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Variceal Haemorrhage — RACP Adult Medicine MCQ

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ModerateGastroenterology & HepatologyVariceal HaemorrhageRACP Adult Medicine

A 45-year-old man with a history of heavy alcohol consumption presents with haematemesis and melaena. On examination, he has ascites, splenomegaly, and caput medusae. His haemoglobin is 72 g/L. What is the most important initial management alongside volume resuscitation?

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Correct answer: D — IV octreotide and prophylactic antibiotics

In acute variceal haemorrhage, the initial management includes volume resuscitation, IV vasoactive therapy (octreotide or terlipressin – commenced before endoscopy), and prophylactic antibiotics (ceftriaxone 1 g IV daily for 7 days), which reduce rebleeding, bacterial infections, and mortality. Endoscopy should be performed within 12 hours but vasoactive therapy and antibiotics should not be delayed.

Reference: eTG – 2025 – Gastrointestinal; Baveno VII – 2022 – Portal Hypertension Consensus