MRCP2-2100

MRCP2-2100

A 50-year-old known alcoholic liver disease patient presents to Accident and Emergency with profuse haematemesis. He has been consuming 6 litres of cider per day for the past week. He denies any abdominal pain or melena. Upon examination, he displays peripheral stigmata of chronic liver disease and appears very pale. His abdomen is soft and there is no tenderness or hepatosplenomegaly. His blood pressure is 90/56 mmHg and he is tachycardic at 120/min. His last OGD 6 months ago showed 3 columns of small varices.

The patient’s blood results are as follows:

– Hb 58 g/l
– Platelets 109 * 109/l
– WBC 8.4 * 109/l
– INR 1.6
– PT 19 seconds

– Na+ 144 mmol/l
– K+ 4.9 mmol/l
– Urea 18.1 mmol/l
– Creatinine 97 µmol/l
– CRP 5 mg/l

– Bilirubin 87 µmol/l
– ALP 189 u/l
– ALT 71 u/l
– Albumin 28 g/l

The patient is transfused 2 units by A&E and given 2 units of Fresh Frozen plasma to correct his coagulopathy. After discussion with the on-call Gastroenterologist, he is given Tazocin 4.5g TDS and Terlipressin 1 mg QDS. He undergoes an OGD which reveals bleeding oesophageal varices. The endoscopist applies 5 bands to the varices but is unable to stop the bleeding. The patient is returned to the ward where he continues to experience haematemesis with low blood pressure and ongoing tachycardia.

What is the next step in managing this patient?