A male client with extreme weakness, pallor, weak peripheral pulses, and disorientation is admitted to the emergency department. His wife reports that he has been “spitting up blood.” A Mallory-Weiss tear is suspected, and the nurse begins taking the client’s history from the client’s wife. The question by the nurse that demonstrates her understanding of Mallory-Weiss tearing is:
A. “Tell me about your husband’s alcohol usage.”
B. “Is your husband being treated for tuberculosis?”
C. “Has your husband recently fallen or injured his chest?”
D. “Describe spices and condiments your husband uses on food.”
Correct Answer: A. “Tell me about your husband’s alcohol usage.”
A Mallory-Weiss tear is associated with massive bleeding after a tear occurs in the mucous membrane at the junction of the esophagus and stomach. There is a strong relationship between ethanol usage, resultant vomiting, and a Mallory-Weiss tear. Mallory-Weiss tears account for an estimated 1-15% of cases of upper gastrointestinal bleeding. Although the age range varies widely, affected individuals are generally in middle age (40s-50s), and men reportedly have a higher incidence than women by a ratio of 2-4:1.
Option B: The bleeding is coming from the stomach, not from the lungs as would be true in some cases of tuberculosis. The presence of a hiatal hernia is a predisposing factor and is found in 35-100% of patients with Mallory-Weiss tears. During retching or vomiting, the transmural pressure gradient is greater within the hernia than the rest of the stomach, and it is the location most likely to sustain a tear
Option C: A Mallory-Weiss tear doesn’t occur from chest injuries or falls. Precipitating factors include retching, vomiting, straining, hiccupping, coughing, primal scream therapy, blunt abdominal trauma, and cardiopulmonary resuscitation. In a few cases, no apparent precipitating factor can be identified. One study reported that 25% of patients had no identifiable risk factor.
Option D: A Mallory-Weiss tear isn’t associated with eating spicy foods. Mallory-Weiss tears are usually associated with other mucosal lesions. In one study, 83% of patients had additional mucosal abnormalities potentially contributing to bleeding or actually causing retching and vomiting that would induce these tears.
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