CCTC CERTIFICATION REVIEW
QUESTIONS WITH ALL CORRECT
ANSWERS
What can green drainage post liver TX indicate? - Answer- Bile leakage
What can a rise in ALP post liver tx indicate? - Answer- Can be a sign of biliary
complications or cholestasis
Lab changes are indicate of graft dysfunction. Which values will be elevated for liver tx?
- Answer- Elevated AST and ALT
Target levels for immunosuppressants are based on a number of factors including: -
Answer- Indication for tx, use of induction therapy, kidney function, overall condition of
pt.
What can lead to metabolic encephalopathy post liver transplant? - Answer- Renal
failure or sepsis
What can lead to hypoxic ischemic encephalopathy post liver transplant? - Answer-
Significant peri-operative hypotension
De Novo seizures can occur post liver transplant and can be caused by what? -
Answer- Electrolyte imbalances, reaction to cyclosporine or tacrolimus, intracranial
hemorrhage or cerebral infarction and intracerebral abscesses
What can cause a post liver transplant patient whose initial postop neurological course
is normal to develop sudden deterioration in neurological status? - Answer- Intracranial
bleed
Risk of primary non-function after liver transplant is: - Answer- 4-6%
Factors related to primary nonfunction of new liver include: - Answer- Donor age,
prolonged cold ischemic time, prolonged donor hospital stay with periods of
hypotension, preservation injury during donor surgery, and donor steatosis(fat in liver)
Early Indicators of non functioning liver: - Answer- decrease in bile production
extreme edema of organ
Abnormal color of organ upon reperfusion(mottled, gray, pale)
, lack of reperfusion in OR
urine output <30ml/hr
hemodynamically unstable
glucose, k, and lactate abnormalities
Coagulopathy
Clinical presentation for hepatic artery stenosis(HAT) - Answer- Increase in LFTs due to
decreased blood flow through the hapatic artery to new organ
Delayed bile leak
Persistent sepsis of unknown cause
What test is the gold standard for HAT diagnosis? - Answer- Angiography
What is treatment for HAT? - Answer- Immediate return to OR for revascularization of
organ
Symptoms of bleeding post liver transplant include: - Answer- Increased swelling in
abdomen
Pallor
Clinical manifestations of hypovolemia
Some BP meds may increase cyclosporine or tacrolimus levels, name 2 - Answer-
Diltiazem(Cardizem)
Verapamil(Calan)
What are causes of cholestasis post liver transplant - Answer- Rejection
Sepsis
Drug toxicity
Preservation injury
Clinical manifestations of cholestasis - Answer- Cloy or white stools
Dark urine
Itching
Pain in upper right quadrant
Jaundice
Inability to digest certain foods
N&V
Locations of bile leaks post liver transplant - Answer- Anastomosis site
T tube exit site
Along the t tube tract at time of removal
Within the liver as result of bile duct destruction(bile leak)
From the cut surface in split liver, living donor transplant, or after biopsy
CMV clinical manifestations - Answer- High fever, rigors, body aches, night sweats
QUESTIONS WITH ALL CORRECT
ANSWERS
What can green drainage post liver TX indicate? - Answer- Bile leakage
What can a rise in ALP post liver tx indicate? - Answer- Can be a sign of biliary
complications or cholestasis
Lab changes are indicate of graft dysfunction. Which values will be elevated for liver tx?
- Answer- Elevated AST and ALT
Target levels for immunosuppressants are based on a number of factors including: -
Answer- Indication for tx, use of induction therapy, kidney function, overall condition of
pt.
What can lead to metabolic encephalopathy post liver transplant? - Answer- Renal
failure or sepsis
What can lead to hypoxic ischemic encephalopathy post liver transplant? - Answer-
Significant peri-operative hypotension
De Novo seizures can occur post liver transplant and can be caused by what? -
Answer- Electrolyte imbalances, reaction to cyclosporine or tacrolimus, intracranial
hemorrhage or cerebral infarction and intracerebral abscesses
What can cause a post liver transplant patient whose initial postop neurological course
is normal to develop sudden deterioration in neurological status? - Answer- Intracranial
bleed
Risk of primary non-function after liver transplant is: - Answer- 4-6%
Factors related to primary nonfunction of new liver include: - Answer- Donor age,
prolonged cold ischemic time, prolonged donor hospital stay with periods of
hypotension, preservation injury during donor surgery, and donor steatosis(fat in liver)
Early Indicators of non functioning liver: - Answer- decrease in bile production
extreme edema of organ
Abnormal color of organ upon reperfusion(mottled, gray, pale)
, lack of reperfusion in OR
urine output <30ml/hr
hemodynamically unstable
glucose, k, and lactate abnormalities
Coagulopathy
Clinical presentation for hepatic artery stenosis(HAT) - Answer- Increase in LFTs due to
decreased blood flow through the hapatic artery to new organ
Delayed bile leak
Persistent sepsis of unknown cause
What test is the gold standard for HAT diagnosis? - Answer- Angiography
What is treatment for HAT? - Answer- Immediate return to OR for revascularization of
organ
Symptoms of bleeding post liver transplant include: - Answer- Increased swelling in
abdomen
Pallor
Clinical manifestations of hypovolemia
Some BP meds may increase cyclosporine or tacrolimus levels, name 2 - Answer-
Diltiazem(Cardizem)
Verapamil(Calan)
What are causes of cholestasis post liver transplant - Answer- Rejection
Sepsis
Drug toxicity
Preservation injury
Clinical manifestations of cholestasis - Answer- Cloy or white stools
Dark urine
Itching
Pain in upper right quadrant
Jaundice
Inability to digest certain foods
N&V
Locations of bile leaks post liver transplant - Answer- Anastomosis site
T tube exit site
Along the t tube tract at time of removal
Within the liver as result of bile duct destruction(bile leak)
From the cut surface in split liver, living donor transplant, or after biopsy
CMV clinical manifestations - Answer- High fever, rigors, body aches, night sweats
