MBBS OSCE · Gastroenterology
OSCE — decompensated cirrhosis with ascites assessment
An 8-minute OSCE on focused examination of chronic liver disease, diagnostic paracentesis interpretation, and initial management of ascites with SBP exclusion.
8 min stationVerification in progress
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Exam tags
NEET-PGINICETUSMLEPLAB
Brief (to candidate)
A 50-year-old man with alcohol use disorder presents with abdominal swelling and mild confusion. He is jaundiced with tense ascites. Examine for chronic liver disease signs, plan investigations including ascitic tap, and start management.
Candidate instructions
- Inspect for chronic liver disease stigmata.
- Demonstrate shifting dullness / fluid thrill approach (describe if mannequin).
- Order bloods and ascitic fluid tests.
- Interpret a sample result: SAAG 1.4, PMN 400/mm³.
- Start treatment for ascites and for SBP.
Examiner checklist
| Domain | Key actions expected |
|---|---|
| Stigmata | Jaundice, spiders, palmar erythema, leuconychia, clubbing, gynaecomastia, caput medusae, ascites, splenomegaly, encephalopathy flap |
| Severity scores | Mentions Child-Pugh components and MELD concept |
| Paracentesis | Diagnostic tap for all hospitalised ascites; cell count/culture in blood culture bottles; SAAG, protein |
| SBP | PMN ≥250 → empiric antibiotics (e.g. cefotaxime/ceftriaxone) ± albumin in selected SBP |
| Ascites Rx | Salt restriction; spironolactone ± furosemide; LVP + albumin if large volume |
| Avoid | NSAIDs, ACEi in tense ascites/hypotension without indication, aminoglycosides |
| Safety | Alcohol cessation, nutrition, variceal screening plan |
Model key actions
- SAAG ≥1.1 = portal hypertension.
- PMN 400 = SBP — treat now, do not wait for culture.
- Diuretics for uncomplicated ascites; tap for tension/symptoms.
- Address precipitants of encephalopathy if confused.
Common errors
- Treating ascites without excluding SBP.
- Starting only loop diuretic without aldosterone antagonist.
- No albumin after large-volume paracentesis.
- Missing transplant referral discussion in decompensated disease.
References1ShowHide
- [1]Biggins SW, Angeli P, Garcia-Tsao G, et al. Diagnosis, Evaluation, and Management of Ascites, Spontaneous Bacterial Peritonitis and Hepatorenal Syndrome: 2021 Practice Guidance by the AASLD. Hepatology, 2021.PMID 33942342