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Variceal upper gastrointestinal bleeding — ABEM Board MCQ

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HardGI/Abdominal emergenciesVariceal upper gastrointestinal bleedingABEM Board

A 69-year-old man arrives as ESI 2 with melena and syncope. BP 86/48, HR 128, hemoglobin is 7.1 g/dL, INR 1.1. He has cirrhosis, ascites, and active hematemesis in the ED. Which of the following is the most appropriate next step in management?

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

Reveal the answer and explanation

Correct answer: B — Start octreotide, ceftriaxone, blood transfusion, and urgent endoscopy planning

Suspected variceal hemorrhage requires resuscitation, vasoactive therapy, antibiotics, transfusion strategy, and urgent endoscopy.

Reference: AASLD portal hypertensive bleeding guidance; ACG upper GI bleeding guideline