LIVER TRANSPLANT Flashcards
WHAT IS THE MOST IMPORTANT FACTOR IN TRANSPLANT?
IMMUNOSUPRESSIVE DRUGS
WHAT ARE CONTRAINDICATIONS TO A LIVER TRANSPLANT?
WIDESPREAD CA, UNCONTROLLED INFECTION OUTSIDE LIVER/GALL BLADDER, SEVERE CARDIAC/NEURO DX, INTRACTABLE DRUG ETOH USE, HIV, INABILITY FOR MEDICAL FOLLOW UP.
HOW DOES LIVER DX AFFECT CAPILLARIES?
THE DX LIVER PRODUCES LESS PROTEIN SO YOU HAVE MORE PUSHERS THAN PULLERS FORCING CAPILLARIES TO LEAK FLUID. RESULTS IN ASCITES AND IV SPACE FILLED WITH TOXINS.
WHAT TYPE OF PULMONARY DEFECT RESULTS FROM ASCITES?
RESTRICTIVE. …DRAIN PLURAL EFFUSION OR ASCITIC FLUID. THEY ALSO MAY HAVE SHUNTING, V/Q MISMATCH, INCREASED CLOSING CAPACITY AND IMPAIRED HYPOXIC VASOCONSTRICTION.
WHAT DOES THE PREOP CARDIAC STATUS OF A LIVER TRANSPLANT PT LOOK LIKE?
WILL SEE LOW BP, LOW CVP (HIGH CIRCULATING TOXINS) BUT HIGH CO.
CARDIAC OUTPUT AND SVR HAVE INVERSE RELATIONSHIP.
SHOULD YOU SEDATE PTS AWAITING LIVER TRANSPLANT?
NO. MANY HAVE HEPATIC ENCEPHALOPATHY AND GIVING THEM SEDATIVES MAY MAKE THEM OBTUNDED.
ENCEPHALOPATHY MAY BE SO BAD IT CAUSES EDEMA AND DIURETICS MAY NEED TO BE GIVEN TO DECREASE ICP.
REVERSE TRENDEL. ON INDUCTION IS HELPFUL TOO.
WHAT IS HEPATORENAL SYNDROME?
REDUCTION IN RENAL FLOW, GFR, U/O, AND DILUTIONAL HYPONATREMIA DESPITE NO KIDNEY PROBLEMS. ITS A LATE COMPLICATION OF LIVER DX.
WHAT COAGULATION ABNORMALITIES DO YOU SEE WITH LIVER TRANS PTS.?
MALABSORPTION OF VIT K….WHICH DECREASES PLASMINOGEN AND ALPHA ANTIPLASMIN.
ALSO SEE DECREASED PRODUCTION OF COAG FACTORS 3, 7, 9, 10.
WHAT IS THE VOLUME OF DISTRIBUTION LIKE IN LIVER PATIENTS?
UNPREDICTABLE.
LESS ALBUMIN SO HIGH LEVELS OF ACIDIC DRUGS
MORE GLYCOPROTIEN SO LOW LEVELS OF BASIC DRUGS.
WHAT 3 FACTORS DETERMINE HEPATIC EXTRACTION OF DRUG?
- HEPATIC BLOOD FLOW
- DRUG PROTEIN BINDING
- MAXIMAL INTRINSIC CAPACITY OF ENZYME
PREOP/TABLETOP PREP FOR LIVER TRANS?
2 BLOOD WARMERS WITH BLOOD IN ROOM.
PLASMALYTE FOR IV FLUID.
UPPER AND LOWER BAIR HUGGER. ALINE, PA CATH.
DOPAMINE INFUSION: 2MICG/KG/MIN.
VENOVENO BYPASS CANNULA SETUP.
INDUCTION DRUGS PLUS SYRINGES OF EPI, NEO, CACL2, BICARB, AMICAR.
INDUCTION FOR LIVER TRANS?
RSI WITH ETOMIDATE OR LOW DOSE PROPOFOL AND SUCCS.
WHAT IS THE POINT OF VENO VENO BYPASS?
TO IMPROVE HEMODYNAMIC STABILITY (REDUCE BLEEDING FROM ENGORGED PORTAL SYSTEM) DURING THE ANHEPATIC PHASE.
WHAT ARE COMPLICATION OF VENO VENO BYPASS?
AIR/THROMBO EMBOLUS. HYPOTHERMIA, AND TRAUMA TO BRACHIAL PLEXUS.
WHAT IS MAINTENANCE PHASE OF LIVER TRANSPLANT LIKE?
IV NARCS, MR, AND ISO. ISO MAINTAINES HEPATIC ARTERIAL AUTOREGULATION AND OXYGENATION BEST.
IF ISO NEEDS TO BE TURNED DOWN IF BP TANKS USE VERSED TO SUPPLEMENT.
CLEARANCE OF FENTANYL AND SUFENTANYL ARE UNCHANGED IN LIVER PTS!! GOOD CHOICE.
