Gastrointestinal Tract Luminal Pathologies, Bowel Obstruction, and Ischaemia — WACS Viva & Clinical Scenarios (Gastrointestinal and Abdominal Imaging)

Exam-style gastrointestinal tract luminal pathologies, bowel obstruction, and ischaemia viva scenarios with examiner probes and model answers for Radiology…

Scenarios covered

• SCENARIO 1: Multiphasic Emergency CT Reporting Station: A 68-year-old male with a history of atrial fibrillation presents to the emergency department with severe, out-of-proportion periumbilical abdominal pain, lactic acidosis, and abdominal distension. Review the provided biphasic contrast-enhanced abdominal CT angiogram. Formulate a structured radiological report detailing the vascular and bowel findings, classify the underlying pathophysiological subtype of mesenteric ischaemia, and enumerate the definitive imaging indicators of transmural bowel infarction.
• SCENARIO 2: Clinical Viva / Spotter Case: A plain abdominal radiograph and subsequent contrast-enhanced CT scan of a 72-year-old female with known cholelithiasis presenting with acute mechanical small bowel obstruction are displayed. Identify and explain the classical diagnostic triad (Rigler triad) demonstrated on the images, describe the typical anatomical impaction sites, and discuss the imaging differential diagnoses for gas in the biliary tree.
• SCENARIO 3: Written Structured Examination: A 32-year-old male presents with chronic intermittent right iliac fossa pain, low-grade fever, weight loss, and altered bowel habits. Outline the systematic fluoroscopic, CT enterography, and MR enterography criteria utilised to differentiate ileocaecal tuberculosis from terminal ileal Crohn disease, and specify the optimal patient preparation and imaging protocols required for diagnostic MR enterography.
• SCENARIO 4: Film Viewing / Fluoroscopy Interpretation Station: A sequence of barium swallow and double-contrast upper gastrointestinal images is presented for a 50-year-old patient with progressive dysphagia and regurgitation. Delineate the discriminatory fluoroscopic morphological signs that distinguish primary achalasia from diffuse oesophageal spasm and distal malignant pseudoachalasia (oesophageal adenocarcinoma). State the essential safety precautions and contrast medium selection criteria when perforation is clinically suspected.
• SCENARIO 5: Emergency OSCE Station: Contrast-enhanced abdominal CT images of a 40-year-old female presenting with acute colicky pain, obstipation, and vomiting demonstrate a transition zone in the mid-ileum with mesenteric torsion. Identify the imaging signs of a closed-loop small bowel obstruction, define the mechanical basis of the 'whirl sign', and articulate the explicit cross-sectional markers that necessitate emergency exploratory laparotomy for bowel strangulation.