Luminal Gastrointestinal Disorders and Malabsorption — WACS Viva & Clinical Scenarios (Gastroenterology and Hepatology)

Exam-style luminal gastrointestinal disorders and malabsorption viva scenarios with examiner probes and model answers for Internal Medicine candidates.

Scenarios covered

• SCENARIO 1: A 42-year-old woman presents with an 8-month history of progressive dysphagia to both liquids and solids, recurrent regurgitation of undigested food, nocturnal coughing, and a 6 kg weight loss. Outline your clinical differentiation between structural obstruction and motility disorders, detail the diagnostic algorithm including high-resolution manometry and endoscopy, and explain the stepwise medical, endoscopic, and surgical therapeutic options.
• SCENARIO 2: A 55-year-old man presents with persistent epigastric pain radiating to the back, early satiety, and microcytic hypochromic anaemia. Discuss the tiered diagnostic approach for uninvestigated dyspepsia with alarm features, the validation and limitations of invasive versus non-invasive Helicobacter pylori testing, the pathophysiology of non-steroidal anti-inflammatory drug-induced gastroduodenal injury, and second-line eradication regimens in the setting of regional clarithromycin resistance.
• SCENARIO 3: A 34-year-old farmer presents with chronic voluminous, pale, foul-smelling stools for 6 months, lower extremity pitting oedema, severe fatigue, and profound macrocytic anaemia. Formulate a structured diagnostic pathway to differentiate Tropical Sprue, Celiac Disease, Small Intestinal Bacterial Overgrowth (SIBO), and Intestinal Lymphangiectasia, including the interpretation of duodenal histology and nutrient repletion strategies.
• SCENARIO 4: A 28-year-old man presents with right iliac fossa pain, low-grade evening pyrexia, intermittent non-bloody diarrhoea, and weight loss. Colonoscopy reveals an ulcerated, deformed ileocaecal valve and terminal ileal mucosal nodularity. Provide a comprehensive comparative analysis differentiating Intestinal Tuberculosis from Crohn Disease, encompassing clinical, endoscopic, radiological, microbiological, and histopathological criteria, alongside therapeutic trial principles.
• SCENARIO 5: Explain the neurohormonal regulation of gastric acid secretion at the parietal cell level, detailing the intracellular signalling cascades of gastrin, histamine, acetylcholine, and somatostatin. Contrast the pharmacokinetics, pharmacodynamics, and clinical indications of Proton Pump Inhibitors (PPIs) and Potassium-Competitive Acid Blockers (P-CABs), highlighting considerations during long-term therapy.