SUBMITTED BY – GADDAM TEJASWINI

DOCTOR OF PHARMACY-4th YEAR

16Z91T0011
SUBMITTED TO- DR.B.HEPSHIBHA
DEPT. OF CLINICAL PHARMACY
Mallory–Weiss syndrome
 Mallory–Weiss syndrome or gastro-
esophageal laceration syndrome refers to
bleeding from a laceration in the mucosa at
the junction of the stomach and esophagus.
The syndrome presents with hematemesis.
PATIENT DETAILS:-
 NAME – ABCD
 AGE – 75 Years
 GENDER - Male
 WEIGHT – 65 Kgs
 IP NO. – ASIP190000661
 DOA – 23/09/2019
REASONS FOR ADMISSION :
 C/O – Hematemesis (3 to 4 episodes in
last 24 hrs) , malena
 H/O – large hiatus hernia, 2 deep linear
ulcers @ Z line , parkinsonism ,
hypertension, diabetics mellitus
 PMHx :

T.Gluconorm SR 500 mg – DM-type

II
T.Met XL – trio 25mg – hypertension
T.Minipress XL 5mg - hypertension
T.Tegrital – 200 mg – trigeminal
neuralgia
T.Clopitab 75mg - antiplatelet
 Diet – mixed
 Allergies – not significant
 SHx – not significant
 Social Hx – smoker- 10 yrs
 General examination
 Patient conscious and mild disorientation
 Gait – Shuffling gait with tendency to fall
forward and backward
 Temp – 98.6 F
 Pulse – 112 / min
 BP – 170 / 11o mmHg
 RESP – 22
 SP02 – 100%
 CVS – S1
Advice
 Complete blood picture
 Troponin T
 Kidney function test
 Blood glucose
 2 D Echo Doppler
 Endoscopy
 USG
 ECG
 COMPLETE BLOOD PICTURE
COMPONENTS REFERENCE 23/09 24/09 25/09 26/09

HEMOGLOBIN 13-17 g/dl 8.8 7.5 7.8 9.3

RBC 4.5 – 5.5 million /mm3 2.7 2.3 2.5 2.9

PCV 40- 50% 25 21 22 26

WBC 4000 – 10000 cells/ 16400 13400 13400 12900

mm3
NEUTROPHILS 40-80% 85 85 84 84

LYMPOCYTES 20-40% 10 10 10 10

MCHC 32-35 g/dl 30 30 31 35

COMPONENTS REFERENCE 23/09 24/09 25/09

Blood urea 13 – 43 mg/dl 126 58 26

Creatinine 0.7 – 1.3 mg/dl 1.1 0.7 0.7

Na+ 136 – 145 mEq/L 135 139 134

k+ 3.5 – 5.1 mEq/L 4.9 3.5 3.7

cl- 98-107mEq/L 100 103 98

Total proteins 6-8g/dl 5.4

Albumin 3.5 – 5.2 g/dl 3.3

Globulin 2.3 – 3.5g/dl 2.1

COMPONENT REFERENCE VALUE
TROPONIN((HIGH 11.2mg/ml 0-14
SENSITIVE)
COMPONENT REFERENCE VALUE
HbA1C >6.5 diabetic 5.4%
Fasting blood 80-120mg/dl 163
glucose
 LIPID PROFILE
COMPONENT REFERENCE VALUE

TOTAL <200mg/dl 120mg/dl

CHOLESTEROL
HDL <40 POOR 27mg/dl
DIRECT LDL <100 – for diabetes 69mg/dl
and heart
VLDL 2-30 mg/dl 24mg/dl
CHOLESTEROL
TRIGLYCERIDES Less than 15 normal 118mg/dl
 USG – Hepatomegaly with fatty infiltration,
cholelithiasis, thick walled UB with BPM
 2-D ECHO DOPPLER - Gr – 1 Lv diastolic
dysfunction
 ENDOSCOPY – Large hiatus hernia, Mallory
Weiss tear
 TREATMENT
 DAY 1
DRUG DOSE ROUTE FREQENCY

INJ. MONOCET Igm Iv 1-0-1

INJ.NEKSIUM 80mg Iv 0-0-1

INJ.XAMIC 500mg iv 1-1-1

INJ.VIT K 10mg iv 0-1-0

INJ.ZOFER 4g iv sos

INJ.LASIX 20mg iv start

TAB.PROLOMET-XL 25mg p/o 0-1-0

TAB.SYNDOPA PLUS 100mg p/o 1-0-1

INJ.TERLYZ WITH 1mg iv stat

100ml
 20 pcv reserved.
 DAY- 2-
ADV- to stop xamic
and to add T.Ropinirole – 0.5mg p/o
0-0-1
to add hinex st with water p/o
3scoops -1-1-1
and add tab.urimax –d p/o 0-1-0
• DAY-3 :- Same
• DAY 4 :- adv to add Duphalac 30ml 0-0-1
GOALS OF THE TREATMENT:
• To relieve signs and symptoms (malena,
Hematemesis )
• To prevent further complications
• Maintain overall quality of life
• Reduce tremor
• Reverse slowed movements.
• Improve posture, gait, balance, speech, and
writing skills.
• Improve mobility and function.
• minimizing medication side effects
• to remove the hernia sac and close the
abnormally wide esophageal hiatus
MONITORING PARAMETERS
 Blood pressure
 Diabetes mellitus
 Adr’s
 Complete blood picture
 movement
PATIENT COUNSELLING:-
 About the disease:
Signs and symptoms
Prognosis
Complications
 About the medication
Medication adherence(dose, frequency)
Adr’s
 About the life style modification
Quit smoking