Comfort Care for Refractory Variceal Bleeding — SCE Palliative Medicine MCQ

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ModerateNon-Malignant Palliative CareComfort Care for Refractory Variceal BleedingSCE Palliative Medicine

A 72-year-old man with advanced cirrhosis (Child-Pugh C) and Clinical Frailty Scale 8, previously treated with variceal band ligation, is now too frail for further endoscopy. He has a recurrent variceal haemorrhage. What is the most appropriate palliative management approach?

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Correct answer: A — Comfort-focused care with dark towels, positioning, midazolam for distress if needed, advance discussion of catastrophic haemorrhage plans and prioritising symptom control and dignity

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

For a patient with end-stage liver disease, extreme frailty, and no realistic prospect of haemostatic intervention, UK palliative care guidelines recommend an approach focused on comfort, dignity, and minimising distress. This includes environmental and positioning measures (such as dark towels to conceal blood and reduce visual distress), rapid-acting sedation for catastrophic haemorrhage (such as midazolam if the patient is distressed or agitated), and careful communication with family and team to ensure goals of care are clear. All other interventions (A–C) are inappropriate due to futility and excess harm; force-feeding (E) is not a recognised or recommended approach in this or any palliative scenario.

Reference: Scottish Palliative Care Guidelines – Bleeding (Healthcare Improvement Scotland), https://www.rightdecisions.scot.nhs.uk/scottish-palliative-care-guidelines/palliative-emergencies/bleeding/