Initial essential step in management of acute esophageal variceal bleeding?

Initial essential step in management of acute esophageal variceal bleeding?

• A. Radiologic embolization
• B. Surgery to stop the bleed
• C. Immediate endoscopic ligation
• D. Hemodynamic resuscitation with vasoactive medications and antibiotics, followed by endoscopic control

Answer: (D)

Bleeding from esophageal varices signals profound portal hypertension, so the priority is to stabilize the patient and reduce ongoing bleeding before definitive control is attempted. Start with hemodynamic resuscitation to maintain perfusion and avoid shock, use vasoactive medications to lower portal pressures and help stop the bleed, and give antibiotic prophylaxis because infection worsens outcomes and increases rebleeding risk in cirrhotic patients. Once the patient is stabilized, proceed with endoscopic therapy to achieve definitive hemostasis. Radiologic embolization or surgery are reserved for cases where endoscopic control fails or is not feasible.

Bleeding from esophageal varices signals profound portal hypertension, so the priority is to stabilize the patient and reduce ongoing bleeding before definitive control is attempted. Start with hemodynamic resuscitation to maintain perfusion and avoid shock, use vasoactive medications to lower portal pressures and help stop the bleed, and give antibiotic prophylaxis because infection worsens outcomes and increases rebleeding risk in cirrhotic patients. Once the patient is stabilized, proceed with endoscopic therapy to achieve definitive hemostasis. Radiologic embolization or surgery are reserved for cases where endoscopic control fails or is not feasible.