A man with known alcohol-related cirrhosis vomits fresh blood and is hypotensive. Alongside resuscitation, which combination is the most appropriate while arranging endoscopy?
Answer and explanation
Correct answer: A. Terlipressin, prophylactic antibiotics and endoscopic variceal band ligation
- Step 1: Cirrhosis with haematemesis suggests variceal bleeding until proven otherwise. Step 2. Vasoactive drugs such as terlipressin reduce portal pressure, antibiotics reduce infection and mortality, and band ligation at endoscopy is the definitive control. Answer: Terlipressin, prophylactic antibiotics and endoscopic variceal band ligation. Why not the others: Proton pump inhibitors do not treat variceal bleeding. Beta-blockers are used for prophylaxis and would be harmful in hypotension, and a shunt is a late rescue. Tranexamic acid has no benefit and a liberal transfusion target can raise portal pressure.
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