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Terlipressin in Variceal Bleeding — SCE Palliative Medicine MCQ

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HardGI SymptomsTerlipressin in Variceal BleedingSCE Palliative Medicine

A patient with a DNAR decision develops suspected acute variceal haemorrhage and has agreed active haemostatic treatment. What pharmacological treatment should begin at presentation?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: ETerlipressin and antibiotics alongside resuscitation and endoscopy

Explanation lettering: E = shown as B · B = shown as C · C = shown as D · D = shown as E

A is correct. NICE recommends terlipressin at presentation for suspected variceal bleeding and prophylactic antibiotics, alongside resuscitation and urgent endoscopic haemostasis. Treatment should not wait for endoscopic confirmation when the presentation is convincing. B neither provides the recommended vasoactive treatment nor urgent endoscopy. C is for portal-hypertension prevention rather than acute resuscitation. D introduces delay and an alternative drug instead of the NICE regimen. E applies only to a specific coagulopathy and is not haemostatic treatment for portal pressure. A DNAR limits CPR; it does not automatically restrict other agreed active treatment.

Reference: NICE CG141: acute upper gastrointestinal bleeding: https://www.nice.org.uk/guidance/cg141/chapter/Recommendations