Managing Acute Variceal Haemorrhage in a Patient with Alcohol-Related Cirrhosis
A branching clinical case simulation for a patient presenting with vomiting fresh blood, jaundiced and confused. Take a history, examine, investigate, diagnose and treat while the patient responds to every decision, then see the score by clinical domain with the reasoning for each mark.
Year 5hard20 min5 stages
- Patient
- 52 years, male
- Presenting complaint
- Vomiting fresh blood, jaundiced and confused
- Decision stages
- History, Examination, Investigations, Treatment, Monitoring
The presentation
You are a final-year medical student in the emergency department of a district general hospital. A 52-year-old man, David Miller, is brought in by ambulance. He has known alcohol-related cirrhosis and has vomited fresh blood at home. He is jaundiced and confused. He has been drinking heavily for 20 years. The paramedics say he is actively vomiting blood and was found on the floor, confused. You see him in the resus bay: he is agitated, jaundiced, with fresh blood on his lips. He is clammy and has a flapping tremor. What do you do first?
What this case teaches
Manage variceal haemorrhage: terlipressin, antibiotics, cautious transfusion; protect the airway in encephalopathy; arrange urgent endoscopy; avoid over-resuscitation.
How the case unfolds
- 1History TakingHistory
- 2Initial ExaminationExamination
- 3InvestigationsInvestigations
- 4TreatmentTreatment
- 5Post-Intervention MonitoringMonitoring
The decisions available at each stage, and what each one costs or earns, appear when you run the case.
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A free account opens the simulator: the patient's observations move with your decisions, and every choice is scored and explained.
Taught in
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Educational content for students and clinicians in training. It does not replace professional judgement, local protocols or current prescribing information.