A Forceful Case of Hematemesis

Explore the case of a 79-year-old woman with Hematemesis and melena after vomiting. Review the diagnosis and management of Mallory-Weiss syndrome.

Tranexamic acid


A 79-year-old woman presented to the emergency department with a 3-day history of hematemesis, melena, and epigastric pain. Approximately 1 day before the onset of symptoms, nonbloody vomiting had developed after she had eaten unrefrigerated food. She was taking aspirin daily for coronary artery disease. Her heart rate was 102 beats per minute, and her blood pressure was 89/66 mmHg. Physical examination was notable for pallor and diaphoresis. Her hemoglobin level was 9.1 g per deciliter (reference range, 11 to 15), a decrease from a baseline level of 12 g per deciliter 6 months previously. Computed tomography of the chest was performed to evaluate for esophageal rupture and showed only a mucosal tear and soft-tissue swelling at the gastroesophageal junction. An upper endoscopy was performed. A diagnosis of Mallory-Weiss syndrome was made. Which of the following would be the LEAST appropriate next step in management for this diagnosis?

What is the most likely diagnosis?

Acid suppression
Anti-emetics
Endoscopic therapy for bleeding
Fluid resuscitation
Tranexamic acid

Endoscopy, Hematemesis, Mallory-Weiss Syndrome, Tranexamic acid, Upper GI Bleed

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