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Variceal upper gastrointestinal bleeding — MCCQE Part 1 MCQ

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HardRectal BleedingVariceal upper gastrointestinal bleedingMCCQE Part 1

A 55-year-old man with cirrhosis presents with haematemesis, melena and hypotension. He has ascites, spider naevi and thrombocytopenia. Which of the following is the most appropriate initial management?

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Correct answer: D — Resuscitation, vasoactive therapy, prophylactic antibiotics and urgent endoscopy

Cirrhosis with haematemesis suggests variceal bleeding; management includes resuscitation, vasoactive therapy such as octreotide, antibiotics and urgent endoscopic therapy. A proton pump inhibitor alone does not address portal hypertensive bleeding. Colonoscopy, NSAIDs and delayed treatment are inappropriate in unstable upper GI haemorrhage.

Reference: Canadian Association for the Study of the Liver; Baveno consensus used in Canadian practice