CCTC CERTIFICATION REVIEW COMPLETE GUIDE

CCTC CERTIFICATION REVIEW COMPLETE GUIDE Absolute Contraindications for liver transplant ️Severe cardiopulmonary disease, uncontrolled HIV, poorly controlled Psych illness, noncompliance, anatomical abnormalities precluding adequate surgical reconstruction Reason for not accepted for liver TX ️Hepatocellular Carcinoma (HCC) outside Milan Criteria What is NAFLD? ️Nonalcoholic Fatty Liver Disease- caused by obesity, hyperglycemia, elevated serum lipids, and high BP What is NASH? ️Non-alcoholic steatohepatitis. Can lead to cirrhosis 3rd common indication for liver TX. What is the MELD score? ️MELD(Model for End Stage Liver Disease) is a predictive model of death within a 3 month period. Ranks your degree of sickness, shows how much you need a liver transplant. The higher the number, the more urgent case is. Score ranges from 6-40. *Score for HCC capped at 34. Calculated using: -INR -Bilirubin -Creatinine -Sodium MELD > 14 needed for liver transplant What can green drainage post liver TX indicate? ️Bile leakage What can a rise in ALP post liver tx indicate? ️Can be a sign of biliary complications or cholestasis Lab changes are indicate of graft dysfunction. Which values will be elevated for liver tx? ️Elevated AST and ALT Target levels for immunosuppressants are based on a number of factors including: ️Indication for tx, use of induction therapy, kidney function, overall condition of pt. What can lead to metabolic encephalopathy post liver transplant? ️Renal failure or sepsis What can lead to hypoxic ischemic encephalopathy post liver transplant? ️Significant peri-operative hypotension De Novo seizures can occur post liver transplant and can be caused by what? ️Electrolyte imbalances, reaction to cyclosporine or tacrolimus, intracranial hemorrhage or cerebral infarction and intracerebral abscesses What can cause a post liver transplant patient whose initial postop neurological course is normal to develop sudden deterioration in neurological status? ️Intracranial bleed Risk of primary non-function after liver transplant is: ️4-6% Factors related to primary nonfunction of new liver include: ️Donor age, prolonged cold ischemic time, prolonged donor hospital stay with periods of hypotension, preservation injury during donor surgery, and donor steatosis(fat in liver) Early Indicators of non functioning liver: ️decrease in bile production extreme edema of organ Abnormal color of organ upon reperfusion(mottled, gray, pale) lack of reperfusion in OR urine output <30ml/hr hemodynamically unstable glucose, k, and lactate abnormalities Coagulopathy Clinical presentation for hepatic artery stenosis(HAT) ️Increase in LFTs due to decreased blood flow through the hapatic artery to new organ Delayed bile leak Persistent sepsis of unknown cause What test is the gold standard for HAT diagnosis? ️Angiography What is treatment for HAT? ️Immediate return to OR for revascularization of organ Symptoms of bleeding post liver transplant include: ️Increased swelling in abdomen Pallor Clinical manifestations of hypovolemia Some BP meds may increase cyclosporine or tacrolimus levels, name 2 ️Diltiazem(Cardizem)