Inflammatory Bowel Disease and Functional Disorders — WACS Viva & Clinical Scenarios (Gastroenterology and Hepatology)

Exam-style inflammatory bowel disease and functional disorders viva scenarios with examiner probes and model answers for Internal Medicine candidates.

Scenarios covered

• SCENARIO 1: A 28-year-old male presents with a 2-week history of passing 8 to 10 bloody bowel motions per day, severe crampy lower abdominal pain, nocturnal diarrhoea, fever, and tachycardia. Plain abdominal radiograph demonstrates a transverse colon diameter of 5.8 cm. Outline the immediate diagnostic risk stratification, initial emergency medical resuscitation protocol, and objective dynamic criteria used to determine the failure of corticosteroid rescue therapy and the need for emergent rescue therapy or colectomy.
• SCENARIO 2: A 34-year-old female presents with chronic right lower quadrant abdominal pain, intermittent low-grade fever, weight loss, and non-bloody watery diarrhoea. Colonoscopy demonstrates ulceration and stricturing around the ileocaecal valve. Detail the systematic clinical, endoscopic, radiological, histopathological, and microbiological approach required in the West African subregion to definitively differentiate ileocaecal Crohn disease from intestinal tuberculosis before initiating immunosuppressive therapy.
• SCENARIO 3: Discuss the extraintestinal manifestations of inflammatory bowel disease, categorising them according to their temporal relationship with intestinal disease activity. Describe the mandatory pre-treatment screening, safety monitoring, pharmacogenetics, and long-term colorectal cancer surveillance protocols required for patients receiving thiopurines and anti-TNF biologic agents.
• SCENARIO 4: A 42-year-old administrative secretary presents with a 9-month history of recurrent lower abdominal cramping that improves after defecation, associated with fluctuating loose stools and bloating occurring 2 to 3 days each week. She expresses extreme anxiety regarding gastrointestinal malignancy. Outline the diagnostic approach using Rome IV criteria, the systematic exclusion of organic alarm features, and the comprehensive, tiered management strategy for Irritable Bowel Syndrome with Diarrhoea (IBS-D).
• SCENARIO 5: Formulate the clinical assessment and evidence-based management of Functional Dyspepsia according to the Rome IV framework, distinguishing between Postprandial Distress Syndrome (PDS) and Epigastric Pain Syndrome (EPS), and detailing the appropriate indications for Helicobacter pylori eradication, acid suppression, prokinetic agents, and central neuromodulators.