A 45-year-old alcoholic presents with haematemesis and melaena. Outline your approach.

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Accepted Answer

I would resuscitate using ABCDE, securing two large-bore cannulae and sending FBC, U&Es, LFTs, clotting, group and crossmatch four units. Given a likely variceal source, I would start terlipressin and broad-spectrum antibiotics such as IV ceftriaxone, correct coagulopathy, and aim for restrictive transfusion targeting Hb 70-80. I would calculate Glasgow-Blatchford and full Rockall scores, keep the patient nil by mouth and refer urgently to the on-call gastroenterology team for endoscopy within 24 hours, or immediately if unstable. I would consider Sengstaken-Blakemore tube as a bridge if uncontrolled bleeding, and escalate to ICU early. Post-endoscopy plan would include secondary prevention with non-selective beta-blocker and band ligation programme.

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