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Severe acute upper gastrointestinal bleeding — SCE Acute Medicine MCQ

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HardGastroenterology and hepatologySevere acute upper gastrointestinal bleedingSCE Acute Medicine

A 76-year-old man with atrial fibrillation on apixaban presents with melaena and dizziness. BP is 86/48 mmHg despite 1 litre crystalloid, pulse 124/min and Hb is 71 g/L. Urea is 18 mmol/L and creatinine is 110 micromol/L. He remains confused and clammy. What is the most appropriate next step in management?

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Correct answer: D — Resuscitate with blood products and arrange immediate endoscopy after stabilisation

He has haemodynamic instability from acute upper GI bleeding, requiring resuscitation with blood products and urgent endoscopy once stabilised. NICE recommends immediate endoscopy after resuscitation in unstable severe upper GI bleeding. Oral PPI alone and outpatient investigation are unsafe; anticoagulation should be withheld and reversal considered in life-threatening bleeding according to local guidance.

Reference: NICE CG141; NICE TA697