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Acute variceal haemorrhage — SCE Acute Medicine MCQ

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ModerateGastroenterology and hepatologyAcute variceal haemorrhageSCE Acute Medicine

A 59-year-old man with cirrhosis from alcohol-related liver disease presents with haematemesis. BP is 98/60 mmHg, pulse 118/min and Hb is 74 g/L. He has tense ascites and stigmata of chronic liver disease. After initial resuscitation, what is the most appropriate disease-specific management?

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Correct answer: A — Give prophylactic antibiotics and vasoactive therapy while arranging urgent endoscopy

This is suspected variceal bleeding in cirrhosis, requiring resuscitation plus early antibiotics, vasoactive therapy and urgent endoscopy. NICE recommends prophylactic antibiotics at presentation in suspected or confirmed variceal bleeding. PPI alone is inadequate, and ascites drainage should not delay haemorrhage control.

Reference: NICE CG141; BSG Variceal Haemorrhage Guidance