ROSH Gastrointestinal Practice Exam

After a night of heavy drinking and forceful vomiting, blood-streaked vomiting could indicate which condition?

1. Bleeding esophageal varices

2. Boerhaave syndrome

3. Mallory-Weiss syndrome

4. Ruptured peptic ulcer

The correct answer is: Mallory-Weiss syndrome

Blood-streaked vomiting following a night of heavy drinking and forceful vomiting is indicative of Mallory-Weiss syndrome. This condition arises due to tears in the mucosa at the gastroesophageal junction, which can be precipitated by intense retching or vomiting, commonly associated with excessive alcohol consumption. In Mallory-Weiss syndrome, the tears result from the rapid increase in abdominal pressure during forceful vomiting, leading to the characteristic blood-streaked vomit. Patients often present with hematemesis following episodes of vigorous heaving. The other conditions, while also possible causes of hematemesis, typically present with different clinical features or scenarios. For instance, bleeding esophageal varices usually result from portal hypertension and tend to be associated with more significant blood loss and signs of liver disease. Boerhaave syndrome involves a rupture of the esophagus and presents with severe chest pain and sometimes crepitus due to subcutaneous emphysema, rather than just blood in vomit. Ruptured peptic ulcers can also lead to significant bleeding but usually manifest with more generalized abdominal pain and signs of peritonitis rather than solely presenting as blood-streaked vomit. Therefore, given the context of heavy drinking and the mechanism involved, Mallory