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Variceal Haemorrhage — RACP Adult Medicine MCQ

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ModerateGastroenterologyVariceal HaemorrhageRACP Adult Medicine

A 55-year-old man with a history of alcohol excess presents with haematemesis and melaena. On examination, he has spider naevi, palmar erythema, and shifting dullness. Upper endoscopy reveals large oesophageal varices with red wale signs. What is the most appropriate acute management?

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Correct answer: C — IV octreotide and endoscopic variceal ligation

Acute variceal bleeding requires a combination of vasoactive therapy (octreotide or terlipressin) and endoscopic variceal ligation (EVL). Octreotide reduces portal pressure and should be started before endoscopy. EVL is the endoscopic treatment of choice (superior to sclerotherapy). Antibiotics (ceftriaxone) should also be given.

Reference: Gastroenterological Society of Australia – 2024 – Variceal Bleeding Guidelines