Case challenge · Gastroenterology / Hepatology / Emergency · teaching

Esophageal Variceal Bleeding — Management Pathway · case challenge

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Case #1Gastroenterology / Hepatology / Emergency

📋 Case data

Bleeding controlled by endoscopy?Endoscopic hemostasis successful

Data is taken from this pathway's reviewed node text. Work through the pathway step by step.

Step 1 / 1 · Bleeding controlled by endoscopy?

After the initial bundle — is bleeding controlled by endoscopy?

💡 A lethal complication of portal hypertension/cirrhosis, 6-week mortality 10–20%. Initial bundle (start on arrival): airway protection (aspiration risk; intubate for massive bleeding/altered consciousness), two large-bore IV lines, cross-match; restrictive transfusion (transfuse only at Hb <7, target 7–8) — over-transfusion raises portal pressure; vasoactive drug on arrival, before endoscopy — terlipressin/octreotide/somatostatin for 3–5 days; prophylactic antibiotics for all cirrhotics with GI bleeding (ceftriaxone 1 g/day, up to 7 days); correct severe coagulopathy, PPI. Endoscopy within 12 h.

For teaching. Decisions and their basis are taken from this site's reviewed care pathways; for licensed clinicians/trainees, this does not replace clinical judgment or local protocols.