Violent vomiting after forceful retching present with sudden severe haematemesis. Diagnosis is

C. i.e. (Mallory weiss syndrome) (1016 - B & L 25th) (813 - S. Das 5th)* A history of vomiting followed by either malaena or haemotema suggest Mallory - Weis syndromeMALLORY -WEISS SYNDROME - vigorous vomiting produces a vertical split in the gastric mucosa immediately below the squamo columnar junction at the cardia in 90% of cases.* Two thirds of patients have a hiatus hernia** and alcoholics*** Typically the patients first vomits food and gastric contents. This is followed by forceful retching and then bloody vomitus* Actual rupture of the distal esophagus can also be produced by vomiting (Boerhaave's Syndrome) but the difference seems to depend on vomiting of food in rupture and non productive retching in gastric mucosal tear* Endoscopy is the best diagnostic method, and an actively bleeding tear can be treated endoscopically with epinephrine injection. Coaptive coagulation. Hemoclips or band ligation (1841 -H17th)* Dieulafoy's lesion - also called persistent caliber artery, is seen most commonly on the lesser curvative of the proximal stomach