Hepatobiliary, Pancreatic, Splenic Surgery and Portal Hypertension — WACS Viva & Clinical Scenarios (General Surgery)

Exam-style hepatobiliary, pancreatic, splenic surgery and portal hypertension viva scenarios with examiner probes and model answers for ANAESTHESIA candidates.

Scenarios covered

• SCENARIO 1: A 56-year-old female with deep obstructive jaundice due to a periampullary tumour is scheduled for an elective pancreaticoduodenectomy (Whipple procedure). Total bilirubin is 280 micromol/L, direct bilirubin 210 micromol/L, INR is 1.8 (corrected to 1.2 after parenteral vitamin K), serum creatinine is 135 micromol/L, and albumin is 26 g/L. Detail your complete perioperative anaesthetic management.
• SCENARIO 2: A 42-year-old male with chronic hepatitis B cirrhosis and portal hypertension presents with hypersplenism and massive splenomegaly causing severe mechanical discomfort and recurrent upper GI bleeding. Haemoglobin is 7.5 g/dL, platelet count is 32000/mm3, and INR is 1.6. Outline your anaesthetic plan and intraoperative blood management for an open splenectomy.
• SCENARIO 3: A 60-year-old male is booked for a right hemi-hepatectomy for a solitary liver metastasis. The surgical team requests a low central venous pressure (CVP <5 mmHg) technique during liver parenchymal transection. Explain how you will achieve, monitor, and defend this technique while maintaining vital organ perfusion.
• SCENARIO 4: A 38-year-old male with severe acute necrotizing pancreatitis at day 14 develops infected pancreatic necrosis and worsening organ failure. He is scheduled for emergency open necrosectomy and drainage. He is intubated, ventilated, and requires norepinephrine at 0.2 mcg/kg/min. Outline your anaesthetic priorities, intraoperative fluid strategy, and temperature regulation.