THEBRIGHT EXAM SOLUTIONS 8/20/2024 8:37 PM
CCTC Review Exam Questions With Correct
Answers
Procedure for liver transplant - answer✔✔Anastomosis of the inferior vena cava, portal vein,
hepatic artery, and the biliary connection via a duct to duct anastomosis (
choledochocholeclochostomy)
Etiology of renal dysfunction immediately post op(liver tx) - answer✔✔Hypotensive episodes,
blood loss, high renal vein pressure intraoperatively and postoperatively due to hemodynamically
instability or sepsis.
Leading cause of non graft related death for liver recipients - answer✔✔Cardiorespiratory failure
Which immunosuppressants cause HTN - answer✔✔Calcineurin inhibitors or corticosteroids
Which lab to monitor with fever post tx - answer✔✔Crp- c reactive protein because protein
present with acute inflammation and sepsis
Indicative of rejection - answer✔✔Light stools and dark urine,
Indicative of poor graft function s/p liver transplant - answer✔✔High lactate and acidosis, high
ALT/AST, PT >25 sec and continues to rise after vit k and FFP
type 2 diabetes - answer✔✔More common, occurs in adulthood, characterized by insulin
resistance. As resistance rise, beta cells are eventually unable to produce necessary amount of
insulin to lower and maintain normal blood glucose levels.
type 1 diabetes mellitus - answer✔✔diabetes in which no beta-cell production of insulin occurs
and the patient is dependent on insulin for survival
Goal of pancreas transplant - answer✔✔To restore normoglycemia, halt or prevent secondary
complications of diabetes
Indications for pancreas transplant alone (PTA) or pancreas after kidney (PAK) transplant -
answer✔✔Type 1 DM manifested by poor metabolic control, especially hypoglycemic
unawareness for many years. On insulin and C-peptide at or < 2 ng/ml or on insulin and C-
peptide at or greater than 2ng/mg and BMI at or less than maximum allowable BMI (currently
28) and pancreatic exocrine insufficiency.
, THEBRIGHT EXAM SOLUTIONS 8/20/2024 8:37 PM
Indications for Simultaneous pancreas-kidney (SPK) transplant - answer✔✔Diagnosis of
diabetes or pancreatic exocrine insufficiency with renal insufficiency
Immunosuppressive medications are covered by which part of Medicare? - answer✔✔Medicare
part B
Standard immunosuppressive for pancreas transplant recipients typically includes: -
answer✔✔Tacrolimus(prograf, FK506), mycophenolate mofetil (cellcept), prednisone(steroid)
Reason why native pancreas left in place during pancreas tx - answer✔✔Allows the exocrine
function of native pancreas to be preserved.
Enteric Drainage( ED) post pancreas transplant - answer✔✔More common, difficult to detect
rejection, donor portal vein anastomosed to recipients SMV(superior mesenteric vein), donor
duodenal segment attached to recipients jejunum, pancreases produces 2L of fluid drainage,
pancreatic enzymes excreted thru the stool
Advantages of Enteric drain (ED) post pancreas transplant - answer✔✔More physiologic, fewer
metabolic imbalances because pancreatic secretions are reabsorbed, less post-op complications
Bladder Drainage (BD) post pancreas transplant - answer✔✔Easier to monitor for rejection with
urine amylase, may cause dehydration and cystitis. Direct monitoring of graft exocrine function,
easier to perform biopsy, less invasive if complications arise.
Disadvantages of Bladder Drainage (BD) post pancreas transplant - answer✔✔Dehydration,
cystitis, UTIs, metabolic acidosis, urine leak, hematuria, 35% go on to need enteric conversion,
pancreatitis
Patients with anastomotic leak post pancreas transplant may present with what? -
answer✔✔Elevated serum amylase levels
C-peptide normal range - answer✔✔0.8-3.1
What is a sign of late rejection post pancreas transplant? - answer✔✔Hyperglycemia
Patients with chronic pancreas rejection can present with what? - answer✔✔Progressive need for
insulin
In pancreas transplant recipients temperature elevations may indicate what? -
answer✔✔Infection, pancreatitis, acute rejection
Cvp range post pancreas transplant - answer✔✔5-10
When should you notify transplant team in regards to urine output s/p pancreas transplant -
answer✔✔Urine output <50 and >200 ml/hr in the first 24hrs post tx
, THEBRIGHT EXAM SOLUTIONS 8/20/2024 8:37 PM
Why is it important for adequate perfusion of graft post pancreas tx - answer✔✔Pancreas graft is
"low blood flow" organ higher potential for graft thrombosis
Which rejection is more common in PTA patients? - answer✔✔Acute happens earlier and more
frequent
Pancreatic graft function monitored by which labs? - answer✔✔Serum glucose, serum amylase
and serum lipase concentrations, glycosylated hgb, fasting C-peptide
What can an acute spike in glucose level early postop pancreas tx indicate? - answer✔✔Vascular
thrombosis of graft, (US COMMONLY ORDERED TO RULE OUT THROMBOSIS)
Serum amylase may be elevated 48-96hrs post pancreas tx due to what? - answer✔✔Damage to
the organ during cold ischemic preservation, manipulation of the organ during recovery,
What can cause elevated serum amylase after pancreas tx - answer✔✔Anastomoses leak, venous
thrombosis, subsequent to transplant biopsy
Decreased amylase in BD drain pancreas recipient can be caused by what? -
answer✔✔Indicative of graft rejection
What is a way to monitor for organ rejection in BD pancreas transplant recipients -
answer✔✔An 8 hour urine collection
Amylase levels 1500- 7000 IU/hr within a few days after pancreas transplant indicate what? -
answer✔✔Good initial graft function
Clinical indications of vascular thrombosis in pancreas transplant recipients - answer✔✔Abrupt
rise in glucose, sharp rise in serum amylase or lipase, tenderness or pain over graft site in BD
recipients: massive hematuria, decrease or absence of urine amylase levels,
Pancreatitis symptoms - answer✔✔Low grade temp, elevated serum amylase and lipase( these
may be elevated first 2-3 days after tx) decreased urine amylase, graft tenderness, abdominal
pain, n&v, endocrine secretory capacity ( insulin secretion) often only mildly impaired
ED pancreas tx anastomotic leak patients present with - answer✔✔Fever, elevated WBC , n& v,
abdominal pain, elevated serum amylase abd creatinine
How is pancreas rejection diagnosed (procedure) - answer✔✔Pancreas allograft biopsy
Diagnoses leading to end stage lung disease in children - answer✔✔Alveolar proteinosis,
bronchiectasis, bronchopulmonary dysplasia, cystic fibrosis, interstitial lung disease, pulmonary
hypertension
