A 56-year-old man with cirrhosis presents CTAS 1 after vomiting blood. BP is 84/50, HR 132, and he is confused. Haemoglobin is 72 g/L, INR is 1.8,

Question

A 56-year-old man with cirrhosis presents CTAS 1 after vomiting blood. BP is 84/50, HR 132, and he is confused. Haemoglobin is 72 g/L, INR is 1.8, and lactate is 4.1 mmol/L. There is no abdominal tenderness. What is the most appropriate next step?

Accepted Answer

Resuscitate, give octreotide and ceftriaxone, and arrange urgent endoscopy

Answer

Start therapeutic heparin because portal vein thrombosis is likely

Answer

Insert a nasogastric tube then wait for haemoglobin to fall

Answer

Perform CT colonography before resuscitation

Answer

Give oral proton pump inhibitor and discharge if bleeding stops

Variceal upper gastrointestinal haemorrhage — RCPSC EM MCQ

A 56-year-old man with cirrhosis presents CTAS 1 after vomiting blood. BP is 84/50, HR 132, and he is confused. Haemoglobin is 72 g/L, INR is 1.8, and lactate is 4.1 mmol/L. There is no abdominal tenderness. What is the most appropriate next step?