Esophageal Varices vs Mallory-Weiss Tear
Esophageal Varices and Mallory-Weiss Tear are easy to mix up on the boards. Here's a side-by-side comparison — presentation, workup, imaging, and first-line treatment — drawn from our full outlines.
Esophageal Varices vs Mallory-Weiss Tear at a glance
- Esophageal Varices: Dilated submucosal esophageal veins from portal hypertension; high-risk source of upper GI bleeding.
- Mallory-Weiss Tear: Longitudinal mucosal tear at the gastroesophageal junction following retching or vomiting, producing hematemesis.
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Side-by-side comparison
| Feature | Esophageal Varices | Mallory-Weiss Tear |
|---|---|---|
| At a glance | Dilated submucosal esophageal veins from portal hypertension; high-risk source of upper GI bleeding. | Longitudinal mucosal tear at the gastroesophageal junction following retching or vomiting, producing hematemesis. |
| Classic presentation | Massive painless hematemesis in a known cirrhotic — variceal bleed until proven otherwise.; Asymptomatic until rupture; Hematemesis (frank red blood or coffee-ground); Melena or hematochezia (if brisk); Light-headedness, syncope, fatigue; Symptoms of cirrhosis: jaundice, abdominal distension, confusion (encephalopathy); Hemodynamic… | Hematemesis after nonbloody emesis is the textbook history.; Hematemesis (bright red or coffee-ground) following a bout of nonbloody vomiting or retching; Epigastric or retrosternal pain (less prominent than Boerhaave); Melena if bleeding is significant or delayed presentation; Lightheadedness, syncope if hemodynamically significant;… |
| Workup / key labs | CBC, type and crossmatch (4+ units PRBCs); BMP, LFTs (AST/ALT, bilirubin, albumin), INR, PT/PTT; Lactate, ABG; Blood and ascitic fluid cultures (high risk of SBP); Variceal screening EGD in newly diagnosed cirrhosis (Baveno VII allows deferral if liver stiffness <20 kPa and platelets >150,000); Surveillance EGD every 1-3 yr based on… | Visualization of a longitudinal mucosal tear at the GE junction on EGD.; CBC, BMP, LFTs, coagulation studies, type and screen; BUN/Cr ratio (often elevated in upper GI bleed from absorbed blood); Lactate and lipase if clinical picture is unclear |
| Imaging | Upper endoscopy (EGD) — diagnostic and therapeutic; perform within 12 h of admission for suspected variceal bleed; Abdominal ultrasound with Doppler — confirms cirrhosis, portal vein patency, splenomegaly; CT abdomen if suspect alternative source or portal vein thrombosis; MRE or vibration-controlled transient elastography (FibroScan)… | Upright CXR if any concern for perforation (free air, pneumomediastinum) — must exclude Boerhaave; Upper endoscopy (EGD) — diagnostic and therapeutic; performed within 24 h; CT chest/abdomen if EGD inconclusive or perforation suspected |
| First-line treatment | Resuscitation: 2 large-bore IVs, restrictive transfusion to Hgb ~7 g/dL (avoid over-transfusion — raises portal pressure); Vasoactive agent — octreotide 50 mcg IV bolus then 50 mcg/h × 3-5 days (or terlipressin where available) — START BEFORE EGD if suspected; Prophylactic IV antibiotic — ceftriaxone 1 g daily × up to 7 days (reduces… | Supportive care: IV fluids, transfuse for hemoglobin <7 g/dL (or <8 if cardiovascular disease), correct coagulopathy; IV proton pump inhibitor: pantoprazole 80 mg bolus then 8 mg/h infusion, or intermittent dosing; Antiemetics: ondansetron or metoclopramide to prevent further retching; Most tears (80-90%) stop bleeding spontaneously and… |
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