You are the intern covering a medical ward at 2 am. A 61-year-old woman with cirrhosis due to hepatitis C is a…

Question

You are the intern covering a medical ward at 2 am. A 61-year-old woman with cirrhosis due to hepatitis C is admitted with hepatic encephalopathy; she is drowsy and not safe to swallow. Gastroscopy 18 months ago showed small oesophageal varices that were not banded. Her international normalised ratio is 1.6 and her platelet count is 74 x 10^9/L. The medical registrar has reviewed her, decided she is to be fed and given lactulose enterally, and documented in the notes that a nasogastric tube may…

Accepted Answer

Insert a fine-bore nasogastric tube at the bedside

Answer

Correct the international normalised ratio with vitamin K first

Answer

Place an orogastric tube instead

Answer

Refer for radiologically assisted placement

Answer

Start parenteral nutrition and defer the tube

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