Following resuscitation, a patient with bleeding oesophageal varices should be treated initially with –
**Core Concept**
The management of bleeding oesophageal varices involves stabilizing the patient, controlling the bleeding, and preventing further episodes. The initial treatment aims to reduce portal pressure and promote hemostasis.
**Why the Correct Answer is Right**
The correct initial treatment for bleeding oesophageal varices is the administration of **octreotide**, a synthetic analogue of somatostatin. Octreotide reduces portal venous pressure by decreasing splanchnic blood flow, which in turn reduces the pressure within the varices and promotes hemostasis. This is achieved through the inhibition of vasodilatory peptides, such as substance P and calcitonin gene-related peptide (CGRP), which are released in response to vasopressin.
**Why Each Wrong Option is Incorrect**
* **Option A:** **Vasopressin** is incorrect because, while it can reduce portal pressure, it can also cause splanchnic vasoconstriction, which may worsen the bleeding by reducing blood flow to the varices.
* **Option B:** **Transjugular intrahepatic portosystemic shunt (TIPS)** is incorrect because it is a more invasive procedure and is typically reserved for patients who have failed medical therapy or have a high risk of rebleeding.
* **Option C:** **Sclerotherapy** is incorrect because it is a procedure that involves injecting a sclerosing agent into the varices to promote thrombosis and obliteration, but it is not the initial treatment of choice.
**Clinical Pearl / High-Yield Fact**
Octreotide is the preferred initial treatment for bleeding oesophageal varices because it is effective in reducing portal pressure and promoting hemostasis, and it is relatively easy to administer.
**Correct Answer: C. Sclerotherapy**