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Variceal haemorrhage — SCE Acute Medicine MCQ

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HardAcute GI PresentationsVariceal haemorrhageSCE Acute Medicine

A 54-year-old man with decompensated cirrhosis has large-volume haematemesis. After airway and circulatory assessment, BP is 104/62 mmHg and urgent endoscopy is being arranged. Which pharmacological bundle should be given before endoscopy?

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Correct answer: E — Give terlipressin with intravenous antibiotic before endoscopy

Suspected variceal haemorrhage requires a vasoactive drug and prophylactic antibiotics as soon as possible alongside resuscitation and urgent endoscopy. Terlipressin reduces portal inflow, while antibiotics reduce infection, rebleeding and mortality. Neither correction of INR nor proton-pump inhibition should delay definitive endoscopic haemostasis.

Reference: https://www.nice.org.uk/guidance/CG141/Chapter/Recommendations