Clinical Case Database / Category: Clinical Care

Management of massive (variceal) GI bleeding

Publication details

Simon J Leedham
Foundation Years Journal, volume 1, issue 3, p.109 (123Doc Education, London, June 2007)


A 56-year-old man with a long history of alcohol abuse was found by his wife collapsed in his home covered in malaena. On arrival paramedics found him to be haemodynamically unstable with a pulse of 120 and BP of 70/40. In the ambulance he vomits approximately 150 mls of fresh blood. On examination in A&E he has multiple stigmata of chronic liver disease. His Glasgow Coma Scale score is 9/15. Initial blood results show a haemoglobin of 7g/dl, platelets of 65 (x109/l), an albumin of 23 g/l, and an INR of 2.1. You are called to see him urgently. How would you manage this patient?

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Simon J Leedham

Gastroenterology SpR and MRC Clinical Research Fellow
Cancer Research UK


0.  Jalan R, Hayes PC, UK guidelines on the management of variceal haemorrhage in cirrhotic patients, British Society of Gastroenterology, 2000


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About the Clinical Cases Database

T​he Foundation Years Clinical Cases Database is​ a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.

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