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a pattern of symptoms indicative of some disease
a complex of concurrent things; "every word has a syndrome of meanings"
any of several imperial dynasties of China ruling from 220 to 265 and from 386 to 556 (同)Wei dynasty

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(疾患の徴候となる一群の)症徴候,症候群 / (事件・社会的状態などのパターンを示す)徴候形態

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/05/08 22:39:15」(JST)

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Mallory–Weiss syndrome or gastro-esophageal laceration syndrome refers to bleeding from tears (a Mallory-Weiss tear) in the mucosa at the junction of the stomach and esophagus, usually caused by severe alcoholism, retching, coughing, or vomiting.

Causes

It is often associated with alcoholism^[1] and eating disorders and there is some evidence that presence of a hiatal hernia is a predisposing condition. Forceful vomiting causes tear of the mucosa at the junction.

NSAID abuse is also a rare association.^{[citation needed]} The tear involves mucosa and submucosa but not the muscular layer (contrast to Boerhaave syndrome which involves all the layers).^[2] The mean age is more than 60 and 80% are men.^{[citation needed]} Hyperemesis gravidarum, which is severe morning sickness associated with vomiting and retching in pregnancy, is also a known cause of Mallory-Weiss tear.^[3]

Presentation

Mallory–Weiss syndrome often presents as an episode of vomiting up blood (hematemesis) after violent retching or vomiting, but may also be noticed as old blood in the stool (melena), and a history of retching may be absent.

In most cases, the bleeding stops spontaneously after 24–48 hours, but endoscopic or surgical treatment is sometimes required and rarely the condition is fatal.there wont be any abdominal pain

Diagnosis

Definitive diagnosis is by endoscopy.

Treatment

Treatment is usually supportive as persistent bleeding is uncommon. However cauterization or injection of epinephrine^[4] to stop the bleeding may be undertaken during the index endoscopy procedure. Very rarely embolization of the arteries supplying the region may be required to stop the bleeding. If all other methods fail, high gastrostomy can be used to ligate the bleeding vessel. It is to be noted that the tube will not be able to stop bleeding as here the bleeding is arterial and the pressure in the balloon is not sufficient to overcome the arterial pressure.

History

The condition was first described in 1929 by G. Kenneth Mallory and Soma Weiss in 15 alcoholic patients.^[5]

References

^ Caroli A, Follador R, Gobbi V, Breda P, Ricci G (1989). "[Mallory-Weiss syndrome. Personal experience and review of the literature]". Minerva dietologica e gastroenterologica (in Italian) 35 (1): 7–12. PMID 2657497.
^ Boerhaave Syndrome at eMedicine
^ Parva M, Finnegan M, Keiter C, Mercogliano G, Perez CM (August 2009). "Mallory-Weiss tear diagnosed in the immediate postpartum period: a case report". J Obstet Gynaecol Can 31 (8): 740–3. PMID 19772708.
^ Gawrieh S, Shaker R (2005). "Treatment of actively bleeding Mallory-Weiss syndrome: epinephrine injection or band ligation?". Current gastroenterology reports 7 (3): 175. PMID 15913474.
^ Weiss S, Mallory GK (1932). "Lesions of the cardiac orifice of the stomach produced by vomiting". Journal of the American Medical Association 98: 1353–5. doi:10.1001/jama.1932.02730420011005.

UpToDate Contents

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1. マロリー・ワイス症候群 mallory weiss syndrome
2. Causes of upper gastrointestinal bleeding in adults
3. 消化管におけるエンドクリップ療法：出血性病変および病変外での出血 endoclip therapy in the gastrointestinal tract bleeding lesions and beyond
4. Approach to upper gastrointestinal bleeding in children
5. ブールハーフェ症候群：食道破裂 boerhaave syndrome effort rupture of the esophagus

English Journal

Characterization of the syndrome of UGI bleeding from a Mallory-Weiss tear associated with transesophageal echocardiography.

Cappell MS1, Dass K, Manickam P.
Digestive diseases and sciences.Dig Dis Sci.2014 Oct;59(10):2381-9. doi: 10.1007/s10620-014-3195-2. Epub 2014 May 18.
AIM: To quantitatively describe the syndrome of Mallory-Weiss tears associated (MWa) with antecedent transesophageal echocardiography (TEE) as a distinct syndrome.METHODS: Cases of MWa were identified by comprehensive, computerized literature search via PubMed and review of textbooks and monographs
PMID 24838497

Management of variceal and nonvariceal upper gastrointestinal bleeding in patients with cirrhosis.

Cremers I1, Ribeiro S2.
Therapeutic advances in gastroenterology.Therap Adv Gastroenterol.2014 Sep;7(5):206-16. doi: 10.1177/1756283X14538688.
Acute upper gastrointestinal haemorrhage remains the most common medical emergency managed by gastroenterologists. Causes of upper gastrointestinal bleeding (UGIB) in patients with liver cirrhosis can be grouped into two categories: the first includes lesions that arise by virtue of portal hypertens
PMID 25177367

Safety and utility of single-session endoscopic ultrasonography and endoscopic retrograde cholangiopancreatography for the evaluation of pancreatobiliary diseases.

Kawakubo K, Kawakami H, Kuwatani M, Haba S, Kudo T, Abe Y, Kawahata S, Onodera M, Ehira N, Yamato H, Eto K, Sakamoto N.
Gut and liver.Gut Liver.2014 May;8(3):329-32. doi: 10.5009/gnl.2014.8.3.329.
Endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) are essential for diagnosing and treating pancreatobiliary diseases. Single-session EUS and ERCP are considered to be essential in reducing the duration of hospital stays; however, complications are a primary conce
PMID 24827632

Japanese Journal

Safety and Utility of Single-Session Endoscopic Ultrasonography and Endoscopic Retrograde Cholangiopancreatography for the Evaluation of Pancreatobiliary Diseases

Gut and Liver 8(3), 329-332, 2014-05
NAID 120005455894

下部消化管内視鏡検査の前処置により特発性食道破裂を発症した1例

日本消化器内視鏡学会雑誌 56(5), 1751-1755, 2014
NAID 130004811790

抜歯後に認められたMallory-Weiss症候群を疑う1例

日本口腔診断学会雑誌 27(3), 295-299, 2014
NAID 130004715635

Related Pictures

★リンクテーブル★

リンク元	「マロリー・ワイス症候群」
関連記事	「syndrome」

「マロリー・ワイス症候群」

Mallory–Weiss syndrome
	Mallory-Weiss tear affecting the esophageal side of the gastroesophageal junction
Classification and external resources
ICD-10	K22.6
ICD-9	530.7
DiseasesDB	7803
MedlinePlus	000269
eMedicine	ped/1359
Patient UK	Mallory–Weiss syndrome
MeSH	D008309

　　[★]

英: Mallory-Weiss syndrome
同: Mallory-Weiss症候群。Mallory-Weiss裂傷？ Mallory-Weiss tears？ Mallory-Weiss lesion Mallory-Weiss laceration

概念

定義：「嘔吐などにより腹腔内圧が急激に上昇して噴門部近傍に裂創が発生し、これを出血源として顕出血をきたしたもの」
頻回かつ激しいの嘔吐により粘膜裂傷を生じこれにより吐血する病態。
胸腔内圧の上昇により食道胃接合部付近に粘膜下層までの裂創を来たす。裂創は噴門部小弯部に好発する。
典型的には激しい嘔吐を繰り返し、2回目以降の嘔吐で多量の新鮮血を認めることが多い。
嘔吐を繰り返すどんな病態もMallory-Weiss症候群の引き金となり得る。

頻度

30-50歳代の男性に多く、全消化管出血例の約3-15%を占める。

原因

嘔吐(アルコール多飲、妊娠悪阻、乗り物酔い、脳腫瘍、髄膜炎、内視鏡検査時の嘔吐反射誘発)
咳嗽、くしゃみ、排便、分娩後　→　腹腔内圧および胃食道内圧の上昇

症状

Mallory-Weiss症候群自体で胸痛や腹痛を伴うことは少ない。

検査

上部消化管内視鏡：食道から胃噴門部小弯にかけて縦走する裂創を認める(主に接合部直下の胃側に生じるが、時に接合部をまたいで食道に及ぶことがある)。小弯に次いで後壁に多い。裂創は1-2 条が多く、深さは粘膜に限局することが多い。
胸部レントゲン：縦隔に気腫がないことを確認
胸部レントゲン：縦隔に気腫がないことを確認

分類

I群：胃限局型　→　最も多い
II群：食道、胃併存型
III群：食道限局型

診断

確定診断は胃カメラによる。

鑑別診断

IMD.843

特発性食道破裂(ブールハーフェ症候群)：腹圧の上昇で起こりうる。粘膜壁全層の裂創。食道下部の左側に好発。出血は少ない。胸背部や腹部の激痛、呼吸困難、ショックを来す。基本的に手術療法。
逆流性食道炎
食道静脈瘤破裂
出血性胃潰瘍
急性胃粘膜病変(AGML)

治療

保存的治療でほとんどが自然止血され、再出血することはあまりない。

絶食、点滴、安静、輸血、止血剤投与
止血困難であれば、クリッピング術を施行する。

臨床経過

数日間で白苔を生じ瘢痕化する

国試

097A031

参考

1.

http://vitaminex.exblog.jp/9065112

「syndrome」

　　[★]

n.

症候群

[1] Caroli A, Follador R, Gobbi V, Breda P, Ricci G (1989). "[Mallory-Weiss syndrome. Personal experience and review of the literature]". Minerva dietologica e gastroenterologica (in Italian) 35 (1): 7–12. PMID 2657497.

[Boerhaave-2] Boerhaave Syndrome at eMedicine

[3] Parva M, Finnegan M, Keiter C, Mercogliano G, Perez CM (August 2009). "Mallory-Weiss tear diagnosed in the immediate postpartum period: a case report". J Obstet Gynaecol Can 31 (8): 740–3. PMID 19772708.

[pmid15913474-4] Gawrieh S, Shaker R (2005). "Treatment of actively bleeding Mallory-Weiss syndrome: epinephrine injection or band ligation?". Current gastroenterology reports 7 (3): 175. PMID 15913474.

[5] Weiss S, Mallory GK (1932). "Lesions of the cardiac orifice of the stomach produced by vomiting". Journal of the American Medical Association 98: 1353–5. doi:10.1001/jama.1932.02730420011005.

匿名

検索

案内

案内

Mallory-Weiss syndrome