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Variceal prophylaxis – propranolol — RACP Paediatrics MCQ

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HardGIVariceal prophylaxis – propranololRACP Paediatrics

A 12-year-old with cirrhosis presents with large-volume haematemesis, tachycardia and cool peripheries. Variceal bleeding is suspected. Airway assessment, vascular access, blood products and cross-matching are underway. Which management sequence is most appropriate?

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

Reveal the answer and explanation

Correct answer: B — Start octreotide and antibiotics, then perform endoscopy after stabilisation

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

E is correct because paediatric variceal haemorrhage requires parallel resuscitation and early portal-pressure-directed therapy, with antibiotics in cirrhotic bleeding and endoscopic haemostasis after initial stabilisation. A loses time by making treatment depend on visual confirmation. B treats non-variceal acid disease and delays haemostasis. C is a rescue bridge for uncontrolled bleeding, not the first manoeuvre. D may worsen haemodynamics and non-selective beta-blockers are not acute-shock treatment. The 2026 Asia-Pacific paediatric statement is applicable to Australian specialist practice and provides contemporary regional guidance where national paediatric evidence is limited.

Reference: Royal Children’s Hospital Melbourne, acute management of an oesophageal variceal bleed: https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Acute_management_of_an_oesophageal_variceal_bleed/; Asia-Pacific Society for Pediatric Gastroenterology, Hepatology and Nutrition, 2026 endoscopic variceal bleeding statement: https://www.pghn.org/pdf/10.5223/pghn.2026.29.1.1