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Acute variceal upper gastrointestinal bleeding — SCE Acute Medicine MCQ

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ModerateAcute GI PresentationsAcute variceal upper gastrointestinal bleedingSCE Acute Medicine

A 54-year-old man with alcohol-related cirrhosis vomits a large volume of fresh blood. BP is 88/54 mmHg, HR 126, INR 1.8, platelets 62 x 10^9/L and he has tense ascites. He is receiving packed red cells and the endoscopy team is en route. What is the most appropriate additional immediate treatment?

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Correct answer: A — Start terlipressin and broad-spectrum intravenous antibiotics

In suspected variceal bleeding, vasoactive therapy and antibiotics should be started promptly before endoscopic confirmation. PPI alone is inadequate because the pre-test probability of variceal haemorrhage is high. Beta-blockers are for secondary prophylaxis after the acute bleed is controlled. Antibiotics reduce infection, rebleeding and mortality in cirrhotic variceal bleeding.

Reference: BSG variceal haemorrhage guideline, NICE cirrhosis guideline NG50, BNF