A 26-year-old woman in the first trimester of pregnancy has been admitted with retching and repeated vomiting with large hematemesis. Her pulse rate is 126/minute and blood pressure is 80 mm Hg systolic. The most likely diagnosis is:

Ans. is a, i.e. Mallory-Weiss syndromeRef. Williams 24/e, p 1074Upper gastrointestinal bleeding:"Occasionally, persistent vomiting may be accompanied by worrisome upper gastrointestinal bleeding. The obvious concern is that there is a bleeding peptic ulceration. However, most of these women have minute linear mucosal tears near the gastroesophageal junction. Women with these co called Mallory-Weiss tears usually respond promptly to conservative measures." --Ref. Williams 23/e, p 1053With persistent retching the less common but more serious oesophageal rupture- 'Boerhaave syndrome' may develop.