Abdominal Sonography 2: Pancreas Transplant

post transplant lymphoproliferative mass ranges from ___-___ in size

3-6 cm

What are the mesenteric vessels?

PV and SMV or traditional PV and iliac

Where would a sonographer find the transplanted pancreas in the traditional surgery?

RLQ or LLQ near the bladder

______ are often associated with hematomas, urinary tract infections and pancreatitis

abscesses

What will be elevated in pancreatic rejection?

amylase and lipase levels

Venous thrombus causes changes in ______ flow

arterial

Two types of surgical techniques: both involve an ______ anastomosis to the recipient _____ ______ artery for blood supply

arterial, common iliac

Fluid collections in pancreatic transplants are _____

bad

Spectral doppler should show ________ monophasic venous flow and ____ resistance arterial waveforms

continuous, low

What is the exocrine function?

digestive enzymes

_____ diagnosis is important for treatment in the _____ stages of fluid collections around pancreas

early, acute

Two types of surgical techniques: they differ in their ____ and _____ drainage

endocrine, exocrine

A normal pancreatic transplant will be _____geneous

homo

Peripancreatic transplant-related fluid collections may be associated with an ______ liklihood of _____ of allograft or increased _____ of the recipient

increased, loss, mortality

Over 80% of patients with pancreatic transplants become free of exogenous _______ requirements within 1 year of surgery

insulin

What is the endocrine function?

insulin

A normal pancreatic transplant will be _____echoic or minimially ____genic to the liver

iso, echo

post transplant lymphoproliferative disorder shows a tendency to arise in the _____ tissue in the ______ regions and around _______ sites

lymphatic, periportal, anastomotic

What will a normal allograft pancreas look like?

normal grayscale morphology

no arterial flow is detected in transplants with _____ _____ ______

occlusive arterial thrombus

Normal sized to bulky edematous pancreas

pancreastitis

Two types of surgical techniques: both involve transplant of the entire _____ gland and a portion of the ______

pancreatic, duodenum

A dilated pancreatic duct may be seen

pancreatitis

Peripancreatic fluid

pancreatitis

What do almost all patients develop symptoms of post surgery?

pancreatitis

thickening of the adjacent gut wall

pancreatitis

What can cause pancreatitis?

partial or complete occlusion of the pancreatic duct, poor perfusion of the allograft, reflux-related

Accounts for 20% of tumors in solid organ transplantations

post transplant lymphoproliferative disorder

May be the result of the aggressive immunosuppressive therapy required to prevent rejection

post transplant lymphoproliferative disorder

Occur as masses that engulf and surround the hilar vessels in both liver and kindey tranplants

post transplant lymphoproliferative disorder

Range of conditions that can occur in any patient with an underlying immunodeficiency

post transplant lymphoproliferative disorder

The involved lymph nodes have an abnormal appearance

post transplant lymphoproliferative disorder

Usually hypoechoic masses or mixed echogenicity

post transplant lymphoproliferative disorder

also known as transplant related malignancies

post transplant lymphoproliferative disorder

Becoming more widely used

recent option

Portal venous enteric drainage

recent option

Provides a more physiological transplant compared to the more traditional technique

recent option

more appropriate glycemic control with lower fasting insulin levels

recent option

no dehydration or metabolic acidosis occurs

recent option

Anatomosis of the donor portal vein to the recipient SMV

recent option, endocrine drainage

donor duodenum to a roux-en-y-loop of jejunum

recent option, exocrine drainage

Allograft may appear hypoechoic or contain multiple anechoic regions

rejection

Grossly elevated RI in the arterial flow have been observed

rejection

Most common cause of pancreastic graft loss post transplantation

rejection

Parenchymal echotexture may be patchy and heterogeneous

rejection

elevated amylase and lipase levels

rejection

A normal pancreas will have a _____, non dilated pancreatic duct that measure less than ______

thin, 2mm

Chronic loss of pancreatic secretion into the bladder

traditional

Systemic venous-bladder drainage

traditional

donor duodenum to the urinary bladder

traditional

results in problems with dehydration, metabolic acidosis, local bladder irritation, and allograft pancreatitis

traditional method

Anastomosis of the donor portal vein to the recipients external iliac vein

tranditional

Pancreas transplants are performed in select patients who have major complications related to what?

type 1 diabetes

Second leading cause of transplant loss

vascular thrombosis

Signs and symtpoms are non specific, detection of ______ ________ is imperative for both salvaging the transplant and preventing life threatening sepsis

vascular thrombosis

______ thrombosis is especially worrisome because of the increased risk of hemorrhagic complications, tissue necrosis, infection, thrombus circulation, could lead to pulmonary embolism

venous

shows high resistance and either no flow or reversal of diastolic flow

venous thrombosis

Traditional surgery has systemic _____-_____ drainage

venous-bladder