Pancreatic and Biliary System Disorders — WACS Viva & Clinical Scenarios (Gastroenterology and Hepatology)

Exam-style pancreatic and biliary system disorders viva scenarios with examiner probes and model answers for Internal Medicine candidates.

Scenarios covered

• SCENARIO 1: A 42-year-old male with a history of alcohol misuse presents with severe, constant epigastric pain radiating to the back, persistent vomiting, and lightheadedness for 18 hours. Physical examination reveals a blood pressure of 95/60 mmHg, heart rate of 118 beats per minute, respiratory rate of 24 breaths per minute, temperature of 37.8°C, and diffuse epigastric tenderness without rebound. Laboratory evaluation reveals a serum lipase of 1,450 U/L, hematocrit of 48%, blood urea nitrogen of 11.4 mmol/L, and arterial blood gas showing mild metabolic acidosis. Outline the immediate resuscitation pro
• SCENARIO 2: A 65-year-old female presents with progressive painless jaundice, dark urine, pale stools, generalized pruritus, and a 10 kg weight loss over three months. Physical examination reveals marked scleral icterus, deep scratch marks across her limbs, and a palpable, non-tender mass in the right upper quadrant. Detail the structured diagnostic algorithm, multi-phase imaging protocol, staging criteria, and management plan for suspected malignant distal biliary obstruction.
• SCENARIO 3: A 54-year-old male with long-standing chronic alcohol consumption presents with chronic postprandial epigastric pain, progressive weight loss, and bulky, offensive stools that are difficult to flush. His fasting plasma glucose is 12.8 mmol/L. Explain the pathophysiological basis of his endocrine and exocrine deficits, the non-invasive diagnostic modalities used to establish the diagnosis, and the comprehensive long-term medical management plan.
• SCENARIO 4: A 50-year-old female presents to the emergency department with a 36-hour history of severe right upper quadrant pain, shaking chills, and yellowing of her eyes. Examination reveals a temperature of 39.4°C, heart rate of 126 beats per minute, blood pressure of 86/50 mmHg, respiratory rate of 26 breaths per minute, scleral icterus, right upper quadrant guarding, and lethargy with disorientation to time and place. Outline the diagnostic grading, emergency hemodynamic resuscitation, antimicrobial selection, and timing of definitive procedural intervention.
• SCENARIO 5: A 40-year-old female with well-controlled ulcerative colitis is referred following routine laboratory testing that demonstrated an alkaline phosphatase of 420 U/L and gamma-glutamyl transferase of 190 U/L, with normal aminotransferases and bilirubin. Differentiate the pathophysiology, diagnostic pathways, imaging findings, complications, and surveillance strategies of Primary Sclerosing Cholangitis from Primary Biliary Cholangitis.