Chapter 20 - Sonographic Techniques in the Transplant Patient

cirrhosis due to chronic Hep C (#1) followed by alcohol abuse

Most common reason for liver transplants in the US

Model for End-stage Liver Disease: scoring system for assessing the severity of chronic liver disease

What is MELD?

increased need for a transplant

What does a higher MELD score mean?

choledochodochostomy

procedure done between a donor and recipient bile ducts

Decreased preservation time in a living donor

A living liver allograft may function more quickly than a cadaveric one. Why?

day 0, immediately after surgery

then day 1 and 7

On what days do you scan a liver allograft?

Hepatic arteries

What vessels are not normally included in a native liver scan, but are very important to evaluate in a transplant patient?

proximal stenosis

A low RI can be a strong indicator of

rejection or hepatic venous congestion

A high RI may indicate

3-7mm

Normal CHD measurement in a transplant patient

5-9mm

Normal CBD measurement in a transplant patient

0.5-0.7

Normal RI of hepatic artery

common

Postoperative fluid collections: common or uncommon?

rejection

Most common cause for liver transplant failure

10

Acute rejection occurs within the first _____ days of transplantation

A

Select the group that maintains a centralized computer network system for all organ procurement organizations and transplant centers.

a. UNOS

b. NASH

c. PBC

d. MELD

B

Which of the following scoring methods helps determine the urgency of a liver transplant in children 12 and under?

a. MELD

b. PELD

c. UNOS

d. WHO

C

What is the most common cause of renal transplants?

a. Chronic infection

b. Glomerulonephritis

c. Renal failure

d. Acute nephrolithiasis

C

Which intervention is used in hopes to cure type 1 diabetes.

a. Insulin injections

b. Islet cell grafting

c. Pancreatic transplant

d. Renal transplant

A

Which of the following vessels is anastomosed with the new liver during a liver transplant procedure?

a. IVC

b. Cystic artery

c. SMA

d. Aorta

B

When is the baseline liver sonogram performed after a liver transplant procedure?

a. Within 1 day after surgery

b. Day 0 or immediately after surgery

c. 7 days after surgery

d. 3 days after surgery

C

Which of the following best indicates the presence of an arteriovenous fistula (AVF)?

a. Flow aliasing

b. Absence of color flow

c. Low resistive index (RI)

d. Focal cystic areas

D

Identify the normal resistive index (RI) in the hepatic artery of a transplant patient.

a. 0.20

b. ± 0.80

c. 0.30 to 0.45

d. 0.50 to 0.70

A

What is the most common cause of liver transplant failure?

a. Rejection

b. Infection

c. Abscesses

d. Vascular compromise

B

What technique parameter helps spread out the waveform during a spectral Doppler study of a renal allograft?

a. Overall gain

b. Sweep speed

c. Angle correct

d. Scale

C

Choose the normal resistive index (RI) range in the arcuate artery of a transplanted kidney.

a. 250 cm/sec

b. 3.0

c. 0.60 to 0.70

d. > 0.90

D

More than ________ of renal transplants develop an infection in the first year.

a. one third

b. 50%

c. one in five

d. 80%

A

Select the renal transplant complication that occurs within the first week of transplantation.

a. Renal vein thrombosis

b. Chronic renal failure

c. Urinary obstruction

d. Renal artery stenosis

B

How would you determine stenosis in a transplanted kidney?

a. Take a blood pressure

b. Perform a resistive index

c. Do a gain study

d. Check bladder wall thickness

C

Choose the indicator of a proximal stenosis in an intraparenchymal artery in the transplanted pancreas.

a. Pulsatile flow

b. High pulsatility index

c. Low resistive index (RI)

d. Normal color flow

D

Which of the following is a rare complication that results from hyperacute rejection of post-transplant pancreas patient?

a. Acute pancreatitis

b. Infection and abscess

c. Pancreatic venous thrombosis

d. Thrombosis and graft loss

A

What is the first step to formally become an organ donor?

a. Register as an organ donor

b. Develop an organ donation protocol

c. Perform above-average sonographic examinations

d. Talk to your family