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
