MBBS OSCE · gastroenterology
OSCE — Hepatic Encephalopathy
Eight-minute OSCE station on Hepatic Encephalopathy: focused history, examination priorities, investigations, emergency and definitive management.
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Brief (to candidate)
You will assess a patient with a presentation consistent with Hepatic Encephalopathy.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Hepatic encephalopathy (HE) is a reversible syndrome of impaired brain function occurring in patients with advanced liver disease and/or portosystemic shunting, produced by gut-derived neurotoxins (predominantly ammonia) that the failing liver cannot clear. Classified by the underlying disease as Type A (acute liver failure), Type B (portosystemic shunt without intrinsic liver disease) or Type C (cirrhosis — the commonest). Severity by the West Haven classification: grade I mild confusion/sleep reversal, grade II lethargy and disorientation with asterixis, grade III somnolent but rousable with gross disorientation, grade IV coma (grades II–IV are overt). In Type C (cirrhotic) HE, an overt ep
Candidate tasks
- Clarify onset, severity, associated features, and red-flag symptoms.
- State focused examination priorities.
- List first-line investigations and any named score/criteria.
- Give immediate resuscitation steps.
- Outline definitive management with doses/routes where standard.
- Name complications and disposition (ward / HDU / theatre / discharge safety-net).
- Mention one special-population modifier (pregnancy, child, elderly, CKD).
Examiner checklist
| Domain | Pass behaviours |
|---|---|
| Definition | Correct working diagnosis language |
| Assessment | Focused, prioritised, red flags sought |
| Investigations | Appropriate first-line + interpretation |
| Emergency care | ABC / time-critical actions first |
| Definitive care | Specific drugs/procedures, not generic phrases |
| Safety | Cirrhotic with new confusion, drowsiness or asterixis — overt hepatic encephalop |
| Safety | West Haven grade III–IV (somnolent or comatose) — admit to HDU/ICU, protect airw |
| Safety | Cirrhotic with new confusion AND fever, ascites or abdominal pain — culture and |
| Communication | Clear plan and safety-netting |
Model outline
Lead with the working diagnosis and life threats. Resuscitate before definitive tests when unstable. Use guideline-standard therapy with named agents and doses. Document escalation criteria and follow-up. A safe candidate is specific, structured, and never delays critical care for non-urgent imaging.