A 29-year-old pregnant woman has had severe vomiting for the last 2 days. Today, she is vomiting large amounts of blood. Her skin is cool and pale, and she is tachycardic. The EMT should suspect: Select one:
A. esophageal varices.
B. esophagitis.
C. acute pancreatitis.
D. Mallory-Weiss tear.
The correct answer and explanation is:
The correct answer is D. Mallory-Weiss tear.
Explanation:
A Mallory-Weiss tear is a tear in the mucosal lining of the esophagus, typically caused by severe vomiting or retching. This condition is commonly seen in individuals who experience episodes of intense vomiting, and it is particularly relevant in this case because the woman has been vomiting severely for the last two days. The tear occurs at the junction of the stomach and esophagus and can result in significant bleeding, which explains the large amounts of blood in her vomit.
The patient’s other symptoms, such as cool and pale skin, tachycardia, and vomiting blood, suggest hypovolemia, which is consistent with the loss of blood from the tear. When a Mallory-Weiss tear occurs, the bleeding is usually self-limited, but if the tear is large, it can lead to shock and requires immediate medical intervention.
Why the other options are less likely:
- A. Esophageal varices: While esophageal varices also cause vomiting of blood, they are typically associated with liver disease or cirrhosis, neither of which is mentioned in this case. Moreover, varices bleed over a longer period, and the vomiting of blood is usually more gradual.
- B. Esophagitis: Esophagitis can cause discomfort and, in some cases, bleeding, but it is less likely to cause the severe and acute vomiting of large amounts of blood as seen here. Additionally, esophagitis is often associated with reflux symptoms, which are not mentioned.
- C. Acute pancreatitis: Acute pancreatitis typically presents with abdominal pain, nausea, and vomiting, but it does not typically cause vomiting of blood. The primary complication of pancreatitis is systemic inflammatory response syndrome (SIRS) and organ failure, not bleeding from the upper gastrointestinal tract.
Thus, a Mallory-Weiss tear is the most plausible diagnosis based on the patient’s symptoms. Immediate medical care is required to manage the bleeding and prevent further complications.