MBBS OSCE · General Surgery
OSCE — Inflammatory Bowel Disease — Surgical Management
Eight-minute OSCE station on Inflammatory Bowel Disease — Surgical Management: 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 Inflammatory Bowel Disease — Surgical Management.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Surgical management of IBD differs between Crohn's disease (surgery is not curative — recurrence is expected) and ulcerative colitis (proctocolectomy is curative). UC: indications include acute severe colitis (failure of IV steroids), toxic megacolon, perforation, dysplasia/cancer. Definitive: proctocolectomy with ileal pouch-anal anastomosis (IPAA/J-pouch). Crohn's: strictureplasty (Heineke-Mikulicz, Finney, Michelassi), resection with anastomosis, abscess drainage, fistula management.
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 | Acute severe UC failing IV steroids (Travis day-3 criteria) — start rescue thera |
| Safety | Toxic megacolon (transverse colon over 6 cm with systemic toxicity) — emergency |
| Safety | Free perforation or uncontrolled colonic haemorrhage in IBD — emergency laparoto |
| 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.