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Active Treatment of Variceal Bleeding in Palliative Patient — SCE Palliative Medicine MCQ

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ModerateNon-Malignant Palliative CareActive Treatment of Variceal Bleeding in Palliative PatientSCE Palliative Medicine

A 68‑year‑old man with advanced hepatocellular carcinoma and portal hypertension develops acute variceal bleeding. He is on the palliative care register but is currently reasonably well (ECOG 2). Should the bleeding be treated actively?

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

Reveal the answer and explanation

Correct answer: D — Yes—acute variceal bleeding is a treatable emergency even in palliative patients; active treatment (resuscitation, vasoactive drugs, endoscopic banding) may restore his function

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

Acute variceal bleeding is a medical emergency that warrants active management even in palliative patients with preserved performance status (ECOG 2). NICE CG141 recommends offering vasoactive drugs (e.g. terlipressin), prophylactic antibiotics, and urgent endoscopic band ligation to arrest bleeding. Palliative care principles support interventions that are reversible and maintain quality of life. Option A is incomplete (omits vasoactive treatment and endoscopy); C is inappropriate as first‑line (surgery is for failures or rescue); D and E conflict with palliative philosophy and UK guidance. Option B aligns with best practice.

Reference: NICE CG141: Acute upper gastrointestinal bleeding – recommendations on variceal bleeding (2012, updated 2016), and NICE Quality Standard QS38 (2013), https://www.nice.org.uk/guidance/cg141/chapter/Recommendations