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MEDICAL SURGICAL 3 > LIVER TRANSPLANT > Flashcards

LIVER TRANSPLANT Flashcards

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USMLE® Step 1 flashcards
1
Q

involves the total removal of the diseased liver and replacement with a healthy liver from a cadaver donor or the right lobe from a live donor in the same anatomic location

A

Liver transplantation

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2
Q

The success of liver transplantation depends on successful ________

A

Immunosuppression

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3
Q

In order to prevent acute rejection in the early, high-risk months after liver
transplantation, some centers employ induction therapy. What are the medications used for this?

A

BL

Basiliximab
Lymphocyte immune globulin (Atgam)

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4
Q

What are the general indications for liver transplantation?

A

IFMH

Irreversible advanced chronic liver disease

Fulminant hepatic failure

Metabolic liver diseases

Hepatic malignancies.

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5
Q

Immunosuppressant agents currently used in liver transplantation

A

3C PRBD

Corticosteroid
Calcineurin Inhibitors
Cell-Cycle Inhibitors

Polyclonal Antibodies (Anti-Thymocyte)
Basiliximab
Daclizumab

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6
Q

Some patients are treated with “triple therapy” using

A

3C

Corticosteroids
Calcineurin inhibitor
Cell-cycle Inhibitor or TOR Inhibitor

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7
Q

Is an objective determination of medical need that stratifies the level of illness for patients awaiting a liver transplant, based on a formula incorporating bilirubin levels, prothrombin time, creatinine, and the cause of liver disease.

A

Model for End-Stage Liver Disease (MELD) classification

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8
Q

Other transplant centers advocate monotherapy with what medication?

A

Calcineurin inhibitor

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9
Q

What factors are included in calculating the MELD score?

A

BP CC

Bilirubin levels
Prothrombin time (INR)
Creatinine levels
Cause of liver disease.

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10
Q

This classification for liver trasnplant system classifies the severity of liver disease and stratifies patients into levels for varied treatment regimens.

A

Child–Pugh score

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11
Q

How does the MELD score differ from the Child–Pugh score?

A

The MELD score is an indicator of short-term mortality for patients with end-stage liver disease (ESLD), while the Child–Pugh score is used for treatment stratification.

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12
Q

Before the donor liver is placed in the recipient, it is flushed with _____________solution to remove potassium and air bubbles.

A

Cold lactated Ringer

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13
Q

is used to decompress the venous system below the diaphragm by temporarily shunting blood to the superior vena cava, minimizing complications from portal hypertension

A

Venovenous bypass

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14
Q

What are types of biliary anastomoses performed during liver transplantation

A

End-to-end anastomosis

Biliary-enteric end-to-side anastomosis or Roux-en-Y procedure

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15
Q

involves creating a biliary-enteric end-to-side anastomosis with a 40- to 50-cm loop of jejunum for biliary drainage.

A

A Roux-en-Y procedure

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16
Q

Describe the criteria for considering living donor liver transplantation (LDLT).

A

High potential for mortality while awaiting a cadaveric liver donor

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17
Q

involves the transplantation of the right hepatic lobe from an adult donor to the recipient, including a formal right hepatic lobectomy and vascular reconstruction

A

Living donor liver transplantation (LDLT).

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18
Q

TRUE or FALSE?

After transplant, the transplanted lobe will regenerate itself, and the removed portion of the donor’s liver will also regenerate.

A

TRUE

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19
Q

Describe the difference between living donor liver transplantation and orthotopic liver transplant.

A

Living donor liver transplantation involves taking a portion of the liver from a living donor, while orthotopic liver transplant involves the whole liver being taken from a recently deceased donor.

20
Q

The single most common indication for liver transplantation in adults is

A

Viral hepatitis C

21
Q

Define the groups for whom liver transplantation is not indicated.

A

Unlikely to survive major surgery

Cannot endure long-term immunosuppression

Patients with diseases likely to recur quickly and fatally

Individuals unwilling to comply with demanding medical regimens

22
Q

What factors determine placement on the liver transplant waiting list?

A

Blood type

Weight

Patient urgency
- Acute liver failure being prioritized as status 1 at the top of the list

23
Q

Describe the criteria for matching a donor liver to a recipient.

A

Blood type and body size

24
Q

What screening is performed on potential liver donors?

A

Infectious diseases and metastatic carcinomas

*to prevent transmission to the recipient.

25
Q

How can ABO incompatibility affect liver transplantation?

A

Cam result to post operative complication of mild hemolysis and increased incidence of acute cellular rejection.

26
Q

_________can improve graft survival for patients who have ABO incompatibility with their donor liver

A

Plasmapheresis

27
Q

The first stage, known as ___________, involves the removal of the native liver and is the longest and most difficult part of the surgery.

A

Recipient hepatectomy

28
Q

What are the four vascular anastomoses involved in the second stage of liver transplant?

A

SIHP

Suprahepatic inferior vena cava
Infrahepatic vena cava
Hepatic artery
Portal vein.

29
Q

__________connects the bile duct to the jejunum and is used for patients with diseased bile ducts, while _____________ connects the patient’s common bile duct to the donor’s bile duct and is used when the common bile duct is healthy.

A

(1) Choledochojejunostomy

(2) Choledochocholedochostomy

30
Q

is considered the most definitive diagnosis for acute rejection of allograft, showing portal and bile duct inflammation and the presence of inflammatory cells in the liver tissue.

A

Liver biopsy

31
Q

This stage involves biliary anastomosis, which is crucial for ensuring proper bile drainage from the donor liver to the recipient.

A

The third stage

32
Q

__________Increases the difficulty in liver transplantation

A

Portal HYpertension

*Venovenous bypasss is used to minimize this problem

33
Q

in thi transplant, a single organ is used to provide grafts for two individuals with ESLD, with the smaller patient receiving the smaller left lobe. This procedure has resulted in a higher complication rate and lower survival rate than traditional liver transplantation.

A

Split-liver transplant

34
Q

This type of liver transplant is more common in pediatric liver transplantation from a parent to his or her infant.

A

Living donor liver transplantation (LDLT)

35
Q

Most common type of liver transplant, the whole liver is taken from a recently deceased donor.

A

Orthotopic Liver Transplantation

36
Q

Most common indication in pediatric patient for liver transplant is

A

Biliary atresia and metabolic
disorders

37
Q

Complication for donor, which is described as not life-threatening, do not result in permanent disability.

A

GRADE 1

38
Q

Complication for donor, which require medications or transfusion.

A

GRADE 2

39
Q

Complication for donor, which can be potentially life-threatening and require
invasive therapy (Resurgery)

A

GRADE 3

40
Q

Complication for donor, which can lead to disability or death

A

GRADE 4

41
Q

Signs of Perforation

A

SEP F

Sudden, severe abdominal pain

Enlarged abdomen

Presence of tenderness and rigidity of the abdominal wall

Fever

42
Q

To balance the importance of good cardiac function against the risk of passive congestion of the liver, the CVP is maintained at

A

10 mL H2O

43
Q

If the stool of the patient is brown post op, the T tube should be?

A

Clamped

*bile

44
Q

If the stool of the patient is gray post op, the T tube should be?

A

Unclamped

*Acholic

45
Q

For patient who undergoes a Roux-en-Y biliary anastomosis, NGT is kept longer to prevent what?

A

Postoperative ileus

46
Q

Late signs of rejection include:

A

Jaundice
Malaise
Dark urine
Clay-colored stools.

MEDICAL SURGICAL 3 (6 decks)

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