Upper and Lower Gastrointestinal Bleeding — WACS Viva & Clinical Scenarios (Gastroenterology and Hepatology)
Exam-style upper and lower gastrointestinal bleeding viva scenarios with examiner probes and model answers for Internal Medicine candidates.
Scenarios covered
- SCENARIO 1: A 52-year-old male with decompensated alcohol-related liver cirrhosis presents to the emergency department with massive haematemesis, tachycardia of 126 beats per minute, and blood pressure of 82/48 mmHg. Outline the immediate pharmacological, resuscitation, and endoscopic management algorithm for acute variceal haemorrhage.
- SCENARIO 2: A 68-year-old female taking regular low-dose aspirin and non-steroidal anti-inflammatory drugs presents with melaena and orthostatic syncope. Discuss the role of pre-endoscopic risk stratification using the Glasgow-Blatchford and Rockall scores, endoscopic classification of peptic ulcer haemorrhage using the Forrest criteria, and targeted therapeutic modalities.
- SCENARIO 3: A 74-year-old male presents with acute, large-volume, painless bright red rectal bleeding and hemodynamic instability. Detail the diagnostic approach to differentiate upper from lower gastrointestinal sources, the application of the Oakland score, and the indications for CT mesenteric angiography versus urgent colonoscopy or catheter-directed arterial embolization.
- SCENARIO 4: A 46-year-old cirrhotic patient with massive bleeding from oesophageal varices develops persistent haematemesis despite dual endoscopic band ligation and intravenous terlipressin infusion. Explain the indications, technical execution, monitoring parameters, and salvage strategies involving balloon tamponade, dedicated oesophageal stents, and transjugular intrahepatic portosystemic shunt (TIPS).
- SCENARIO 5: A 62-year-old female presents with persistent obscure gastrointestinal bleeding and severe iron deficiency anaemia following non-diagnostic esophagogastroduodenoscopy and colonoscopy. Describe the investigative algorithm including small bowel capsule endoscopy, device-assisted enteroscopy, and mesenteric angiography.