Chapter 20: Sonographic Techniques in the Transplant Patient

5. 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

a. IVC The IVC, hepatic, and portal vessels all require anastomosis during a liver transplant procedure.

17. 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

a. Register as an organ donor If you are interested in more information about becoming an organ donor or would like to share with others, please visit: donatelife.net.

9. What is the most common cause of liver transplant failure? a. Rejection b. Infection c. Abscesses d. Vascular compromise

a. Rejection Rejection is the most common cause of liver transplant failure.

13. 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

a. Renal vein thrombosis Urinary obstruction occurs within the first 6 months, renal vein thrombosis occurs within the first week, and renal artery stenosis occurs within the first year of transplantation.

1. 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

a. UNOS The United Network for Organ Sharing (UNOS) maintains a centralized computer networking system for all organ procurement organizations and transplant centers while seeking to be fair and effective in selecting transplant candidates.

6. 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

b. Day 0 or immediately after surgery The transplanted liver has a baseline examination immediately after surgery (day 0 examination) with follow-up examinations on days 1 and 7.

2. 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

b. PELD The Model for End-Stage Liver Disease (MELD) scale for adults and Pediatric End-Stage Liver Disease (PELD) for children under 12 years of age help determine the urgency of a liver transplant.

14. 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

b. Perform a resistive index Performing a resistive index (RI) helps determine rejection status of a transplanted kidney. Blood flow velocities exceeding 250 cm/sec and an RA to iliac artery ratio above 3.0 strongly suggest stenosis.

10. 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

b. Sweep speed Increasing the sweep speed of the spectral Doppler tracing spreads out the waveform, allowing for an increase in measurement accuracy.

11. 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

c. 0.60 to 0.70 The RA velocities should be below 250 cm/sec, with a renal to iliac artery ratio of less than 3.0. A normal RI in the arcuate artery is in the range of 0.60 to 0.70, with borderline values between 0.70 and 0.80.

7. 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

c. Low resistive index (RI) A low RI can be a strong indicator of a proximal stenosis the sonographer may not be able to otherwise identify or a presence of an arteriovenous fistula (AVF). A high RI may indicate rejection or hepatic venous congestion.

15. 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

c. Low resistive index (RI) A low RI is a strong indicator of a proximal stenosis; a high RI may indicate rejection or venous congestion. Accurate stenosis measurements require angle correction when evaluating the pancreatic artery with spectral Doppler. Also, include spectral Doppler with velocity measurements in the distal, mid-, and proximal pancreatic artery and at the anastomosis between the iliac artery and pancreatic artery.

4. Which intervention is used in hopes to cure type 1 diabetes. a. Insulin injections b. Islet cell grafting c. Pancreatic transplant d. Renal transplant

c. Pancreatic transplant Patients receive a pancreas transplant in hopes to cure type 1 diabetes. Type 2 diabetes patients are not a consideration for pancreas transplant.

3. What is the most common cause of renal transplants? a. Chronic infection b. Glomerulonephritis c. Renal failure d. Acute nephrolithiasis

c. Renal failure The most common cause for needing a renal transplant is chronic end-stage renal disease or renal failure. An uncommon transplant indication is acute renal failure.

8. 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

d. 0.50 to 0.70 The normal resistive index (RI) in the hepatic artery is in the range of 0.50 to 0.70.

12. More than ________ of renal transplants develop an infection in the first year. a. one third b. 50% c. one in five d. 80%

d. 80% More than 80% of renal transplant recipients develop at least one infection within the first year. These can include pneumonia, wound infections, or urinary tract infections.

16. 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

d. Thrombosis and graft loss A rare complication, hyperacute rejection, occurs immediately postoperative, causing thrombosis and graft loss. Acute rejection usually occurs 1 to 3 weeks following transplantation. Pancreatitis is the second most common complication occurring within the first 4 weeks of transplantation.