A 62-year-old male with cirrhosis presents with massive hematemesis. Pulse is , BP . Along with fluid resuscitation, what immediate pharmacotherapy should be started before endoscopy?
Answer and explanation
Correct answer: A. Intravenous octreotide infusion and prophylactic ceftriaxone
- Step 1: Upper GI bleeding in a cirrhotic patient is presumptive acute esophageal variceal hemorrhage.
- Step 2: Early vasoactive therapy with somatostatin analog (octreotide) reduces splanchnic blood flow and portal pressure.
- Step 3: Prophylactic antibiotics (ceftriaxone) significantly reduce bacterial infection and rebleeding mortality.
Answer
Intravenous octreotide infusion and prophylactic ceftriaxone.
Why not the others: Beta-blockers are contraindicated during acute shock and active bleeding; tranexamic acid does not reduce mortality in variceal bleed; sucralfate is ineffective.
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