MBBS OSCE · Gastroenterology / General Medicine

OSCE — assessment and management of severe acute pancreatitis

An 8-minute OSCE station assessing the candidate's structured assessment, severity grading (Revised Atlanta) and immediate management of a patient with severe acute pancreatitis. Marks for the goal-directed moderate fluid strategy (WATERFALL), adequate analgesia, early feeding, and the no-routine-antibiotic decision.

8 min stationVerification in progress
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Exam tags

NEET-PGINICETUSMLEPLAB

Brief (to candidate)

A 56-year-old man with known gallstones who drinks heavily presents with severe constant epigastric pain radiating to the back, vomiting, and faint flank bruising. He is confused, RR 28, SpO2 90% on air, BP 84/52. Lipase is 6 times the upper limit of normal; calcium 1.8 mmol/L, CRP 180 mg/L. You have 8 minutes to assess him, grade severity, and outline immediate management.[2]

Candidate instructions

  1. Take a focused, structured history and examine using an ABCDE approach; look for Cullen's/Grey-Turner's signs.[2]
  2. Grade severity using the Revised Atlanta classification (and name a bedside score such as BISAP).
  3. Outline the immediate management, including fluids, analgesia and feeding, with drug/dose and timing.
  4. State your disposition (ward vs ICU), the role of antibiotics and ERCP, and discharge/safety-net advice (cholecystectomy, alcohol cessation).

Examiner checklist (mark each domain / 10)

DomainKey actions expected
Diagnosis (2 of 3)States pain + lipase >3× ULN (imaging not required); pursues gallstones + alcohol as cause[1]
ABCDE / resuscitationOxygen to SpO2 94–98%; IV access; WATERFALL moderate lactated Ringer's (10 mL/kg bolus only if hypovolaemic, then 1.5 mL/kg/h — not 20 mL/kg then 3 mL/kg/h)[5]
Severity — Revised AtlantaReproduces mild / moderately severe / severe; identifies persistent organ failure → severe; ICU[2]
Analgesia + feedingAdequate IV opioid analgesia; early enteral feeding within 24–48 h (not NPO)[1]
Antibiotics decisionNo routine prophylactic antibiotics; only for infected necrosis/cholangitis[1]
ERCP / cholecystectomyERCP only for cholangitis/obstruction (within 24 h); cholecystectomy same admission if mild
Communication & safety-netClear plan; ICU referral; alcohol cessation + cholecystectomy to prevent recurrence; thiamine

Model key actions

  • Moderate, goal-directed lactated Ringer's (WATERFALL — avoid aggressive boluses); urinary catheter for hourly output.[5]
  • Revised Atlanta = severe (persistent organ failure) → ICU/HDU.[2]
  • IV opioid analgesia and early enteral feeding within 24–48 h; no routine prophylactic antibiotics.[1]
  • Recognise Grey-Turner's sign as necrotising/haemorrhagic disease; arrange contrast CT at 48–72 h if severe.
  • Treat the cause: cholecystectomy for gallstones once resolved; alcohol cessation and thiamine.

Common errors

  • Aggressive fluid resuscitation (fluid overload); failing to state resuscitation goals.[5]
  • Prolonged nil by mouth or routine prophylactic antibiotics — both outdated and harmful.
  • Not grading severity (managing a severe patient on a general ward).
  • Over-relying on amylase (can be normal in hypertriglyceridaemia); not excluding perforated ulcer / mesenteric ischaemia / leaking AAA.
  • Early surgery for necrosis — use the step-up drainage approach; delay ~4 weeks if possible.
References3Show
  1. [1]Working Group IAP/APA Acute Pancreatitis Guidelines IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology, 2013.PMID 24054878
  2. [2]Banks PA, Bollen TL, Dervenis C, et al. Classification of acute pancreatitis—2012: revision of the Atlanta classification. Gut, 2013.PMID 23100216
  3. [5]de-Madaria E, Buxbaum JL, Maisonneuve P, et al. Aggressive or Moderate Fluid Resuscitation in Acute Pancreatitis. New England Journal of Medicine, 2022.PMID 36103415
OSCE — assessment and management of severe acute pancreatitis · MBBS OSCE · NeetVellum