Hepatic Havoc: Escape room
Can you solve the case?
Start
How it Works
You are part of a medical team trying to save a patient who has presented with signs of liver failure. After initial investigations, you suspect cirrhosis, but you must confirm the diagnosis and recommend appropriate management. Carefully review the provided information, solve the puzzles to uncover vital findings, and ‘escape’ by successfully stabilizing the patient. Good luck!
Anatomy and Physiology of the Liver
Click through the various labels of the liver to learn more!
Liver
Functions of the Liver
The liver stores excess glucose as glycogen (glycogenolysis) and produces glucose from amino acids when blood sugar is low (gluconeogenesis). It also converts free fatty acids into triglycerides during fasting [5]
The liver catabolizes both endogenous substances like hormones and proteins, and exogenous substances such as drugs and alcohol, to maintain balance in the body [5]
Most serum proteins, such as albumin, clotting factors,complem-ent, iron and copper binding proteins, are synthesized in the liver [5]
Uses things
Breaks things
Make things
"Metabolic"
"Catabolic"
"Synthetic"
The main excretory product of the liver is bile which is important for fat absorption in the small intestine [5]
An important storage site for glycogen, triglycerides, iron, copper and lipid soluble vitamins [5]
Gets rid of things
Stores things
"Excretory"
Meet the Patient
Now that you have refreshed your knowledge about the liver, lets meet the patient.
Mx. Daniel Carter, a 61-year-old former construction worker, was brought to the ER by his sister. He has a history of chronic health issues which have worsened in recent months. Recently unemployed and living alone, his diet has become irregular, and he has struggled to maintain his health due to his sedentary lifestyle. His condition is deteriorating quickly, can you stabilize him in time?
Escape Education
Complete the activity for each lesson to get closer to your diagnosis
Symptoms 101
Labs 101
Histology 101
Final Diagnosis
Causes 101
Disease Management 101
Histology 101
Histology is often one of the first types of imaging pathologists use when diagnosing patients. Check out the video below for an in-depth walkthrough of the histology of the liver!
Question 01/03
Histology of the liver is particularly distinct and unique. What is a defining characteristic of liver histology?
Circular walls of muscle.
Large, dense nuclei.
Hexagonal lobules.
Histology 101
Use the virtual slide box below to explore liver histology at different stages of health and disease.
Alcoholic hepatitis
Acute hepatitis
Lobules & portal triad
Healthy liver
Liver histology changes with disease. As a disease progresses in the liver, more abnormal cells and follicles are seen. Most often, regenerative nodules will be evident in end-stage liver disease.
01
Question 03/03
Histological abnormalities are spotted in a section of Mr. Daniel Carter's liver. What is a possible diagnosis?
Type 1 Diabetes Mellitus.
Bacterial infection of the liver.
Alcoholic Liver Disease.
01
Question 03/03
Perfect, you're getting close!
Move on to the next lesson to continue stabilizing Mx. Carter...
Continuing
Escape Education
Complete the activity for each lesson to get closer to your diagnosis
Symptoms 101
Labs 101
Histology 101
Final Diagnosis
Causes 101
Disease Management 101
Symptoms 101
Lets take a closer look at Mr. Carter's symptoms. Click on the audio file to hear what he has to say about how he feels.
02
Question 01/02
02
At first, Mr. Carter’s complaints seemed mild, fatigue, nausea, and loss of appetite, but something isn’t adding up. Your team decides to take a closer look... Click on the various parts of the body to learn more.
02
Question 02/02
🚨 Uh oh, Code Red! Mr. Carter suddenly starts vomiting blood! His heart rate is dropping, and bruises are forming across his body. You must act fast! You need to fill in the blanks correctly to uncover the reason for his sudden complications.
02:00
02
Phew... you did. Your team has worked tirelessly to piece together the clues, and now the full picture is clear: Mr. Carter’s liver is in severe distress and he is experiencing multiple life-threatening complications. Review the key findings of his symptoms and complications before moving on to the next lesson!
✔️ Portal Hypertension – Increased venous pressure caused by abnormal backflow of blood [5] ✔️ Jaundice – His failing liver can no longer process bilirubin [5] ✔️ Ascites & Edema – Fluid buildup due to portal hypertension and low albumin production [5] ✔️ Easy Bruising – Decreased liver function leading to impaired blood clot formation [5] ✔️ Esophageal Varices – Ruptured veins caused by increased portal pressure [5] ✔️ Impaired Drug Metabolism – Medications are lingering longer due to parenchymal insufficiency [5]
Excellent, you have passed!
Move on to the next lesson
Continuing
Escape Education
Complete the activity for each lesson to get closer to your diagnosis
Symptoms 101
Labs 101
Histology 101
Final Diagnosis
Causes 101
Disease Management 101
Labs 101
Oh no! Mx. Carter is still not stable and your patient is deteriorating. They appear jaundiced, are increasingly confused, and their abdomen is visibly distended. The symptoms are pointing towards liver failure… but you need more data to assess the situation properly.
What should you do next?
Choose your next step carefully. The right decision could save the patient.
Order a brain CT
Call the family
Run lab tests
Start antibiotics
You’ve made the right call. The lab work has arrived – and it’s time to interpret the results. This will help determine the severity of cirrhosis and guide the next steps in management.
[7]
Click for Hint
Use the values above to calculate the Child-Pugh score.
Add up the points and determine the correct Child-Pugh class (A, B, or C) to unlock the next clue.”
Enter your answer (score + class) on the next slide.
Use the values above to calculate the Child-Pugh score.
Add up the points and determine the correct Child-Pugh class (A, B, or C) to unlock the next clue.”
Enter your answer (score + class)
[7]
Click for Hint
Great, you have passed!
Proceed to the next lesson
Continuing
Escape Education
Complete the activity for each lesson to get closer to your diagnosis
Symptoms 101
Labs 101
Histology 101
Final Diagnosis
Disease Management 101
Causes 101
Causes 101
To confirm & treat Mx.Carter's condition we need to figure out the cause of his cirrhosis. Cirrhosis can develop over time due to various underlying conditions. Click each icon below to explore the most common causes.
Incorrect nswer
Correct Answer
Incorrect Answer
Incorrect Anser
04
Question 01/03
Build a Liver
Your choices shape your liver’s future. Pick a lifestyle profile that may lead from NAFLD to NASH to unlock the next clue.
Correct Answer
Incorrect Answer
Incrrect Answer
04
Question 02/03
You enter Mx. Carter’s hospital room. He’s trembling and drenched in sweat[1]. His voice is shaky as he says: “I haven’t had a drink today… I usually have a few by now.”
04
Question 03/03
Correct! Mx. Carter is going through alcohol withdrawl. The team asks him some questions about his lifestlye. Click on each card to reveal his answers.
Mr. Carter diet is irregular but he eats mainly carbs and protein. He limits his saturated and trans fat intake but treats himself occasionaly to maintain a normal BMI range.
Mr. Carter discloses his chronic alcohol use for 10+ years. He usually has 4-6 standard drinks per day. He does not do any other substances.
Before his unemployment, he was active most days of the week. With his health issues he does as much exercise as he can.
Physical Activity
Substance Use
DIET
Perfect, you have passed!
Advance to the next lesson
Continuing
Escape Education
Complete the activity for each lesson to get closer to your diagnosis
Symptoms 101
Labs 101
Histology 101
Final Diagnosis
Disease Managment 101
Causes 101
Disease Management 101
🧠 Let’s Test Your Knowledge further with the Disease Management Crossword Puzzle!
Next
Disease Management 101
Hint 1: Medication used to treat hepatic encephalopathy by reducing ammonia levels [4]
Neomycin
Lactulose
Rifaximin
Disease Management 101
Hint 2: Diagnostic procedure used to assess ascitic fluid for infection [4]
Paracentesis
Ascitic tap
Fluid analysis
Disease Management 101
Hint 3: Transplant - The only definitive treatment for end-stage liver disease [6]
Hepatic
Organ
Liver
Disease Management 101
Hint 4: A non-selective beta-blocker commonly used for portal hypertension [4]
Carvedilol
Propranolol
Nadolol
Disease Management 101
Hint 5: This diuretic is often combined with furosemide to manage ascites [6]
Spironolactone
Eplerenone
Amiloride
Disease Management 101
Hint 6: Procedure to remove fluid from the abdomen [6]
Puncture
Peritoneocentesis
Paracentesis
Disease Management 101
Hint 7: Used to reduce portal hypertension [6]
Beta blockers
Paracentesis
Portosystemic
Disease Management 101
Congrats! You've completed the Disease Management Crossword Puzzle!
Perfect, you have passed!
Move on to the next lesson
Continuing
Escape Education
Complete the activity for each lesson to get closer to your diagnosis
Symptoms 101
Labs 101
Histology 101
Final Diagnosis
Disease Managment 101
Causes 101
Final Diagnosis
Congratulations Doctor! After navigating complex symptoms, decoding hidden clues, and interpreting vital test results, your team has stabilized the patient just in time. But before you can discharge this case, there’s one final task...
Perfect, you have passed!
You have completed all the lessons, we have finished
Great!
Escape Education
Great! You have passed all the lessons in time. Now, get your diploma!
Let's go!
Pathology School
Congratulations!
Healthcare Diploma
You did it! You successfully diagnosed and saved the patient's life.
This answer is incorrect
Try again, come on!
Back
Infections
Hepatitis Viruses
Chronic infection with hepatitis B or C viruses causes continuous inflammation of the liver. If left untreated, this can result in fibrosis and eventually cirrhosis, even if symptoms don’t appear right away[5].
Drugs/Toxins
Can cause toxic hepatitis
Exposure to certain chemicals, drugs, or toxins (like high doses of acetaminophen) can damage liver cells and lead to cirrhosis[5].
Common Bile Duct
Bile leaves the liver via the right and left hepatic ducts which join to form the common hepatic duct; this then becomes known as the common bile duct (CBD) after it is joined by the cystic duct from the gallbladder [5].
Autoimmune Diseases
In autoimmune hepatitis, the body’s immune system attacks liver cells. Other diseases like primary biliary cholangitis (PBC) or primary sclerosing cholangitis (PSC) affect the bile ducts, causing inflammation and scarring that can result in cirrhosis over time[3,5].
Portal Vein
Since the liver has a dual blood system, it also receives nutrient-rich, but deoxygenated, blood from the gastrointestinal tract through the portal vein for processing before draining into the central vein [5].
The Aorta
The aorta supplies the liver with oxygen-rich blood through the hepatic artery [5].
NAFLD/NASH
Non-alcoholic fatty liver disease (NAFLD) is caused by fat buildup in the liver without alcohol use but often due to obesity, diabetes, and poor diet and lifestyle choices. Its more severe form, Non-alcoholic steatohepatitis (NASH), leads to inflammation and scarring[5].
Genetics
Metabolic Disorders
Some inherited conditions can lead to liver damage and cirrhosis over time:• Hemochromatosis causes excess iron to build up in the liver, damaging tissues[5]. • Wilson’s disease leads to toxic copper accumulation due to poor copper elimination[3]. • Alpha-1 antitrypsin deficiency results in abnormal protein buildup in liver cells, causing inflammation and scarring[5].
Inferior Vena Cava
After the arterial and venous blood enters the liver via the hepatic artery and portal veins, it flows through the sinusoids during which it washes over the hepatocytes for processing. This blood then exits through the central veins, into the hepatic veins, and finally returns to the heart via the inferior vena cava [5].
The Gallbladder
The gallbladder is a pear-shaped sac that lies behind the liver. Its main function is to store and concentrate bile that is produced by hepatocytes and release the stored bile via the cystic duct when needed [5].
Alcohol
Long-term heavy alcohol consumption damages liver cells, causing inflammation and scarring. Over time, this repeated injury leads to alcoholic cirrhosis, one of the most common preventable forms of liver damage[5].
Hepatic Artery
The liver is unique as it has a dual blood supply, receiving blood from two major vessels; one of which is the heaptic artery to supply the liver with oxygen-rich blood before draining into the central vein [5].
The Liver
The liver, located in the upper right portion of the abdomen just above the gallbladder, is one of the body's largest and most essential organs. Weighing approximately 1.2 to 1.5 kg in an average adult, it is divided into two main lobes: the right and left lobes. It is composed of various cell types, but its primary functional units are hepatocytes. Also, between these hepatocytes exist permeable capillaries called sinusoids [5].
Hepatic Havoc: Escape room
Sharan Gill
Created on March 31, 2025
Start designing with a free template
Discover more than 1500 professional designs like these:
View
Adventure Breakout
View
Team Building Mission Escape Game
View
Onboarding Escape Game
View
Christmas Escape Room
View
Flags Challenge
View
Museum Escape Room
View
Education Escape Room
Explore all templates
Transcript
Hepatic Havoc: Escape room
Can you solve the case?
Start
How it Works
You are part of a medical team trying to save a patient who has presented with signs of liver failure. After initial investigations, you suspect cirrhosis, but you must confirm the diagnosis and recommend appropriate management. Carefully review the provided information, solve the puzzles to uncover vital findings, and ‘escape’ by successfully stabilizing the patient. Good luck!
Anatomy and Physiology of the Liver
Click through the various labels of the liver to learn more!
Liver
Functions of the Liver
The liver stores excess glucose as glycogen (glycogenolysis) and produces glucose from amino acids when blood sugar is low (gluconeogenesis). It also converts free fatty acids into triglycerides during fasting [5]
The liver catabolizes both endogenous substances like hormones and proteins, and exogenous substances such as drugs and alcohol, to maintain balance in the body [5]
Most serum proteins, such as albumin, clotting factors,complem-ent, iron and copper binding proteins, are synthesized in the liver [5]
Uses things
Breaks things
Make things
"Metabolic"
"Catabolic"
"Synthetic"
The main excretory product of the liver is bile which is important for fat absorption in the small intestine [5]
An important storage site for glycogen, triglycerides, iron, copper and lipid soluble vitamins [5]
Gets rid of things
Stores things
"Excretory"
Meet the Patient
Now that you have refreshed your knowledge about the liver, lets meet the patient.
Mx. Daniel Carter, a 61-year-old former construction worker, was brought to the ER by his sister. He has a history of chronic health issues which have worsened in recent months. Recently unemployed and living alone, his diet has become irregular, and he has struggled to maintain his health due to his sedentary lifestyle. His condition is deteriorating quickly, can you stabilize him in time?
Escape Education
Complete the activity for each lesson to get closer to your diagnosis
Symptoms 101
Labs 101
Histology 101
Final Diagnosis
Causes 101
Disease Management 101
Histology 101
Histology is often one of the first types of imaging pathologists use when diagnosing patients. Check out the video below for an in-depth walkthrough of the histology of the liver!
Question 01/03
Histology of the liver is particularly distinct and unique. What is a defining characteristic of liver histology?
Circular walls of muscle.
Large, dense nuclei.
Hexagonal lobules.
Histology 101
Use the virtual slide box below to explore liver histology at different stages of health and disease.
Alcoholic hepatitis
Acute hepatitis
Lobules & portal triad
Healthy liver
Liver histology changes with disease. As a disease progresses in the liver, more abnormal cells and follicles are seen. Most often, regenerative nodules will be evident in end-stage liver disease.
01
Question 03/03
Histological abnormalities are spotted in a section of Mr. Daniel Carter's liver. What is a possible diagnosis?
Type 1 Diabetes Mellitus.
Bacterial infection of the liver.
Alcoholic Liver Disease.
01
Question 03/03
Perfect, you're getting close!
Move on to the next lesson to continue stabilizing Mx. Carter...
Continuing
Escape Education
Complete the activity for each lesson to get closer to your diagnosis
Symptoms 101
Labs 101
Histology 101
Final Diagnosis
Causes 101
Disease Management 101
Symptoms 101
Lets take a closer look at Mr. Carter's symptoms. Click on the audio file to hear what he has to say about how he feels.
02
Question 01/02
02
At first, Mr. Carter’s complaints seemed mild, fatigue, nausea, and loss of appetite, but something isn’t adding up. Your team decides to take a closer look... Click on the various parts of the body to learn more.
02
Question 02/02
🚨 Uh oh, Code Red! Mr. Carter suddenly starts vomiting blood! His heart rate is dropping, and bruises are forming across his body. You must act fast! You need to fill in the blanks correctly to uncover the reason for his sudden complications.
02:00
02
Phew... you did. Your team has worked tirelessly to piece together the clues, and now the full picture is clear: Mr. Carter’s liver is in severe distress and he is experiencing multiple life-threatening complications. Review the key findings of his symptoms and complications before moving on to the next lesson!
✔️ Portal Hypertension – Increased venous pressure caused by abnormal backflow of blood [5] ✔️ Jaundice – His failing liver can no longer process bilirubin [5] ✔️ Ascites & Edema – Fluid buildup due to portal hypertension and low albumin production [5] ✔️ Easy Bruising – Decreased liver function leading to impaired blood clot formation [5] ✔️ Esophageal Varices – Ruptured veins caused by increased portal pressure [5] ✔️ Impaired Drug Metabolism – Medications are lingering longer due to parenchymal insufficiency [5]
Excellent, you have passed!
Move on to the next lesson
Continuing
Escape Education
Complete the activity for each lesson to get closer to your diagnosis
Symptoms 101
Labs 101
Histology 101
Final Diagnosis
Causes 101
Disease Management 101
Labs 101
Oh no! Mx. Carter is still not stable and your patient is deteriorating. They appear jaundiced, are increasingly confused, and their abdomen is visibly distended. The symptoms are pointing towards liver failure… but you need more data to assess the situation properly.
What should you do next? Choose your next step carefully. The right decision could save the patient.
Order a brain CT
Call the family
Run lab tests
Start antibiotics
You’ve made the right call. The lab work has arrived – and it’s time to interpret the results. This will help determine the severity of cirrhosis and guide the next steps in management.
[7]
Click for Hint
Use the values above to calculate the Child-Pugh score. Add up the points and determine the correct Child-Pugh class (A, B, or C) to unlock the next clue.” Enter your answer (score + class) on the next slide.
Use the values above to calculate the Child-Pugh score. Add up the points and determine the correct Child-Pugh class (A, B, or C) to unlock the next clue.” Enter your answer (score + class)
[7]
Click for Hint
Great, you have passed!
Proceed to the next lesson
Continuing
Escape Education
Complete the activity for each lesson to get closer to your diagnosis
Symptoms 101
Labs 101
Histology 101
Final Diagnosis
Disease Management 101
Causes 101
Causes 101
To confirm & treat Mx.Carter's condition we need to figure out the cause of his cirrhosis. Cirrhosis can develop over time due to various underlying conditions. Click each icon below to explore the most common causes.
Incorrect nswer
Correct Answer
Incorrect Answer
Incorrect Anser
04
Question 01/03
Build a Liver
Your choices shape your liver’s future. Pick a lifestyle profile that may lead from NAFLD to NASH to unlock the next clue.
Correct Answer
Incorrect Answer
Incrrect Answer
04
Question 02/03
You enter Mx. Carter’s hospital room. He’s trembling and drenched in sweat[1]. His voice is shaky as he says: “I haven’t had a drink today… I usually have a few by now.”
04
Question 03/03
Correct! Mx. Carter is going through alcohol withdrawl. The team asks him some questions about his lifestlye. Click on each card to reveal his answers.
Mr. Carter diet is irregular but he eats mainly carbs and protein. He limits his saturated and trans fat intake but treats himself occasionaly to maintain a normal BMI range.
Mr. Carter discloses his chronic alcohol use for 10+ years. He usually has 4-6 standard drinks per day. He does not do any other substances.
Before his unemployment, he was active most days of the week. With his health issues he does as much exercise as he can.
Physical Activity
Substance Use
DIET
Perfect, you have passed!
Advance to the next lesson
Continuing
Escape Education
Complete the activity for each lesson to get closer to your diagnosis
Symptoms 101
Labs 101
Histology 101
Final Diagnosis
Disease Managment 101
Causes 101
Disease Management 101
🧠 Let’s Test Your Knowledge further with the Disease Management Crossword Puzzle!
Next
Disease Management 101
Hint 1: Medication used to treat hepatic encephalopathy by reducing ammonia levels [4]
Neomycin
Lactulose
Rifaximin
Disease Management 101
Hint 2: Diagnostic procedure used to assess ascitic fluid for infection [4]
Paracentesis
Ascitic tap
Fluid analysis
Disease Management 101
Hint 3: Transplant - The only definitive treatment for end-stage liver disease [6]
Hepatic
Organ
Liver
Disease Management 101
Hint 4: A non-selective beta-blocker commonly used for portal hypertension [4]
Carvedilol
Propranolol
Nadolol
Disease Management 101
Hint 5: This diuretic is often combined with furosemide to manage ascites [6]
Spironolactone
Eplerenone
Amiloride
Disease Management 101
Hint 6: Procedure to remove fluid from the abdomen [6]
Puncture
Peritoneocentesis
Paracentesis
Disease Management 101
Hint 7: Used to reduce portal hypertension [6]
Beta blockers
Paracentesis
Portosystemic
Disease Management 101
Congrats! You've completed the Disease Management Crossword Puzzle!
Perfect, you have passed!
Move on to the next lesson
Continuing
Escape Education
Complete the activity for each lesson to get closer to your diagnosis
Symptoms 101
Labs 101
Histology 101
Final Diagnosis
Disease Managment 101
Causes 101
Final Diagnosis
Congratulations Doctor! After navigating complex symptoms, decoding hidden clues, and interpreting vital test results, your team has stabilized the patient just in time. But before you can discharge this case, there’s one final task...
Perfect, you have passed!
You have completed all the lessons, we have finished
Great!
Escape Education
Great! You have passed all the lessons in time. Now, get your diploma!
Let's go!
Pathology School
Congratulations!
Healthcare Diploma
You did it! You successfully diagnosed and saved the patient's life.
This answer is incorrect
Try again, come on!
Back
Infections
Hepatitis Viruses
Chronic infection with hepatitis B or C viruses causes continuous inflammation of the liver. If left untreated, this can result in fibrosis and eventually cirrhosis, even if symptoms don’t appear right away[5].
Drugs/Toxins
Can cause toxic hepatitis
Exposure to certain chemicals, drugs, or toxins (like high doses of acetaminophen) can damage liver cells and lead to cirrhosis[5].
Common Bile Duct
Bile leaves the liver via the right and left hepatic ducts which join to form the common hepatic duct; this then becomes known as the common bile duct (CBD) after it is joined by the cystic duct from the gallbladder [5].
Autoimmune Diseases
In autoimmune hepatitis, the body’s immune system attacks liver cells. Other diseases like primary biliary cholangitis (PBC) or primary sclerosing cholangitis (PSC) affect the bile ducts, causing inflammation and scarring that can result in cirrhosis over time[3,5].
Portal Vein
Since the liver has a dual blood system, it also receives nutrient-rich, but deoxygenated, blood from the gastrointestinal tract through the portal vein for processing before draining into the central vein [5].
The Aorta
The aorta supplies the liver with oxygen-rich blood through the hepatic artery [5].
NAFLD/NASH
Non-alcoholic fatty liver disease (NAFLD) is caused by fat buildup in the liver without alcohol use but often due to obesity, diabetes, and poor diet and lifestyle choices. Its more severe form, Non-alcoholic steatohepatitis (NASH), leads to inflammation and scarring[5].
Genetics
Metabolic Disorders
Some inherited conditions can lead to liver damage and cirrhosis over time:• Hemochromatosis causes excess iron to build up in the liver, damaging tissues[5]. • Wilson’s disease leads to toxic copper accumulation due to poor copper elimination[3]. • Alpha-1 antitrypsin deficiency results in abnormal protein buildup in liver cells, causing inflammation and scarring[5].
Inferior Vena Cava
After the arterial and venous blood enters the liver via the hepatic artery and portal veins, it flows through the sinusoids during which it washes over the hepatocytes for processing. This blood then exits through the central veins, into the hepatic veins, and finally returns to the heart via the inferior vena cava [5].
The Gallbladder
The gallbladder is a pear-shaped sac that lies behind the liver. Its main function is to store and concentrate bile that is produced by hepatocytes and release the stored bile via the cystic duct when needed [5].
Alcohol
Long-term heavy alcohol consumption damages liver cells, causing inflammation and scarring. Over time, this repeated injury leads to alcoholic cirrhosis, one of the most common preventable forms of liver damage[5].
Hepatic Artery
The liver is unique as it has a dual blood supply, receiving blood from two major vessels; one of which is the heaptic artery to supply the liver with oxygen-rich blood before draining into the central vein [5].
The Liver
The liver, located in the upper right portion of the abdomen just above the gallbladder, is one of the body's largest and most essential organs. Weighing approximately 1.2 to 1.5 kg in an average adult, it is divided into two main lobes: the right and left lobes. It is composed of various cell types, but its primary functional units are hepatocytes. Also, between these hepatocytes exist permeable capillaries called sinusoids [5].