Mallory-Weiss syndrome differential diagnosis: Difference between revisions

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__NOTOC__
__NOTOC__
{{Mallory-Weiss syndrome}}
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Mallory-Weiss_syndrome]]
{{CMG}} {{AE}} {{DM}}
{{CMG}}; {{AE}} {{DM}}
 
{{PleaseHelp}}


==Overview==
==Overview==
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==Differential Diagnosis==
==Differential Diagnosis==
Mallory-Weiss syndrome must be differentiated from other diseases that cause esophageal ulcers such as:<ref name="pmid7812643">{{cite journal |vauthors=Sutton FM, Graham DY, Goodgame RW |title=Infectious esophagitis |journal=Gastrointest. Endosc. Clin. N. Am. |volume=4 |issue=4 |pages=713–29 |year=1994 |pmid=7812643 |doi= |url=}}</ref>
Mallory-Weiss syndrome must be differentiated from other diseases that cause esophageal ulcers such as:<ref name="pmid7812643">{{cite journal |vauthors=Sutton FM, Graham DY, Goodgame RW |title=Infectious esophagitis |journal=Gastrointest. Endosc. Clin. N. Am. |volume=4 |issue=4 |pages=713–29 |year=1994 |pmid=7812643 |doi= |url=}}</ref>
 
<small>
{|
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! rowspan="2" |Diseases
! rowspan="2" |Diseases
! colspan="7" |History and Symptoms
! colspan="8" |History and Symptoms
! colspan="4" |Physical Examination
! colspan="4" |Physical Examination
! colspan="3" |Laboratory Findings
! colspan="3" |Laboratory Findings
Line 26: Line 24:
!History of medication
!History of medication
!Vomiting
!Vomiting
!History of alcoholism
!Tachycardia
!Tachycardia
!Skin Pallor
!Skin Pallor
!Hypotension
!Hypotension
!Weak pulse
!Weak pulse
!CBC
!Hemoglobin
!Platelets
!Platelets
!BUN
!BUN
Line 41: Line 40:
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | + (with heavy bleeding)
| style="background: #F5F5F5; padding: 5px;" | + (with heavy bleeding)
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| style="background: #F5F5F5; padding: 5px;" | + (with heavy bleeding)
| style="background: #F5F5F5; padding: 5px;" | + (with heavy bleeding)
| style="background: #F5F5F5; padding: 5px;" | + (with heavy bleeding)
| style="background: #F5F5F5; padding: 5px;" | + (with heavy bleeding)
| style="background: #F5F5F5; padding: 5px;" |<math>\downarrow</math>
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |<math>\downarrow</math>
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |<math>\uparrow</math>
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |Tears are usually single and located in the esophagogastric junction, usually extends into the cardia and sometimes into the esophagus
| style="background: #F5F5F5; padding: 5px;" |Tears are usually single and located in the esophagogastric junction, usually extends into the cardia and sometimes into the esophagus
|-
|-
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| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
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| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
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| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
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| style="background: #F5F5F5; padding: 5px;" |Ulcerations are usually in distal esophagus, and maybe irregular and multiple
| style="background: #F5F5F5; padding: 5px;" |Ulcerations are usually in distal esophagus, and maybe irregular and multiple
|}
|}
 
</small>
Mallory-Weiss syndrome must be differentiated from other causes of [[Upper gastrointestinal bleeding]]:<ref name="pmid15173790">{{cite journal |vauthors=Boonpongmanee S, Fleischer DE, Pezzullo JC, Collier K, Mayoral W, Al-Kawas F, Chutkan R, Lewis JH, Tio TL, Benjamin SB |title=The frequency of peptic ulcer as a cause of upper-GI bleeding is exaggerated |journal=Gastrointest. Endosc. |volume=59 |issue=7 |pages=788–94 |year=2004 |pmid=15173790 |doi= |url=}}</ref><ref name="pmid18206878">{{cite journal |vauthors=Enestvedt BK, Gralnek IM, Mattek N, Lieberman DA, Eisen G |title=An evaluation of endoscopic indications and findings related to nonvariceal upper-GI hemorrhage in a large multicenter consortium |journal=Gastrointest. Endosc. |volume=67 |issue=3 |pages=422–9 |year=2008 |pmid=18206878 |doi=10.1016/j.gie.2007.09.024 |url=}}</ref><ref name="pmid21962318">{{cite journal |vauthors=Balderas V, Bhore R, Lara LF, Spesivtseva J, Rockey DC |title=The hematocrit level in upper gastrointestinal hemorrhage: safety of endoscopy and outcomes |journal=Am. J. Med. |volume=124 |issue=10 |pages=970–6 |year=2011 |pmid=21962318 |doi=10.1016/j.amjmed.2011.04.032 |url=}}</ref><ref name="pmid24275716">{{cite journal |vauthors=Wollenman CS, Chason R, Reisch JS, Rockey DC |title=Impact of ethnicity in upper gastrointestinal hemorrhage |journal=J. Clin. Gastroenterol. |volume=48 |issue=4 |pages=343–50 |year=2014 |pmid=24275716 |pmc=4157370 |doi=10.1097/MCG.0000000000000025 |url=}}</ref>
Mallory-Weiss syndrome must be differentiated from other causes of [[Upper gastrointestinal bleeding]]:<ref name="pmid15173790">{{cite journal |vauthors=Boonpongmanee S, Fleischer DE, Pezzullo JC, Collier K, Mayoral W, Al-Kawas F, Chutkan R, Lewis JH, Tio TL, Benjamin SB |title=The frequency of peptic ulcer as a cause of upper-GI bleeding is exaggerated |journal=Gastrointest. Endosc. |volume=59 |issue=7 |pages=788–94 |year=2004 |pmid=15173790 |doi= |url=}}</ref><ref name="pmid18206878">{{cite journal |vauthors=Enestvedt BK, Gralnek IM, Mattek N, Lieberman DA, Eisen G |title=An evaluation of endoscopic indications and findings related to nonvariceal upper-GI hemorrhage in a large multicenter consortium |journal=Gastrointest. Endosc. |volume=67 |issue=3 |pages=422–9 |year=2008 |pmid=18206878 |doi=10.1016/j.gie.2007.09.024 |url=}}</ref><ref name="pmid21962318">{{cite journal |vauthors=Balderas V, Bhore R, Lara LF, Spesivtseva J, Rockey DC |title=The hematocrit level in upper gastrointestinal hemorrhage: safety of endoscopy and outcomes |journal=Am. J. Med. |volume=124 |issue=10 |pages=970–6 |year=2011 |pmid=21962318 |doi=10.1016/j.amjmed.2011.04.032 |url=}}</ref><ref name="pmid24275716">{{cite journal |vauthors=Wollenman CS, Chason R, Reisch JS, Rockey DC |title=Impact of ethnicity in upper gastrointestinal hemorrhage |journal=J. Clin. Gastroenterol. |volume=48 |issue=4 |pages=343–50 |year=2014 |pmid=24275716 |pmc=4157370 |doi=10.1097/MCG.0000000000000025 |url=}}</ref>
*  [[Peptic ulcer|PUD]]
* [[Variceal bleeding|Esophagogastric varices]]
* [[Gastritis|Severe or erosive gastritis/duodenitis]]
* [[Angiodysplasia]]
===Preferred Table===
{|
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! rowspan="2" |Diseases
! rowspan="2" |Diseases
! colspan="4" |History and Symptoms
! colspan="6" |History and Symptoms
!
!
! colspan="4" |Physical Examination
! colspan="4" |Physical Examination
! colspan="4" |Laboratory Findings
! colspan="3" |Laboratory Findings
! rowspan="2" |Other Findings
! rowspan="2" |Upper endoscopy
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
!Finding
!Hematemesis
1
 
!Finding 2
!Epigastric pain
!Finding 3
!Retching
!Finding
!History of alcoholism
4
!Light-headedness
!Physical Finding 1
!history of cirrhosis
!Physical Finding 2
!NSAIDs use
!Physical Finding 3
!''Helicobacter pylori'' infection
!Physical Finding 4
!Tachycardia
!Lab Test 1
!Hypotension
!Lab Test 2
!Skin Pallor
!Lab Test 3
!Weak pulse
!Lab Test 4
!CBC
!Platelets
!BUN
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 1
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Mallory-Weiss syndrome
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | + (with heavy bleeding)
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | + (with heavy bleeding)
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | + (with heavy bleeding)
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | + (with heavy bleeding)
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |<math>\downarrow</math>
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |<math>\downarrow</math>
| style="background: #F5F5F5; padding: 5px;" |<math>\uparrow</math>
| style="background: #F5F5F5; padding: 5px;" |Tears are usually single and located in the esophagogastric junction, usually extends into the cardia and sometimes into the esophagus
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 2
| style="background: #DCDCDC; padding: 5px; text-align: center;" |PUD
| style="background: #F5F5F5; padding: 5px;" |'''↑'''
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | + (with heavy bleeding)
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | + (with heavy bleeding)
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | + (with heavy bleeding)
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | + (with heavy bleeding)
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |<math>\downarrow</math>
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |<math>\downarrow</math>
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |<math>\uparrow</math>
| style="background: #F5F5F5; padding: 5px;" |Discrete mucosal lesions with a punched-out smooth ulcer base with whitish fibrinoid base
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 3
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Esophagogastric varices
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" |↓
| style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | + (with heavy bleeding)
| style="background: #F5F5F5; padding: 5px;" | + (with heavy bleeding)
| style="background: #F5F5F5; padding: 5px;" | + (with heavy bleeding)
| style="background: #F5F5F5; padding: 5px;" | + (with heavy bleeding)
| style="background: #F5F5F5; padding: 5px;" |<math>\downarrow</math>
| style="background: #F5F5F5; padding: 5px;" |<math>\downarrow</math>
| style="background: #F5F5F5; padding: 5px;" |<math>\uparrow</math>
| style="background: #F5F5F5; padding: 5px;" |The varices may be in the esophagus and/or the stomach.
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 4
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Severe or erosive gastritis/duodenitis
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | + (with heavy bleeding)
| style="background: #F5F5F5; padding: 5px;" | + (with heavy bleeding)
| style="background: #F5F5F5; padding: 5px;" | + (with heavy bleeding)
| style="background: #F5F5F5; padding: 5px;" | + (with heavy bleeding)
| style="background: #F5F5F5; padding: 5px;" |<math>\downarrow</math>
| style="background: #F5F5F5; padding: 5px;" |<math>\downarrow</math>
| style="background: #F5F5F5; padding: 5px;" |<math>\uparrow</math>
| style="background: #F5F5F5; padding: 5px;" |Erythema, mucosal erosions, the absence of rugal folds, and visible vessels
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 5
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Angiodysplasia
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | + (with heavy bleeding)
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | + (with heavy bleeding)
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | + (with heavy bleeding)
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | + (with heavy bleeding)
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |<math>\downarrow</math>
| style="background: #F5F5F5; padding: 5px;" |<math>\downarrow</math>
| style="background: #F5F5F5; padding: 5px;" |<math>\uparrow</math>
| style="background: #F5F5F5; padding: 5px;" |small, flat, cherry-red lesions with a fern-like pattern
|}
|}



Latest revision as of 22:21, 7 February 2019

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohamed Diab, MD [2]

Overview

Mallory-Weiss syndrome must be differentiated from other causes of Upper gastrointestinal bleeding such as PUD, Esophagogastric varices, Severe or erosive gastritis/duodenitis, Angiodysplasia.

Differential Diagnosis

Mallory-Weiss syndrome must be differentiated from other diseases that cause esophageal ulcers such as:[1]

Diseases History and Symptoms Physical Examination Laboratory Findings Upper endoscopy
Hematemesis Epigastric pain Light-headedness Retching Heartburn History of medication Vomiting History of alcoholism Tachycardia Skin Pallor Hypotension Weak pulse Hemoglobin Platelets BUN
Mallory-Weiss syndrome + + + (with heavy bleeding) + - - + + + (with heavy bleeding) + (with heavy bleeding) + (with heavy bleeding) + (with heavy bleeding) Tears are usually single and located in the esophagogastric junction, usually extends into the cardia and sometimes into the esophagus
Infectious esophagitis - + - - - - - - - - - - Ulcerations are multiple and usually involve the proximal esophagus
Medication-induced esophagitis - + - - - + - - - - - - Ulcerations are usually singular and deep
Reflux esophagitis - + - - + - - - - - - - Ulcerations are usually in distal esophagus, and maybe irregular and multiple

Mallory-Weiss syndrome must be differentiated from other causes of Upper gastrointestinal bleeding:[2][3][4][5]

Diseases History and Symptoms Physical Examination Laboratory Findings Upper endoscopy
Hematemesis Epigastric pain Retching History of alcoholism Light-headedness history of cirrhosis NSAIDs use Helicobacter pylori infection Tachycardia Hypotension Skin Pallor Weak pulse CBC Platelets BUN
Mallory-Weiss syndrome + + + + + - - - + (with heavy bleeding) + (with heavy bleeding) + (with heavy bleeding) + (with heavy bleeding) <math>\downarrow</math> <math>\downarrow</math> <math>\uparrow</math> Tears are usually single and located in the esophagogastric junction, usually extends into the cardia and sometimes into the esophagus
PUD +/- + - +/- - - + + + (with heavy bleeding) + (with heavy bleeding) + (with heavy bleeding) + (with heavy bleeding) <math>\downarrow</math> <math>\downarrow</math> <math>\uparrow</math> Discrete mucosal lesions with a punched-out smooth ulcer base with whitish fibrinoid base
Esophagogastric varices + + +/- + + - - + (with heavy bleeding) + (with heavy bleeding) + (with heavy bleeding) + (with heavy bleeding) <math>\downarrow</math> <math>\downarrow</math> <math>\uparrow</math> The varices may be in the esophagus and/or the stomach.
Severe or erosive gastritis/duodenitis + + +/- - - +/- - + (with heavy bleeding) + (with heavy bleeding) + (with heavy bleeding) + (with heavy bleeding) <math>\downarrow</math> <math>\downarrow</math> <math>\uparrow</math> Erythema, mucosal erosions, the absence of rugal folds, and visible vessels
Angiodysplasia + + - - +/- - - - + (with heavy bleeding) + (with heavy bleeding) + (with heavy bleeding) + (with heavy bleeding) <math>\downarrow</math> <math>\downarrow</math> <math>\uparrow</math> small, flat, cherry-red lesions with a fern-like pattern

References

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  4. Balderas V, Bhore R, Lara LF, Spesivtseva J, Rockey DC (2011). "The hematocrit level in upper gastrointestinal hemorrhage: safety of endoscopy and outcomes". Am. J. Med. 124 (10): 970–6. doi:10.1016/j.amjmed.2011.04.032. PMID 21962318.
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