Small Bowel Tx

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Author:
docdewaal
ID:
60908
Filename:
Small Bowel Tx
Updated:
2014-10-20 10:35:14
Tags:
Pediatric GI Small Bowel Transplantation
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Description:
Overview of pediatric small bowel transplantation
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  1. List the signs of acute rejection (ACR):
    • 1. Diarrhea/Increased stoma output
    • 2. Abdominal pain, distension, and ileus.
    • 3. Fever
    • 4. Sepsis (due to disruption of the gut mucosal barrier which leads to bacterial and fungal infections)

    The majority of the episodes occur during the first 90 days post tx.
  2. List the signs of chronic rejection:
    • Largest category for graft-loss after the second year.
    • Signs include:
    • -abdominal pain with diarrhea or bowel obstruction
    • -weight-loss
    • -failure to thrive.
    • The overall incidence of chronic rejection exceeds 10%.
    • The median time for the development of CR is 39 months (range of 22-67 months)
  3. What is the mechanism of action for tacrolimus?
    Suppresses cellular immunity (inhibits T-lymphocyte activation), by binding to an intracellular protein, FKBP-12 and complexes with calcineurin dependant proteins to inhibit calcineurin phosphatase activity
  4. What is the general immunosuppresive method used in SBTx?
    • Most centers use an induction regimen that includes anti-lymphocyte or anti-IL-2 receptor antibodies, with baseline immunosuppression consisting of a combination of tacrolimus (TAC), +/- corticosteroids.
    • Initially, TAC is administered intravenously and switched to oral dosage as soon as the intestine resumes normal function.
    • The twelve hour target trough level for TAC is 15 to 20 ng/ml in the first 90 days of the transplant
    • The TAC target trough levels is 5 to 10 ng/ml after 90 days
  5. What are some of the significant SE of TAC?
    • Cardiovascular:
    • -Hypertension (13% to 62%)
    • -Edema (peripheral 11% to 36%)
    • -Chest pain (19%)
    • -Edema (18%)
    • -Pericardial effusion (heart transplant 15%)

    • Central nervous system:
    • -Headache (25% to 64%)
    • -Insomnia (30% to 64%)
    • -Pain (24% to 63%)
    • -Fever (19% to 48%)
    • -Dizziness (19%)

    • Dermatologic:
    • -Pruritus (15% to 36%)
    • -Rash (10% to 24%)

    • Endocrine:
    • -Hypophosphatemia (28% to 49%)
    • -Hypomagnesemia (16% to 48%)
    • -Hyperglycemia & diabetes (21% to 47%)
    • -Hyper/Hypokalemia (8% to 45%)
    • -Hyperlipemia (10% to 31%)

    • Gastrointestinal:
    • -Liver function tests abnormal (6% to 36%)
    • -Ascites (7% to 27%)
    • -Diarrhea (24% to 72%)
    • -Abdominal pain (29% to 59%)
    • -Nausea (32% to 46%)
    • -Constipation (23% to 36%)
    • -Anorexia (7% to 34%)
    • -Vomiting (14% to 29%)
    • -Dyspepsia (18% to 28%)

    Genitourinary: Urinary tract infection (16% to 34%)

    • Hematologic:
    • -Anemia (5% to 50%)
    • -Leukopenia (13% to 48%)
    • -Leukocytosis (8% to 32%)
    • -Thrombocytopenia (14% to 24%)

    • Neuromuscular & skeletal:
    • -Tremor (34% to 56%; heart transplant 15%)
    • -Weakness (11% to 52%)
    • -Paresthesia (17% to 40%)
    • -Back pain (17% to 30%)
    • -Arthralgia (25%)

    • Renal:
    • -Abnormal kidney function (36% to 56%)
    • -Creatinine increased (23% to 45%)
    • -BUN increased (12% to 30%)
    • -Oliguria (18% to 19%)

    • Respiratory:
    • -Atelectasis (5% to 28%)
    • -Pleural effusion (30% to 36%)
    • -Dyspnea (5% to 29%)
    • -Cough increased (18%)

    • Infectious Disease:
    • -Infection (24% to 45%)
    • -CMV infection (32%)

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