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 mallory wiess syndrome vs boerhaave's  

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Author9 Posts

Can anybody differentiate both ?


Boerhaave is excessive forceful vomiting which may lead to esophageal rupture.

Mallory-Wiess is a result of alcohol intake leading to bleeding of esophageal vessels,and probably hematemesis.



but what is the cause for boerhaaves ?


Boerhaave's Syndrome
Usually in men, although neonatal esophageal rupture occurs primarily in girls
Associated with the clinical triad of vomiting, chest pain and subcutaneous/mediastinal emphysema
In neonates, there is cyanosis and dyspnea associated with a right tension pneumothorax immediately after birth
In Boerhaave’s, the inciting cause may be vomiting, straining, childbirth or a blunt blow to the abdomen or thorax
Tears are vertically oriented, 1-4 cm in length
Almost all (90%) occur along the left posterolateral wall of the distal esophagus
X-ray: Mediastinal emphysema, Left pleural effusion, Mediastinal widening, Subcutaneous emphysema, Nacleiro sign [a V-shaped radiolucency seen through the heart representing air in the left lower mediastinum that dissects under the left diaphragmatic pleura]
In neonatal rupture, pneumomediastinum is uncommon
Diagnosis: First use a water-soluble contrast agent (Gastrografin, oral Hypaque) If no perforation is found, then barium may be used


mallory-weiss and Boerhaave both can be caused by forceful vomiting for whatever reason,

the difference is that in mallory-weiss the tear is mucosal and patient present with upper gi bleed

and in Boerhaave's esophagus is perforated through all layers, which basically leads to mediastinitis, which is potentially lethal, and manifests with very severe substernal pain initially and then fever and leucocytosis etc..


thanks to all of you smiling face


good points


and oh, the typical USMLE question for boerhave's is the case of a bulimic pt or alcoholic.

And when the doctor places the sthetoscope on the pt's chest, he'll hear a crunching sound (Hamman's mediastinal crunch) that results from air dissecting subq???? (subq emphysema) since the lower portion of esophagus has been torn completely (all 3 layers).


yes Boerhaave is the transmural tear with the subcutaneous emphysema and Mallory weiss tear is the longitudinal tera in the mucosa of the esophagus....nodnod

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