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Acute variceal haemorrhage — RACP Adult Medicine MCQ

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HardGastroenterology and hepatologyAcute variceal haemorrhageRACP Adult Medicine

A 57-year-old man with cirrhosis presents with haematemesis and melaena. Blood pressure is 92/58 mmHg, pulse 118/min, bilirubin is 74 micromol/L, INR is 2.1 and creatinine is 142 micromol/L. Endoscopy confirms bleeding oesophageal varices. What is the most important prognostic factor?

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Correct answer: E — Severity of underlying liver dysfunction and acute haemodynamic compromise

Outcome after variceal bleeding is driven by liver disease severity, renal dysfunction and shock, not simply the endoscopic appearance. Dyspepsia and PPI history do not stage portal hypertensive bleeding risk. Amylase and lactose intolerance are not relevant prognostic markers.

Reference: Gastroenterological Society of Australia guidance; Therapeutic Guidelines (eTG)