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Acute variceal haemorrhage — ESEGH MCQ

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HardGI BleedingAcute variceal haemorrhageESEGH

A 49-year-old woman with known cirrhosis presents with haematemesis and melaena. Blood pressure is 92/54 mmHg after initial fluid resuscitation, pulse 116/min and haemoglobin is 76 g/L. She has ascites and spider naevi. Oesophagogastroduodenoscopy is being arranged urgently. What is the most important next step?

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

Suspected acute variceal haemorrhage requires early vasoactive therapy and antibiotics alongside resuscitation and urgent endoscopy. A PPI alone is appropriate for non-variceal ulcer bleeding but is insufficient when portal hypertensive bleeding is likely. Endoscopy should be urgent once stabilised, and over-transfusion can worsen portal pressure. The teaching point is to treat suspected variceal bleeding before endoscopic confirmation.

Reference: NICE CG141; BSG/BASL Decompensated Cirrhosis Care Bundle