OSCE — Autoimmune Liver Disease (PBC, PSC & AIH)

Brief (to candidate)

You will assess a patient with a presentation consistent with autoimmune liver disease (PBC, PSC or AIH). You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.^[2][6]

Clinical context

Autoimmune liver disease is three conditions. PBC is an autoimmune epithelitis of small intrahepatic ducts, predominantly in females, marked by AMA and treated with UDCA 13 to 15 mg/kg/day. PSC causes multifocal biliary strictures, is associated with ulcerative colitis in 60 to 80% of cases, carries a cholangiocarcinoma lifetime incidence of 10 to 20%, and has no medical therapy proven to modify progression. AIH is a hepatitic disease scored on autoantibodies, IgG, histology and viral exclusion, treated with corticosteroids plus azathioprine.^[2][6][10]

Candidate tasks

1. Clarify onset, severity, associated features, and red-flag symptoms.
2. State focused examination priorities.
3. List first-line investigations and any named score/criteria.
4. Give immediate resuscitation steps if the patient is unstable (cholangitis, variceal bleed, acute severe AIH).
5. Outline definitive management with sourced doses/routes.
6. Name complications and disposition.
7. Mention one special-population modifier (childhood AIH type 1 versus type 2; PSC plus UC colonoscopy).^{[2][6][10][11]}

Examiner checklist

^{[2] [5] [6] [10] [11]}

Model outline

Lead with the working diagnosis from LFT pattern. Confirm AMA for PBC, MRCP for PSC, Hennes score for AIH (exclude viral hepatitis). Give UDCA 13 to 15 mg/kg/day for PBC and reassess at 6 to 12 months (GLOBE or UK-PBC). Do not use high-dose UDCA (28 to 30 mg/kg/day) in PSC. For AIH induce with a corticosteroid plus azathioprine 1 to 2 mg/kg/day (budesonide only if non-cirrhotic). Document escalation: transplant for decompensated disease; ERCP for dominant PSC strictures.^{[2][5][6][10][11]}

References5ShowHide

1. [2]Dalekos GN, Gatselis N, Androutsakos T, et al. Consensus statements of the Hellenic Autoimmune Liver Diseases Study Group on the diagnosis and current management of primary biliary cholangitis Ann Gastroenterol, 2026.PMID 41868880
2. [6]Malik S, Dbouk N, Grant LM, Samant H. Primary Sclerosing Cholangitis StatPearls, 2026.PMID 30725866
3. [10]Hennes EM, Zeniya M, Czaja AJ, et al. Simplified criteria for the diagnosis of autoimmune hepatitis Hepatology, 2008.PMID 18537184
4. [11]Manns MP, Woynarowski M, Kreisel W, et al. Budesonide induces remission more effectively than prednisone in a controlled trial of patients with autoimmune hepatitis Gastroenterology, 2010.PMID 20600032
5. [5]Lindor KD, Kowdley KV, Luketic VA, et al. High-dose ursodeoxycholic acid for the treatment of primary sclerosing cholangitis Hepatology, 2009.PMID 19585548