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Upper GI bleeding — RCPSC IM MCQ

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ModerateGastroenterology/HepatologyUpper GI bleedingRCPSC IM

A 59-year-old man with cirrhosis from alcohol-related liver disease presents with hematemesis and melena. Blood pressure is 102/64 mm Hg after crystalloid, heart rate is 108/min, hemoglobin is 82 g/L, platelets are 78 x 10^9/L, and INR is 1.7. He is started on ceftriaxone, octreotide and a proton pump inhibitor. What is the most appropriate investigation?

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Correct answer: E — Upper endoscopy within 12 hours after resuscitation

Suspected acute variceal bleeding requires resuscitation, vasoactive therapy, antibiotic prophylaxis and early upper endoscopy for diagnosis and endoscopic therapy. Imaging is not the initial diagnostic test in a patient stable enough for endoscopy.

Reference: Canadian Association of Gastroenterology and Baveno portal hypertension guidance