A 60 years old male with alcoholic liver disease presented to emergency with a history of hematemesis. Which of the following is false regarding his management'
(A) Somatostatin infusion is indicated (B) Negative nasogastric aspirate does not exclude variceal bleed (C) Nasogastric tube inseion can provoke variceal bleeding (D) Upper GI endoscopy is done initially
(C) Answer- C. Nasogastric tube inseion can provoke variceal bleedingOctreotide is the preferred pharmacologic agent for initial management of acute variceal bleeding.Management of Acute Variceal Bleeding:Patients should be admitted to an ICU for resuscitation and managementa.Blood resuscitation should be performed to a hemoglobin level of 8 g/dL.Over-replacement of packed red blood cells and the overzealous administration of saline can lead to both rebleeding and increased moality.Administration of FFP and platelets in patients with severe coagulopathy.Shunt therapy (surgical shunts or TIPS) has been shown to control refractory variceal bleeding.Combination of pharmacologic and EVL therapy improve initial control of bleeding and increase the 5-day hemostasis rate.