Sun21November1151AM 10

A 70-year-old male presents with haematemesis and melaena.

His presenting blood pressure is 80/46 mmHg, with a heart rate of 114 bpm. He is known to have idiopathic cirrhosis and there is mild encephalopathy.

You start to resuscitate him with colloid, blood, FFP and dextrose.

Which of the following is the most appropriate next step at this moment?

(Please select 1 option)

Terlipressin Correct

Lactulose

Ciprofloxacin

Oral beta blockers

OGD

Explanation

Terlipressin causes splanchnic vasoconstriction thereby restricting bleeding from varices which is the likely cause of bleeding in this patient.

In the acute gastrointestinal bleed described above glypressin is the best treatment to aid cardiovascular resuscitation. Beta-blockade comes into play later in order to treat portal hypertension chronically.

Lactulose should be considered to guard against progression of encephalopathy.

OGD should be considered but full resuscitation and optimal medical management should be attempted in the first instance.

In the event of ascites, ciprofloxacin is used as prophylaxis against spontaneous bacterial peritonitis. This is of secondary importance here.

Answer Statistics

1

78%

2

2%

3

4%

4

18%

Times answered: 279