list could go on. With these clinical specifications, we guide the study of the disease and allow ourselves to make its main divisions, which are in accordance with their anatomical location, being them High Digestive Hemorrhage and Low Digestive Hemorrhage. This differentiation will talk about clinical, diagnostic methods, prognosis, treatment and evolution of the disease.
Now, when we talk about Mallory-Weis Syndrome, we are talking about a High Digestive lesion due not only to the clinic, but also to its anatomical location. Well, the high hemorrhages enclose everything that goes from the pharynx to the duodenojejunal angle (or Treitz angle); and this, our pathology under study, is located between these regions.
Mallory-Weis syndrome
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Now, understanding that pathophysiological basis, we only need to understand that upper digestive hemorrhages are externalized through hematemesis and melena.
These signs are present in the patients who, prior to a (classic) sudden increase in abdominal pressure produced by vomiting, suffer a longitudinal penetrating lesion of the lower esophagus. All this is preceded by nausea, not hematic vomiting, and gastroesophageal reflux.
This type of abdominal pressure injuries are traumas that represent 17% of the causes of High Digestive Hemorrhages; and, although it may not always have melenas, its clinic is usually quite florid and evident at endoscopy, which can range from a clean laceration to an active vessel tear (persistent hemorrhage).
As I said, the Surgery service makes a feast of these cases, cases of a stomach tear due to vomiting. However, the treatment will not always be surgical. Angiographic treatments, with intra-arterial infusions of vasopressin or embolus formers, are first-line when the adjunct doctor believes it is possible to free a poor patient from the pavilion's beds.
Referencias Bibliográficas
«Bleeding in the Digestive Tract». 17 de septiembre de 2014.
Sanchez, Alejandro. Algoritmo Hemorragia Digestiva Superior. Mayo 17, 2015.
Norton J. Greenberger, MD, Clinical Professor of Medicine, Harvard Medical School; Senior Physician, Brigham and Women's Hospital. Hemorragia Digestiva
Galindo, Fernando. Hemorragia Digestiva. Director de Carrera y Profesor de Cirugía. Gastroenterológica en la Universidad Católica. Argentina, Bs. As.
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