CCTN EXAM WITH COMPLETE
SOLUTIONS GRADED A+
How to assess carbohydrate absorption - Answer-D-xylose breathalyzer test and
presence of fecal reducing substances
Fat absorption in intestinal transplant - Answer--Improper absorption is common, may
be result of disturbance of lymphatic system
-24 hour stool collection measures percentage of fat absorption and level of fat-soluble
vitamins present in the feces
Average stomal output in transplant - Answer-40-60m/kg/day in children
1-2L/day in adults
How to increase fat absorption in intestinal transplant - Answer-- pancreatic enzymes
- fat-soluble multivitamin daily
- low-fat diet
- interim IV intralipids
Standard dose for ET feeding - Answer-2mL/hr in infants
10mL/hr in adults
can be increased until caloric requirements are acquired as TPN is decreased
Radioallergosorbent test (RAST) - Answer-A blood test for Allergen-specific
Immunoglobulin E (IgE), which determines the patient's food allergies or causes of
asthma. Used instead of skin pricking when patients are on antihistamines or have
dermatitis. May give false negatives if the allergen is cooked or processed.
Detection of Rejection in Intestinal Transplant - Answer-Surveillance endoscopy is
conducted through ileostomy twice a week for first 4-6weeks. Indicators of rejection are
edema, granularity, erythema, and duskiness. Severe rejection will include mucosal
ulcers, aperistalsis, and denuded mucosa with pseudomembranes. Definitive diagnosis
requires a histology report. Overall incidence is at 90% because there is a large amount
of lymphoid tissue linked to the intestines
Long-term goal for intestinal transplant - Answer-Tolerate regular oral diet without
supplemental support by one year post op in adults and two years post op in children
Fluid and electrolyte balance in intestinal transplant - Answer-Imbalances result from
increased stomal output of water, sodium, magnesium, and bicarbonate. Pay attention
,to kidney function and electrolytes. Typically fluids are at 2/3 maintenance to sustain
CVP of 6-10cm H2o and UO of 0.5-1.5mL/kg/hr.
Complications of Intestinal Transplant - Answer-GIB
Leaks
Hypermotility
Intestinal Transplant Infections - Answer-Over 80% of intestinal transplant patients will
develop a bacterial infection (Staphylococcus and Enterococcus).
CMV is most common viral infection and can cause gastroduodenitis, colitis of native
large intestine, pneumonitis, CNS disease, hepatitis, and retinitis.
For fungal infections like candida, treatment with Amphotericin B, Abelcet, or
Fluconazole.
Effect of Fluconazole and Tacrolimus - Answer-They potentiate each other, monitor for
high tacro levels
Domiciliary Exposure - Answer-Infectious agents residing in patient's home unit such as
air, water, pathogens in the home
Nondomiciliary Exposure - Answer-Infectious agents reside outside patient's home
Viral infections - Answer-Influenza, CMV, Papovavirus (HPV, SV40, BK, JC), EBV
(mononucleosis), HSV-1 & HSV-2, Varicella Zoster virus, RSV, Hepatitis, HHV-6,
parainfluenza, coronavirus, Parvoviridae B19,
Cytomegalovirus (CMV) - Answer-The most widespread and significant pathogen for
transplanted recipients. Native organs are not as susceptible as allograft organs are.
Kidney - glomerulopathy
Liver - vanishing bile duct syndrome
Heart - accelerated cardiac vasculopathy
Lung - bronciolitis obliterans
Can also cause: pneumonitis, myocaditis, gastroenteritis, pancreatitis, encephalitis, and
retinitis
Fungal Infections - Answer-Less common than bacterial or viral infections but have the
highest mortality rate of the three. Most common are Candida, Cryptococci, and
Aspergillus.
Most common diseases requiring pancreas transplant - Answer-Type 1 DM without
signs of advanced diabetic nephropathy
Most common diseases requiring liver transplant - Answer-Alcoholism
Cholestatis
Chronic Hepatitis
Genetic Diseases
, Metabolic Diseases
Cholestasis - Answer-Bile cannot flow from liver to duodenum
Causes of ESRD - Answer-HTN
DM
glomerulonephritis
PKD
HIV
lupus
Reasons for Intestinal Transplant - Answer-Chron's disease
Small Bowel Stenosis
Necrotizing entercolitis
Trauma
Vascular Accidents
Mesenteric thrombosis, atresia, or stenosis
Hirschsprung disease - Answer-congenital megacolon with improper peristalsis resulting
in intestinal obstruction, pediatric need for transplant
Chronic intestinal pseudo-obstruction - Answer-A rare obstructive gut motility disorder of
the muscles and nerves in the intestine, pediatric need for transplant
Pediatric indication for intestinal transplant - Answer-Hirschsprung disease
chronic intestinal pseudo obstruction
volvulus
gastroschisis (abdominal wall herniation)
congenital atresia
necrotizing enterocolitis
trauma
short gut syndrome
Short gut syndrome - Answer-the inability of the small intestine to adequately absorb
nutrition, fluids, and to regulate electrolytes, can be structural or functional, usually
acquired
Indications for Heart Transplant - Answer-CHF with Class 3-4 symptoms, max therapy,
reduced exercise capacity, severe O2 dependence
End stage heart disease
Myocarditis
Myxomas
Refractory angina
Restrictive, dilated, or ischemic cardiomyopathy
life-threatening V arrhythmias
SOLUTIONS GRADED A+
How to assess carbohydrate absorption - Answer-D-xylose breathalyzer test and
presence of fecal reducing substances
Fat absorption in intestinal transplant - Answer--Improper absorption is common, may
be result of disturbance of lymphatic system
-24 hour stool collection measures percentage of fat absorption and level of fat-soluble
vitamins present in the feces
Average stomal output in transplant - Answer-40-60m/kg/day in children
1-2L/day in adults
How to increase fat absorption in intestinal transplant - Answer-- pancreatic enzymes
- fat-soluble multivitamin daily
- low-fat diet
- interim IV intralipids
Standard dose for ET feeding - Answer-2mL/hr in infants
10mL/hr in adults
can be increased until caloric requirements are acquired as TPN is decreased
Radioallergosorbent test (RAST) - Answer-A blood test for Allergen-specific
Immunoglobulin E (IgE), which determines the patient's food allergies or causes of
asthma. Used instead of skin pricking when patients are on antihistamines or have
dermatitis. May give false negatives if the allergen is cooked or processed.
Detection of Rejection in Intestinal Transplant - Answer-Surveillance endoscopy is
conducted through ileostomy twice a week for first 4-6weeks. Indicators of rejection are
edema, granularity, erythema, and duskiness. Severe rejection will include mucosal
ulcers, aperistalsis, and denuded mucosa with pseudomembranes. Definitive diagnosis
requires a histology report. Overall incidence is at 90% because there is a large amount
of lymphoid tissue linked to the intestines
Long-term goal for intestinal transplant - Answer-Tolerate regular oral diet without
supplemental support by one year post op in adults and two years post op in children
Fluid and electrolyte balance in intestinal transplant - Answer-Imbalances result from
increased stomal output of water, sodium, magnesium, and bicarbonate. Pay attention
,to kidney function and electrolytes. Typically fluids are at 2/3 maintenance to sustain
CVP of 6-10cm H2o and UO of 0.5-1.5mL/kg/hr.
Complications of Intestinal Transplant - Answer-GIB
Leaks
Hypermotility
Intestinal Transplant Infections - Answer-Over 80% of intestinal transplant patients will
develop a bacterial infection (Staphylococcus and Enterococcus).
CMV is most common viral infection and can cause gastroduodenitis, colitis of native
large intestine, pneumonitis, CNS disease, hepatitis, and retinitis.
For fungal infections like candida, treatment with Amphotericin B, Abelcet, or
Fluconazole.
Effect of Fluconazole and Tacrolimus - Answer-They potentiate each other, monitor for
high tacro levels
Domiciliary Exposure - Answer-Infectious agents residing in patient's home unit such as
air, water, pathogens in the home
Nondomiciliary Exposure - Answer-Infectious agents reside outside patient's home
Viral infections - Answer-Influenza, CMV, Papovavirus (HPV, SV40, BK, JC), EBV
(mononucleosis), HSV-1 & HSV-2, Varicella Zoster virus, RSV, Hepatitis, HHV-6,
parainfluenza, coronavirus, Parvoviridae B19,
Cytomegalovirus (CMV) - Answer-The most widespread and significant pathogen for
transplanted recipients. Native organs are not as susceptible as allograft organs are.
Kidney - glomerulopathy
Liver - vanishing bile duct syndrome
Heart - accelerated cardiac vasculopathy
Lung - bronciolitis obliterans
Can also cause: pneumonitis, myocaditis, gastroenteritis, pancreatitis, encephalitis, and
retinitis
Fungal Infections - Answer-Less common than bacterial or viral infections but have the
highest mortality rate of the three. Most common are Candida, Cryptococci, and
Aspergillus.
Most common diseases requiring pancreas transplant - Answer-Type 1 DM without
signs of advanced diabetic nephropathy
Most common diseases requiring liver transplant - Answer-Alcoholism
Cholestatis
Chronic Hepatitis
Genetic Diseases
, Metabolic Diseases
Cholestasis - Answer-Bile cannot flow from liver to duodenum
Causes of ESRD - Answer-HTN
DM
glomerulonephritis
PKD
HIV
lupus
Reasons for Intestinal Transplant - Answer-Chron's disease
Small Bowel Stenosis
Necrotizing entercolitis
Trauma
Vascular Accidents
Mesenteric thrombosis, atresia, or stenosis
Hirschsprung disease - Answer-congenital megacolon with improper peristalsis resulting
in intestinal obstruction, pediatric need for transplant
Chronic intestinal pseudo-obstruction - Answer-A rare obstructive gut motility disorder of
the muscles and nerves in the intestine, pediatric need for transplant
Pediatric indication for intestinal transplant - Answer-Hirschsprung disease
chronic intestinal pseudo obstruction
volvulus
gastroschisis (abdominal wall herniation)
congenital atresia
necrotizing enterocolitis
trauma
short gut syndrome
Short gut syndrome - Answer-the inability of the small intestine to adequately absorb
nutrition, fluids, and to regulate electrolytes, can be structural or functional, usually
acquired
Indications for Heart Transplant - Answer-CHF with Class 3-4 symptoms, max therapy,
reduced exercise capacity, severe O2 dependence
End stage heart disease
Myocarditis
Myxomas
Refractory angina
Restrictive, dilated, or ischemic cardiomyopathy
life-threatening V arrhythmias
