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CCTC EXAM REVIEW EXAM 2023
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CCTC EXAM REVIEW EXAM 2023 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. 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 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 -Voordelen van het kopen van samenvattingen bij Stuvia op een rij:
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