Professional and Linguistic Assessments Board (PLAB) Practice Exam

What is the treatment of choice for variceal hemorrhage?

1. Beta-blockers

2. Lactulose

3. Terlipressin

4. Endoscopy

The correct answer is: Terlipressin

The treatment of choice for variceal hemorrhage involves using terlipressin, a vasopressin analogue. This medication works by causing vasoconstriction of the splanchnic blood vessels, resulting in reduced portal pressure and decreased blood flow to the varices, which helps control bleeding. Terlipressin also plays a crucial role in promoting hemostasis by improving liver perfusion and helping to stabilize the patient’s condition during the acute event. It is typically administered alongside other therapies such as antibiotic prophylaxis and endoscopy for optimal management of variceal hemorrhage. In contrast, while beta-blockers are important in the long-term management of portal hypertension to prevent the first occurrence of variceal bleeding, they are not effective in treating an active hemorrhagic episode. Lactulose is primarily used to manage hepatic encephalopathy and does not address the hemorrhage directly. Endoscopy is vital for the intervention itself, such as band ligation or sclerotherapy, but the immediate pharmacological treatment that helps stabilize the patient is terlipressin.