Master Boerhaave Syndrome with Picmonic for Medicine

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Boerhaave Syndrome

Boar-half
Picmonic
Boerhaave syndrome is described by rupture of the esophageal wall, which can be a result of violent retching or iatrogenic injury. It can present with chest pain, subcutaneous emphysema, odynophagia and shock. This is a surgical emergency that requires immediate treatment.
8 KEY FACTS
PATHOPHYSIOLOGY
Esophageal Rupture
Sarcophagus with rupture

In contrast to Mallory-Weiss tears (which are mucosal), Boerhaave syndrome is described by rupture or perforation of the esophagus (through the mucosal and muscular layers).

Increased Esophageal Pressure while Vomiting
Sarcophagus vomiting with increased-pressure

This rupture is caused through a sudden rise of internal esophageal pressure during vomiting, and can stem from excessive food and alcohol intake, or bulimia. Another common cause of this syndrome is iatrogenic perforation.

Lower 1/3 of Esophagus
Lower Third-of-sarcophagus

Most cases of Boerhaave's syndrome occur at the distal (lower-third) esophagus.

SIGNS AND SYMPTOMS
Chest Pain
Chest Pain-bolt

After vomiting, or a procedure, patients may display excruciating retrosternal chest pain, and possibly upper abdominal pain.

Odynophagia
O-dino-fajita

In less evident cases, where Boerhaave's is suspected, the caregiver may find that the patient presents with odynophagia, or painful swallowing of liquids and foods.

Subcutaneous Emphysema
Sub-q-tip M-Fist-Zebra

Though not a very important diagnostic finding, due to its lack of sensitivity, patients with this syndrome can develop subcutaneous emphysema, or crepitus, near the mediastinum.

MANAGEMENT
Shock
Electric-shock

If there is bleeding from the esophageal rupture, patients may go into hypovolemic shock from blood loss.

Surgical Emergency
Emergency Surgeon

This condition is usually a surgical emergency. Due to its high morbidity and mortality, potential for rapid clinical deterioration and fatal outcome without treatment, all patients suspected of having Boerhaave syndrome should have surgical consultation.

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