The document discusses liver transplantation. It begins by describing liver anatomy and then discusses indications for pediatric liver transplantation such as various diseases and conditions. It outlines symptoms of liver disease and contraindications for transplantation. It describes the preparation process including required tests and where donor livers come from. The technique of the transplantation surgery and post-procedure care are explained. Complications and required follow-up visits are also summarized.
History of liver transplant.
Why and When liver need to be transplant ?
What at basic requirements in LT.
Success and Failure %age
Global statistics of organ donation
History of liver transplant.
Why and When liver need to be transplant ?
What at basic requirements in LT.
Success and Failure %age
Global statistics of organ donation
Acute kidney injury is common among hospitalized patients. It affects some 3–7% of patients admitted to the hospital and approximately 25–30% of patients in the intensive care unit.
Congenital anomalies of the kidney and urinary tractDhanya Raghu
CAKUT are a group of phenotypically diverse structural malformations characterized by defects in renal and urinary tract development.
Nearly half of children who develop end-stage renal disease (ESRD) have asymmetric, irregularly shaped kidneys, often referred to as bilateral renal scarring and frequently associated with lower urinary tract anomalies, including vesicoureteral reflux (VUR).
Congenitally abnormal kidneys may be large or small, cystic or irregular in outline, and absent or misplaced.
Acute kidney injury is common among hospitalized patients. It affects some 3–7% of patients admitted to the hospital and approximately 25–30% of patients in the intensive care unit.
Congenital anomalies of the kidney and urinary tractDhanya Raghu
CAKUT are a group of phenotypically diverse structural malformations characterized by defects in renal and urinary tract development.
Nearly half of children who develop end-stage renal disease (ESRD) have asymmetric, irregularly shaped kidneys, often referred to as bilateral renal scarring and frequently associated with lower urinary tract anomalies, including vesicoureteral reflux (VUR).
Congenitally abnormal kidneys may be large or small, cystic or irregular in outline, and absent or misplaced.
Best Kidney transplant hospital in Uttar Pradesh home
Apollo Hospitals Lucknow is one of the best kidney transplant centres in Lucknow, Uttar Pradesh. The hospital offers comprehensive kidney transplantation services and has a dedicated team of transplant surgeons, nephrologists, and other specialists who work together to provide the best care for patients. The hospital is equipped with advanced medical technology, including state-of-the-art operating rooms, intensive care units, and dialysis facilities.
The hospital has a well-established transplantation program and has performed a significant number of kidney transplants with high success rates. The hospital also has a track record of performing complex transplant cases and provides post-transplant care to ensure the best outcomes for patients.
In addition to the technical aspects of transplantation, the hospital also provides psychological and emotional support to patients and their families before, during, and after the transplantation process.
In summary, Apollo Hospitals Lucknow is a notable kidney transplantation center in Lucknow, Uttar Pradesh, known for its experienced team of transplant surgeons and nephrologists, advanced medical technology, high success rates and comprehensive care. It's always important to consult with medical professionals and conduct thorough research when seeking medical treatment.
Best Liver Transplantation, Liver Treatment and Liver Transplant Hospitals in Hyderabad, Bangalore, Chennai and Mumbai
Global Hospitals India’s leading Multi-Specialty, Multi-Organ Transplant Centre with locations in Hyderabad, Chennai, Bangalore and Mumbai. The hospital is home to the Institute of Liver, Pancreases Diseases and Transplants that is the foremost liver transplant facilities in the country with expertise for both live-donor and cadaver transplants.
The hospitals offers state-of-the-art infrastructure alongside a team of high-skilled doctors - with competencies to treating a wide array of liver-related ailments and emergencies.
Global Hospitals is the leading tertiary healthcare provider and has pioneered several advanced liver transplant surgeries. Acomprehensive liver disease and transplant centre - the institute has successfully performed over 600 transplants.
Comprising of some of the best known transplant surgeons, the state-of-the-art infrastructure facility delivers best post-operative care for complex hepatology cases and Hepatobiliary Surgeries, including Hepatitis C, Liver Cirrhosis, Fatty Liver Disease and others
Empowering ACOs: Leveraging Quality Management Tools for MIPS and BeyondHealth Catalyst
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Health Education on prevention of hypertensionRadhika kulvi
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CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
The Importance of Community Nursing Care.pdfAD Healthcare
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Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
3. LIVER ANATOMY
The liver is located in the right upper
portion of the abdominal cavity, just
beneath the diaphragm, and is
protected by the rib cage. It sits on top
of the stomach, right kidney, and
intestines. It is supplied with blood by
the portal vein, which drains the
splenic, intestinal, and colonic areas
and is a rich source of nutrients and
substances absorbed from the gut.
7. LIVER TRANSPLANT SYMPTOMS
People who have liver disease may
have many of the following problems: -
Jaundice - Yellowing of the skin or
eyes - Itching , tea-colored urine -
Gray- or clay-colored blood
movements - Ascites - An abnormal
buildup of fluid in the abdomen -
Vomiting of blood - Tendency to bleed -
Mental confusion, forgetfulness
8. CONTRAINDICATIONS TO PEDIATRIC LIVER
TRANSPLANTATION
Transplantation is not indicated if an
acceptable alternative is available or if
contraindications, such as malignancy,
a terminal condition, or poor expected
outcome exist
9. . Alternatives to liver transplantation
Alternatives to liver transplantation that are
currently being researched include liver support
devices, artificial organ construction, and
hepatocyte transplantation.
Waiting period
Once a pediatric patient is found to be a
suitable candidate for a liver transplant, the
patient's name is placed on a waiting list for an
organ. Unfortunately, many more potential
recipients are on the waiting list than there are
organs available each year.
10. PREPARATION
Where Does a Liver for a Transplant Come
From?
There are two types of liver transplantation options:
living donor transplantation and cadaveric
transplantation.
1.Living donor - Living donor liver transplants are an
option for some patients with end-stage liver
disease. This involves removing a segment of liver
from a healthy living donor and implanting it into a
recipient. The donor, who may be a blood relative,
spouse or friend, will have extensive medical and
psychological evaluations to ensure the lowest
possible risk. Blood type and body size are critical
factors in determining who is an appropriate donor.
- Recipients for the living donor transplantation
must be active on the transplant waiting list.
11. WHERE DOES A LIVER FOR A TRANSPLANT
COME FROM?
2.Cadaver In cadaveric liver transplantation, the
donor may be a victim of an accident or head injury.
The donors heart is still beating, but the brain has
stopped functioning. Such a person is considered
legally dead, because his or her brain has
permanently and irreversibly stopped working.
12. WHICH TESTS ARE REQUIRED BEFORE
GETTING A LIVER TRANSPLANT?
If specific problems are identified,
additional tests
Computed tomography,
X-rays
A computer to generate pictures of the liver,
showing its size and shape.
Doppler ultrasound: to determine if the
blood vessels to and from your liver are
open. - Echocardiogram :to help evaluate
your heart.
13. CONT…
Pulmonary function studies to
determine your lungs' ability to
exchange oxygen and carbon dioxide.
Blood tests to determine blood type,
clotting ability, and biochemical status
of blood and to gauge liver function.
AIDS testing and hepatitis screening
14. ANESTHESIA IN PEDIATRIC LIVER
TRANSPLANTATION
Living donors receive general
anesthesia and immediate
transplantation of a portion of their
liver into the recipient. Therefore,
the patient receiving the transplant
is prepared for surgery within the
same time frame as the donor.
15. CONT…
A liver from a deceased donor must
be transplanted into the recipient
within 12-18 hours.
anesthesiologists performs an
operation to remove the liver from
the donor. The liver is then
preserved and packed for transport
16. TECHNIQUE
Most liver transplants are orthotopically
performed, meaning the new liver is placed
in the same location as the diseased liver.
This requires that the diseased liver be
removed. This portion of the operation is
critical and can take several hours,
depending on the extent of previous surgery
and the adhesions and scar tissue that
developed.
18. CONT…
If the new liver is a whole liver, the intra hepatic
portion of the inferior vena cava can be
removed as well, or it can be left in the recipient
and the new liver "piggybacked" onto the cava.
If the new liver is coming from a living donor or
is the result of a reduction or splitting of the
deceased donor's liver, then the inferior vena
cava must be left in place and the new liver will
be anastomosed to the native vena cava. The
preferred preservation time for the new liver is
less than 12 hours, although the maximum time
is reported to be 24 hours
20. CONT…
The implantation requires the
reestablishment of blood flow to the liver
via the portal vein and hepatic artery and
the reestablishment of blood flow away
from the liver via the hepatic veins. After
the blood flow has been restored, the bile
duct's continuity with the GI tract must be
established. In pediatric transplantation,
this is usually via a hepaticojejunostomy.
22. POST-PROCEDURE
Immediate postoperative care
Following liver transplant surgery, patients
frequently remain on a ventilator for the first
24-48 hours. Patients are moved out of the
pediatric ICU (PICU) in a few days,
depending on their recovery
Reintroduction of oral intake can begin
within the week following surgery. Typically,
hospital stays range from 1-2 weeks. Blood
tests are performed within the first few
weeks following transplantation to confirm
correct medication levels.
23. CONT..
Prior to discharge, the transplant team
provides follow-up care and medication
instructions.
The patient and family should be
instructed to continue a rehabilitation
program that includes exercise, proper
nutrition, and the continuation of
immunosuppression and other
medications.
25. CONT..
Induction, maintenance, and
antirejection therapy
Induction immunosuppression therapy refers
to all medications given in intensified doses
immediately after transplantation for the
purpose of preventing acute rejection.
Although the drugs may be continued after
discharge for the first 30 days after
transplant, they are usually not used long-
term for immunosuppression maintenance.
28. FOLLOW-UP VISITS ARE REQUIRED FOR
CHECK-UPS.
These begin soon after the patient returns home.
Initially, outpatient visits may occur weekly or even
more often. As time passes, the frequency of follow-
up visits usually decreases.
