Prepared by Alvin H. and Syameer F.

OSCE Case Practice 1: Pathology Station

Marking Schemes
Well Partially Not
done done done

1. Described the specimen: 2.0 1.0 0

a. This is a liver;
b. It belongs to John;
c. Enlarged soft pale yellow liver;
d. Due to fat-filled vacuoles in hepatocytes.

2. Described the histopathological spectrum of alcoholic liver disease.

a. Alcoholic liver disease
i. Enlarged soft pale yellow liver;
ii. Due to fat-filled vacuoles in hepatocytes.
b. Alcoholic steatohepatitis
i. Hepatocyte necrosis with focal Reticulin collapse; 1.0 0.5
ii. Mallory’s Hyaline, focal neutrophil infiltrate.
c. Alcoholic fibrosis (steatofibrosis)
i. Cytokines & chemokines from Kupffer cells stimulate the
hepatic stellate cells (Cells of Ito); 1.0 0.5
ii. To form fibrous tissue;
iii. More widespread hepatocyte necrosis progressing to
disorganized fibrosis.
d. Alcoholic cirrhosis
i. Attempted hepatocyte regeneration but forming non- 1.0 0.5
functioning regenerative nodules of hepatocytes,
interrupted bile flow, deranged blood flow with abnormal
anastomoses leading to portal hypertension.
Ref: Pathology Slides on Liver Pathology P.11.
http://moodle.vle.monash.edu/pluginfile.php/4620337/mod_label/intro/CCL_07_Liver
%20Pathology.pdf

1.0 0.5

4.0 2.0 0
3. Described the possible pathogenesis of alcoholic liver disease. More than 3.0 1.5 0
three (3) of any of the followings entitled to 4.0, otherwise less or equal to
one (1) is considered not done.
a. Ethyl Alcohol (ETOH) processing in the liver increases the
NAD/NADH ratio, which causes more fatty acid synthesis and less
fatty acid oxidation, hence fatty liver;
b. Acetaldehyde produced from ETOH may also damage liver cells;
c. ETOH might convert hepatocytes into myofibroblasts, which lay
down collagen and cause fibrosis;
d. ETOH enhances the effects of other toxins on the liver e.g.
paracetamol.
Prepared by Alvin H. and Syameer F.
Ref: http://www.oxfordmedicaleducation.com/gastroenterology/alcoholic-liver-disease-ald-questions/

4. Investigations for patient with Alcoholic Liver Disease:

List 5 or more investigations to be considered well done, 2 or more will be
considered partially done.
a. LFT
I. Check for serum AST/ALT levels and ratio. Ratio>2 in ALD
II. Increased ALP indicate cholestasis association 1.5 0.75
III. Increased GGT
IV. Elevated bilirubin levels
V. Low albumin
b. FBC
I. Anaemia
II. Leucocytosis

1.5 0.75

III. High MCV

IV. Thrombocytopenia
c. INR, PT
d. BUN, Creatinine – check for GI bleeding and Hepatorenal 0.5 0.25
syndrome respectively
e. Ultrasound – Screen for HCC 0.5 0.25
Ref: http://bestpractice.bmj.com.ezproxy.lib.monash.edu.au/best-practice/monograph/1116.html

0.5 0.25

4.5 2.25 0
5. Complications of liver cirrhosis: 4 1.25 0
List 5 or more complications to be considered well done, 2 or more will be
considered partially done.

a. Death
b. Ascites
c. Portal hypertension
d. Coagulopathy
e. Renal failure
f. APO
g. Hepatic encephalopathy
h. GI bleeding
i. Hepatorenal syndrome
j. HCC
k. Sepsis
Ref: http://bestpractice.bmj.com.ezproxy.lib.monash.edu.au/best-
practice/monograph/1116/follow-up/complications.html

6. Management of patient with Alcoholic Liver Disease:

Prepared by Alvin H. and Syameer F.

a. Encourage abstinence from alcohol; 0.5 0.25

b. Stop smoking;
0.5 0.25
c. Weight reduction;
d. Vitamin supplementation; 0.5 0.25
e. Immunization.
0.5 0.25
Ref: http://bestpractice.bmj.com.ezproxy.lib.monash.edu.au/best-
practice/monograph/1116/treatment/details.html
0.5 0.25

2.5 1.25 0

Total Marks: _________ /20

Comments:
Prepared by Alvin H. and Syameer F.
Clinical Vignette
Please read and follow the instructions carefully.

John is a 38-year-old Caucasian man presenting to the emergency department of Monash Health for severe
alcohol abuse with nausea and vomiting. He has a significant medical history of chronic heavy alcohol
consumption of a half pint of vodka daily for about 5 years until 1 year ago; since then he has severe
intermittent binge alcohol intake. He reports no other significant medical problems.
You will be asked to describe and elaborate on the specimen prepared for you in this OSCE station and also
to answer a few questions. Please state reasons for each of your answers.
Prepared by Alvin H. and Syameer F.

Questions
The below specimen belongs to John

1. What is this specimen? Describe it.

2. Described the histopathological spectrum of alcoholic liver disease.
3. Described the possible pathogenesis of alcoholic liver disease.
4. What are the investigations you want to do for this patient?
5. What are the complications of liver cirrhosis?
6. How would you manage this patient?