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145 Cards in this Set
- Front
- Back
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What are the indicators for needing a renal transplant? |
End stage renal disease, Chronic renal disease, renal failure, glomerulonephritis, Systemic Lupus, Adult Polycystic Disease, Diabetes 1, Pt on renal dialysis |
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Indicators of liver transplant? |
End stage liver disease: Cirrhosis due to chronic hepatitis C, followed by alcohol abuse. Cancer, fulminate liver failure, Biliary atresia, HEpatocellular Disease, vascular disease |
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For a renal transplant: what types? |
Cadaveric or living. Living lasts longer. |
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For a liver transplant, what type? What’s about the liver segment? |
Living or cadaveric. Single hepatic artery, single hepatic vein, single portal vein. |
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For a liver transplant, what type? What’s about the liver segment? |
Living or cadaveric. Single hepatic artery, single hepatic vein, single portal vein. |
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What labs are evaluated for liver and kidney? |
Kidney: creatinine Liver: AST, bilirubin, alkaline phosphate. Anti rejection medication levels |
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Fifth most common malignant tumor. It’s a primary malignant tumor in the liver? |
Hepatocellular carcinoma |
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Fifth most common malignant tumor. It’s a primary malignant tumor in the liver? |
Hepatocellular carcinoma |
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Signs and sx for someone needing a renal transplant? |
Decreased urine output, edema in the legs / feet, SOB, nausea, chest pain, difficult sleeping, seizures. |
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Fifth most common malignant tumor. It’s a primary malignant tumor in the liver? |
Hepatocellular carcinoma |
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Signs and sx for someone needing a renal transplant? |
Decreased urine output, edema in the legs / feet, SOB, nausea, chest pain, difficult sleeping, seizures. |
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To gather a baseline post op, what is completed for a liver transplant evaluation? |
Evaluate day 0: eval in 2 planes left and right hepatic lobes, caudate lobe, IVC, Hepatic VEins, portal veins, Rt lobe of liver compared to right kidney. Eval hepatic artery: RT, LT, Main hepatic artery (Doppler) Obtain RI- low RI indicator of prox stenosis and high RI indicated rejection or hepatic venous congestion. |
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For a living donor transplant of the liver, what is not provided? |
Right lobe of liver is only present, NOT left lobe. |
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Normal resistance of Hepatic Artery is? |
0.50-0.70. Left hepatic vein appears more pulsation because it’s closer proximity to the heart. |
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Post op of urgent liver transplant include which findings? |
Hepatic Artery Thrombosis / stenosis, portal vein, stenosis, hepatic vein stenosis, IVC thrombosis or occlusion, fluid (..not limited to). |
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Post op of liver transplant include which findings? |
Hepatic Artery Thrombosis / stenosis, portal vein, stenosis, hepatic vein stenosis, IVC thrombosis or occlusion, fluid (..not limited to). |
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Most common cause for liver transplant failure? |
Rejection. Acute rejection: First 10 days. Chronic rejection- slowly over time, deteriorating liver graft causing fibrosis. |
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Post op of liver transplant include which findings? |
Hepatic Artery Thrombosis / stenosis, portal vein, stenosis, hepatic vein stenosis, IVC thrombosis or occlusion, fluid (..not limited to). |
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Most common cause for liver transplant failure? |
Rejection. Acute rejection: First 10 days. Chronic rejection- slowly over time, deteriorating liver graft causing fibrosis. |
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Post op liver transplant, pt dx include: RUQ pain, fever, tachycardia, hepatomegaly, ascites. Finding? |
Acute rejection |
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Post op of liver transplant include which findings? |
Hepatic Artery Thrombosis / stenosis, portal vein, stenosis, hepatic vein stenosis, IVC thrombosis or occlusion, fluid (..not limited to). |
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Most common cause for liver transplant failure? |
Rejection. Acute rejection: First 10 days. Chronic rejection- slowly over time, deteriorating liver graft causing fibrosis. |
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Post op liver transplant, pt dx include: RUQ pain, fever, tachycardia, hepatomegaly, ascites. Finding? |
Acute rejection |
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Post op of liver transplant: pt sx include: fever, RUQ pain, jaundice. Finding? |
Abscess / infection (intrahepatic) |
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Post op of liver transplant include which findings? |
Hepatic Artery Thrombosis / stenosis, portal vein, stenosis, hepatic vein stenosis, IVC thrombosis or occlusion, fluid (..not limited to). |
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Most common cause for liver transplant failure? |
Rejection. Acute rejection: First 10 days. Chronic rejection- slowly over time, deteriorating liver graft causing fibrosis. |
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Post op liver transplant, pt dx include: RUQ pain, fever, tachycardia, hepatomegaly, ascites. Finding? |
Acute rejection |
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Post op of liver transplant: pt sx include: fever, RUQ pain, jaundice. Finding? |
Abscess / infection (intrahepatic) |
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Who are at increased risk to develop an infection post transplant? |
People who are on immunosuppressive medication present with biliary structure or arterial insufficiency. |
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At which location is Thrombosis and stenosis most common to occur at? chronic IVC stenosis is common in which patients? |
At anastomosed sites. Pediatric patients or retransplanted |
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Hepatic vein stenosis occurs in which patients? |
Mostly occurs in living donor transplants |
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Hepatic vein stenosis occurs in which patients? |
Mostly occurs in living donor transplants |
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What are the thrombosis types? Thrombus Sono appearance? |
Occlusive and nonocclusive. Occlusive: no color flow or spectral Doppler. Nonocclusive: some flow visualized around thrombus. New verse old thrombus: old is anechoic and new is echogenic. |
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Hepatic vein stenosis occurs in which patients? |
Mostly occurs in living donor transplants |
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What are the thrombosis types? Sono appearance? |
Occlusive and nonocclusive. Occlusive: no color flow or spectral Doppler. Nonocclusive: some flow visualized around thrombus. New verse old thrombus: old is anechoic and new is echogenic. |
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What is the indicator of hepatic artery stenosis: velocity, RI.. |
Low resistive index < 0.50 with a velocity > 200 cm/ sec and tardus Parvus waveform. (Torturous HA, common to get an elevated false velocity measurement. |
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What’s the most common vasculature complicatjon of liver transplantation? |
Hepatic artery thrombosis |
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What can lead to biliary ischemia? |
Hepatic Artery Thrombosis or Stenosis because it’s the only vascular supply to the biliary ducts. |
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Sono appearance: hypoechoic, wedge shaped located along the periphery of the liver. Finding? |
Hepatic infarction |
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Located at the anastomosed site or occur to angioplasty complication. Most often asymptomatic. Anechoic structure often containing nonocclusive thrombus along the walls located along the course of the hepatic artery. Has a ying yang pattern of flow / bidirectional flow. Finding? |
Hepatic artery pseudo aneurysm. |
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Located at the anastomosed site or occur to angioplasty complication. Most often asymptomatic. Anechoic structure often containing nonocclusive thrombus along the walls located along the course of the hepatic artery. Has a ying yang pattern of flow / bidirectional flow. Finding? |
Hepatic artery pseudo aneurysm. |
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What’s the most common obstruction post liver transplant? |
Biliary ductal obstruction (from stricture at anastomosis but also second to choledocholithiasis. |
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Day 0, what is most common to see along the perihepatic spaces and near vascular and biliary anastomosed sites? |
Hematoma |
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Day 0, what is most common to see along the perihepatic spaces and near vascular and biliary anastomosed sites? |
Bleeding/ Hematoma and seromas. |
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Sono appearance of fresh hematoma to aged hematoma? |
Fresh: internal echoes, echogenic. Age: liquify and become anechoic and may contain septations. |
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What’s a Seroma? |
Clear, serous fluid collection found in the first few days post pancreas transplant. (Most common complication post op pancreas) aside from bleeding |
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What’s a Seroma? |
Clear, serous fluid collection found in the first few days post transplant. |
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Typically found in the groin or retroperitoneal space. Septations or debris within the fluid collection seen. (Most common peritransplant fluid collection for renal transplant) |
Lymphocele |
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This is > 70% in the first month transplant. Leak location: biliary tube site. It’s round, hypoechoic or anechoic fluid collection with no vascular flow. Finding? |
Bile leak and Biloma |
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This is > 70% in the first month transplant. Where’s the Leak location: It’s round, hypoechoic or anechoic fluid collection with no vascular flow. Finding? |
Location: Bile leak and Biloma |
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This resolves 7-10 days later post transplant. |
Ascites |
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Most common cancer malignancies after liver transplant are? |
Skin cancer (exclude melanoma), kaposi sarcoma, non Hodgkin lymphoma. Lymphoma (seen intra or extrahepatic) |
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Most common cancer malignancies after liver transplant are? |
Skin cancer (exclude melanoma), kaposi sarcoma, non Hodgkin lymphoma. Lymphoma (seen intra or extrahepatic) |
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Early post op following transplant - air seen in the portal and mesenteric veins is a common finding. What about if it’s beyond post operative state? |
Poor prognosis: underlying cause of portal venous gas: intestinal ischemia, necrosis, ulcerative colitis, intrabdominal abscess. Bowel ischemia common, dangerous in the elderly. 75-90% mortality rate. |
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Most common cancer malignancies after liver transplant are? |
Skin cancer (exclude melanoma), kaposi sarcoma, non Hodgkin lymphoma. Lymphoma (seen intra or extrahepatic) |
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Early post op following transplant - air seen in the portal and mesenteric veins is a common finding. What about if it’s beyond post operative state? |
Poor prognosis: underlying cause of portal venous gas: intestinal ischemia, necrosis, ulcerative colitis, intrabdominal abscess. Bowel ischemia common, dangerous in the elderly. 75-90% mortality rate. |
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Most severe complication found in the solid organ? More commonly where? |
Post transplant Lymphoproliferative Disorder. More commonly in the extrahepatic. Sono: hypoechoic, May encase the hepatic hilum. |
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Most common benign liver tumor? |
Hemangioma (hypervascular) |
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Most common benign liver tumor? |
Hemangioma (hypervascular) |
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Air in the biliary tree, recent ERCP, incompetent sphincter of oddi, spontaneous biliary- enteric fistula. Finding? |
Pneumobilia |
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Most common benign liver tumor? |
Hemangioma (hypervascular) |
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Air in the biliary tree, recent ERCP, incompetent sphincter of oddi, spontaneous biliary- enteric fistula. Finding? |
Pneumobilia |
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A fatty liver is common in what type of patients? |
70% diabetic patients |
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Pt has RUQ pain, nausea, vomit, loss appetite, full. Sono appearance: hyperechoic lesion, well defined, posterior acoustic enhancement, little or no Doppler. Hypo abd mimics mets. |
Hemangioma |
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Renal Transplant is placed? |
Right iliac fossa |
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If pancreas and kidney replaced with trasnplants, where are they placed? |
Kidney is placed in Lt iliac fossa. Pancreas is placed in Rt iliac fossa. |
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For renals, the anastomosed occurs with what vessels? |
Renal vein to external iliac vein with a suture. |
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For renal transplant a Low RI and High RI indicate? |
Low RI: indicator of proximal stenosis High RI: rejection, renal venous congestion or chronic small vessel disease. |
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When interrogating a renal transplant: what do you Eval? |
Renal vein, Renal artery, actuate arteries (upper, mid, lower pole). Eval bladder (mass, distribution, infection), obtain RI. Eval anastomosed site: between iliac artery and vein and renal artery. |
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Renal artery velocity (normal) is? What’s a normal RI for arcuate artery? |
<250 cm / sec with a renal to iliac artery ratio < 3.0. Arcuate artery: 0.60-0.70. Borderline values between 0.70-0.80. |
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What’s the spectral waveform for renal vein and iliac vein? Iliac artery and CFA? |
RV and Iliac Vein: Monophasic Flow. Iliac artery and CFA: Triphasic Flow |
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What’s the spectral waveform for renal vein and iliac vein? Iliac artery and CFA? |
RV and Iliac Vein: Monophasic Flow. Iliac artery and CFA: Triphasic Flow |
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Renal Post of urgent findings include? |
Renal artery severe stenosis, RA / RV / CFA / iliac artery, iliac vein thrombosis or occlusion. |
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What’s the spectral waveform for renal vein and iliac vein? Iliac artery and CFA? |
RV and Iliac Vein: Monophasic Flow. Iliac artery and CFA: Triphasic Flow |
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Renal Post of urgent findings include? |
Renal artery severe stenosis, RA / RV / CFA / iliac artery, iliac vein thrombosis or occlusion. |
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What elevates blood flow velocities with the main vessels of the organ. It stabilized and the velocities become normal. |
Edema |
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What is the most common complication for a biopsy? |
Bleeding |
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What causes a Urinoma? |
During an ultrasound guided biopsy, damage to the collecting system or ureter can create a urine leak forming urinoma. |
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What complication is more common to occur in cadaver transplants? |
Acute Tubular Necrosis, it’s related to length of cold ischemic time of transplant prior to transplantation. |
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What complication is more common to occur in cadaver transplants? |
Acute Tubular Necrosis, it’s related to length of cold ischemic time of transplant prior to transplantation. |
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This is a common post op complication that occurs within the first year of transplantation. Kidneys enlarged, edematous, elevated RI between 0.80-0.90- indicator of dysfunction. What is the most common cause of HTN? |
Acute rejection and acute tubular necrosis. Acute rejection is the most common cause. 50% of patients will develop HTN post kidney transplant. |
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This is uncommon, occurs first few weeks after renal transplantation. This can mimic acute rejection. |
Peritransplant abscess. Acute pyelonephritis. |
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This is uncommon, occurs first few weeks after renal transplantation. This can mimic acute rejection. |
Peritransplant abscess. Acute pyelonephritis. |
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Contains gas within the collecting system? What does fever and debris or low level echoes in a collecting system suggest? |
Emphysematous pyelonephritis Pyonephrosis |
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What’s the common site for a renal obstruction? |
Urethral implantation into the bladder. |
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Who has a higher risk form developing renal calculi? |
Renal transplant recipients |
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Rare complication of renal? Urgent finding post op? |
Renal vein thrombosis. Acute renal vein thrombosis. If it does show up (1st week of transplant). |
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What’s the most common vascular complication in the renal transplant? What is a stenotic velocity for renal artery? What type waveform is an indicator for proximal stenosis? |
Renal artery stenosis. Occurs in the first year following the transplant. > 250cm / s and renal artery to iliac artery ratio > 3.0. Tardus parvus arcuate artery waveform. |
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What’s the most common vascular complication in the renal transplant? What is a stenotic velocity for renal artery? What type waveform is an indicator for proximal stenosis? |
Renal artery stenosis. Occurs in the first year following the transplant. > 250cm / s and renal artery to iliac artery ratio > 3.0. Tardus parvus arcuate artery waveform. |
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This is a focal or diffuse; hypo wedge with no color flow. Flow visualized in the infarct area. Finding? |
Infarct |
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Immediate post op period, biopsy, trauma and what’s common and resolve on its own? Sometimes if large enough it can displace the kidney or cause compression in the ureter and hydro may develop. |
Hematoma. Seroma- serous fluid collection. Me along vascular anastomosed site. |
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What’s the most common peritransplant fluid collection in a renal transplant? What is found medial to the transplant and most common fluid collection to cause? |
Lymphocele. Hydronephrosis. |
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Rare complication, found in the first two weeks after renal transplant? |
Urinoma and urine leak. Urine may leak from Renal pelvis, ureter, ureteroneocystostomy site due to ureteral necrosis. |
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Rare complication, found in the first two weeks after renal transplant? |
Urinoma and urine leak. Urine may leak from Renal pelvis, ureter, ureteroneocystostomy site due to ureteral necrosis. |
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Where is a Urinoma found? How and why can Urinoma can increase risk? |
Between the bladder and kidney; well defined fluid collection, no septations. Can rupture and increase risk of infection, abd ascites, abscess formation. |
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Renal cell carcinoma common with renal transplant? |
Rare |
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Renal cell carcinoma common with renal transplant? |
Rare |
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This is rare, but a tumor of the urinary tract and most often occurs in transplanted patients. Finding? |
Transition cell carcinoma; in transplant recipient more aggressive. |
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Renal cell carcinoma common with renal transplant? |
Rare |
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This is rare, but a tumor of the urinary tract and most often occurs in transplanted patients. Finding? |
Transition cell carcinoma; in transplant recipient more aggressive. |
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Most severe complication found in a solid organ and stem cell transplantation? Who is at a increase Rick of malignancies? |
Post transplant lymphoproliferative disorder. Pt who undertakenimmunosuppressants medication increase risk 2-5 times more than general population. |
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Renal cell carcinoma common with renal transplant? |
Rare |
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This is rare, but a tumor of the urinary tract and most often occurs in transplanted patients. Finding? |
Transition cell carcinoma; in transplant recipient more aggressive. |
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Most severe complication found in a solid organ and stem cell transplantation? Who is at a increase Rick of malignancies? |
Post transplant lymphoproliferative disorder. Pt who undertakenimmunosuppressants medication increase risk 2-5 times more than general population. |
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What’s the most common benign kidney lesion? |
Angiomyolipoma; associated with TB. |
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Renal cell carcinoma common with renal transplant? |
Rare |
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This is rare, but a tumor of the urinary tract and most often occurs in transplanted patients. Finding? |
Transition cell carcinoma; in transplant recipient more aggressive. |
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Most severe complication found in a solid organ and stem cell transplantation? Who is at a increase Rick of malignancies? |
Post transplant lymphoproliferative disorder. Pt who undertakenimmunosuppressants medication increase risk 2-5 times more than general population. |
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What’s the most common benign kidney lesion? |
Angiomyolipoma; associated with TB. |
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Pancreas transplants preferred location is? |
RLQ |
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Renal cell carcinoma common with renal transplant? |
Rare |
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This is rare, but a tumor of the urinary tract and most often occurs in transplanted patients. Finding? |
Transition cell carcinoma; in transplant recipient more aggressive. |
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Most severe complication found in a solid organ and stem cell transplantation? Who is at a increase risk of malignancies? |
Post transplant lymphoproliferative disorder. Pt who undertakenimmunosuppressants medication increase risk 2-5 times more than general population. |
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What’s the most common benign kidney lesion? |
Angiomyolipoma; associated with TB. |
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Pancreas transplants preferred location is? |
RLQ |
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Anastomosed for pancreas transplant end to side versus side to side? |
End to side: Donor portal vein and recipient common iliac vein and IVC confluence. Side to Side: Between the terminal ileum and the allograft duodenum using sutures for both outer and inner layers. |
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In a allotransplant there is a risk of portal vein thrombosis during what procedure? |
Islet cells from a donor are infused into hepatic sinusoids using catheter into portal vein. |
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What are you evaluating when interrogating the pancreas transplant? |
Eval with Doppler venous and arterial: pancreatic artery and vein. Spectral Doppler on prox, mid, distal pancreas and anastomosed iliac artery and vein. Obtain RI. Eval CFA for adequate flow to the leg. Low RI- prox stenosis High RI- rejection or venous congestion. |
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What are you evaluating when interrogating the pancreas transplant? |
Eval with Doppler venous and arterial: pancreatic artery and vein. Spectral Doppler on prox, mid, distal pancreas and anastomosed iliac artery and vein. Obtain RI. Eval CFA for adequate flow to the leg. Low RI- prox stenosis High RI- rejection or venous congestion. |
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Normal pancreas transplant sono finding includes? |
Homogenous, blob appearance, borders hard to visualize, pancreatic duct < 3mm. Velocity should be < 200 cm/ sec. normal RI in intraparenchymal artery < 0.80. |
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What are you evaluating when interrogating the pancreas transplant? |
Eval with Doppler venous and arterial: pancreatic artery and vein. Spectral Doppler on prox, mid, distal pancreas and anastomosed iliac artery and vein. Obtain RI. Eval CFA for adequate flow to the leg. Low RI- prox stenosis High RI- rejection or venous congestion. |
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Normal pancreas transplant sono finding includes? |
Homogenous, blob appearance, borders hard to visualize, pancreatic duct < 3mm. Velocity should be < 200 cm/ sec. normal RI in intraparenchymal artery < 0.80. |
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Most common complication for biopsy? Assoc factors? |
Bleeding. Associated risk factor for bleeding: elevated BP, HTN. |
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What are you evaluating when interrogating the pancreas transplant? |
Eval with Doppler venous and arterial: pancreatic artery and vein. Spectral Doppler on prox, mid, distal pancreas and anastomosed iliac artery and vein. Obtain RI. Eval CFA for adequate flow to the leg. Low RI- prox stenosis High RI- rejection or venous congestion. |
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Normal pancreas transplant sono finding includes? |
Homogenous, blob appearance, borders hard to visualize, pancreatic duct < 3mm. Velocity should be < 200 cm/ sec. normal RI in intraparenchymal artery < 0.80. |
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Most common complication for biopsy? Assoc factors? |
Bleeding. Associated risk factor for bleeding: elevated BP, HTN. |
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In the pancreas, how can a pseudocyst be created? |
During a biopsy, knicking a major blood vessel or pancreatic duct can create a pseudocyst or leak . |
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For the pancreas transplant; what is the primary cause of allograft loss? |
Rejection. Hyper acute rejection: rare, immediate post op, cause is thrombosis and graft loss. Chronic rejection: major long term cause of graft failure after first 6 months. |
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For pancreas transplant, what’s the second most common complication? Infections occur 50% of the time with post transplant patients where? |
Pancreatitis. At the surgical site. |
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For pancreas transplant, what’s the second most common complication? Infections occur 50% of the time with post transplant patients where? |
Pancreatitis. At the surgical site. |
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What infections are more common with renal transplants? This finding has thicker walls, irregular walls, inflamed tissue, associated with hyperemia sometimes, findings? |
Superficial. Abscess. |
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What’s the second most common cause of allograft failure? |
Venous thrombosis |
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What’s the second most common cause of allograft failure? |
Venous thrombosis |
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Thrombosis occurs more commonly on pancreas venous or pancreas arterial side? |
MC on venous side. |
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If this is found too late, it can lead to necrosis and require emergent pancreatoctomy? |
Thrombosis |
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If this is found too late, it can lead to necrosis and require emergent pancreatoctomy? |
Thrombosis |
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What develops that causes the pancreas to enlarge, hypoechoic, and lacks blood flow? |
Necrosis and infarct |
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If this is found too late, it can lead to necrosis and require emergent pancreatoctomy? |
Thrombosis |
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What develops that causes the pancreas to enlarge, hypoechoic, and lacks blood flow? |
Necrosis and infarct |
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What is the 4th most common cause of cancer. Hypoechoic pancreas and dilated pancreatic duct. |
Pancreatitis adenocarcinoma. |
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Post transplant the most severe complication found in solid organ and stem cell transplantation? Most polymorphic masses are caused by? Most monomorphic mass are? |
Post transplant Lymphoproliferative disorder. Cause by EBV 60-80% in 1 year of transplant. Non Hodgkin lymphoma. |
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Post transplant the most severe complication found in solid organ and stem cell transplantation? Most polymorphic masses are caused by? Most monomorphic mass are? |
Post transplant Lymphoproliferative disorder. Cause by EBV 60-80% in 1 year of transplant. Non Hodgkin lymphoma. |
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PTLD is involved in? |
Lymph nodes and liver followed by Gi tract. |
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This is most common peritransplant fluid collection in renal? |
Lymphocele |
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Pancreas, most common complication? Most common complication post op? |
Bleeding/ hematoma Post op: Seroma |
