eMedicine Specialties > Pediatrics: Surgery > Transplantation

Intestinal and Multivisceral Transplantation: Workup

Author: Seigo Nishida, MD, PhD, Associate Director of Adult Intestinal Transplant Program, Associate Professor of Clinical Surgery, Division of Liver/GI Transplantation, Department of Surgery, University of Miami School of Medicine
Coauthor(s): Andreas G Tzakis, MD, PhD, Professor, Department of Surgery, Miller School of Medicine, University of Miami; David M Levi, MD, Associate Professor of Clinical Surgery, Department of Surgery, Division of Liver and Gastrointestinal Transplantation, Division of General Surgery, Jackson Memorial Hospital, Miller School of Medicine, University of Miami; Tomoaki Kato, MD, Associate Professor of Clinical Surgery, Department of Surgery, Division of Liver and Gastrointestinal Transplantation, Miller School of Medicine, University of Miami; Jose R Nery, MD, Associate Professor, Department of Surgery, Division of Liver and Gastrointestinal Transplantation, Miller School of Medicine, University of Miami; Juan Madariaga, MD, Professor, Department of Surgery, Miller School of Medicine, University of Miami; John F Thompson, MD, Associate Professor, Department of Pediatrics, Miller School of Medicine, University of Miami; Phillip Ruiz, Jr, MD, PhD, Professor of Pathology, Department of Pathology and Surgery, Miller School of Medicine, University of Miami; G Patricia Cantwell, MD, Associate Clinical Professor, Department of Pediatrics, University of Miami; Director of Pediatric Critical Care Medicine, Miller School of Medicine, Jackson Children's Hospital
Contributor Information and Disclosures

Updated: Jan 24, 2008

Workup

Laboratory Studies

  • Perform an automated cell count (ACC) and platelet (Plt) count to rule out anemia and thrombocytopenia.
  • Assess electrolyte levels to look for electrolyte imbalance caused by short bowel syndrome.
  • Perform liver function tests to rule out cholestatic liver failure and evaluate liver function.
    • Serum glutamic-oxaloacetic transaminase (SGOT, aspartate aminotransferase) test
    • Serum glutamic-pyruvic transaminase (SGPT, alanine aminotransferase) test
    • Alkaline phosphatase (ALKP) test
    • Glucose tolerance test (GTTP)
  • Measure prothrombin time (PT) and activated partial thromboplastin time (aPTT) to rule out coagulation abnormalities and evaluate liver function.
  • Perform coagulation studies to rule out the cause of thrombosis.
    • Protein C deficiency study
    • Protein A deficiency study
    • Factor deficiency study
    • Vitamin study
  • Perform urinalysis to evaluate renal function and rule out infection.
  • Assess creatine clearance to evaluate renal function.
  • Perform a culture to rule out infection.
  • Assess vitamin levels to evaluate nutrition.
  • Perform an absorption test to evaluate intestinal function.

Imaging Studies

  • Doppler ultrasonography of the extremities to assess the patency of the vein
  • Doppler ultrasonography of the liver to assess the patency of the vessel
  • CT scanning of the abdomen
  • Upper GI series with small bowel follow-through
  • Angiography of the abdomen
  • Upper GI endoscopy
  • MRI
  • Magnetic resonance angiography

Other Tests

  • Echocardiography
  • Stress echocardiography
  • Nuclear medicine studies

Diagnostic Procedures

  • Biopsy of the intestine for pathological diagnosis (if indicated): If intestinal failure is functional, the diagnosis depends on the pathological findings and exclusion. Biopsy of the intestine is necessary for the final diagnosis. Perform case-by-case evaluations.

Histologic Findings

More on Intestinal and Multivisceral Transplantation

Overview: Intestinal and Multivisceral Transplantation
Workup: Intestinal and Multivisceral Transplantation
Treatment: Intestinal and Multivisceral Transplantation
Follow-up: Intestinal and Multivisceral Transplantation
Multimedia: Intestinal and Multivisceral Transplantation
References
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References

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Further Reading

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Keywords

intestinal transplantation, multivisceral transplantation, polysplanchnic transplantation, intestinal failure, short bowel syndrome, total parenteral nutrition, TPN, cytomegalovirus, CMV, polysplanchnic transplantation, volvulus, thrombosis, encephalopathy, tetany, calcium deficiency, magnesium deficiency, hyperalimentation, necrotizing enterocolitis, mesenteric thrombosis, gastroschisis, desmoid tumor, intestinal atresia, Hirschsprung disease, Crohn disease, pseudoobstruction, microvillus inclusion disease, central vein thrombosis, cholestatic TPN-induced liver failure, catheter-associated sepsis, catheter-associated vascular thrombosis

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Contributor Information and Disclosures

Author

Seigo Nishida, MD, PhD, Associate Director of Adult Intestinal Transplant Program, Associate Professor of Clinical Surgery, Division of Liver/GI Transplantation, Department of Surgery, University of Miami School of Medicine
Seigo Nishida, MD, PhD is a member of the following medical societies: American Society of Transplant Surgeons, Japan Surgical Society, Society for Surgery of the Alimentary Tract, and Transplantation Society
Disclosure: Nothing to disclose.

Coauthor(s)

Andreas G Tzakis, MD, PhD, Professor, Department of Surgery, Miller School of Medicine, University of Miami
Andreas G Tzakis, MD, PhD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Angiology, American College of Surgeons, American Medical Association, American Society of Transplant Surgeons, American Spinal Injury Association, International College of Surgeons, Pennsylvania Medical Society, and Society of University Surgeons
Disclosure: Nothing to disclose.

David M Levi, MD, Associate Professor of Clinical Surgery, Department of Surgery, Division of Liver and Gastrointestinal Transplantation, Division of General Surgery, Jackson Memorial Hospital, Miller School of Medicine, University of Miami
Disclosure: Nothing to disclose.

Tomoaki Kato, MD, Associate Professor of Clinical Surgery, Department of Surgery, Division of Liver and Gastrointestinal Transplantation, Miller School of Medicine, University of Miami
Tomoaki Kato, MD is a member of the following medical societies: American Gastroenterological Association, American Medical Association, and American Society of Transplant Surgeons
Disclosure: Nothing to disclose.

Jose R Nery, MD, Associate Professor, Department of Surgery, Division of Liver and Gastrointestinal Transplantation, Miller School of Medicine, University of Miami
Disclosure: Nothing to disclose.

Juan Madariaga, MD, Professor, Department of Surgery, Miller School of Medicine, University of Miami
Juan Madariaga, MD is a member of the following medical societies: American Medical Association, American Society of Transplant Surgeons, Medical Society of the State of New York, and Society of Surgical Oncology
Disclosure: Nothing to disclose.

John F Thompson, MD, Associate Professor, Department of Pediatrics, Miller School of Medicine, University of Miami
John F Thompson, MD is a member of the following medical societies: Alpha Omega Alpha, American Gastroenterological Association, and North American Society for Pediatric Gastroenterology and Nutrition
Disclosure: Nothing to disclose.

Phillip Ruiz, Jr, MD, PhD, Professor of Pathology, Department of Pathology and Surgery, Miller School of Medicine, University of Miami
Phillip Ruiz, Jr, MD, PhD is a member of the following medical societies: American Association for the Advancement of Science, American Association of Immunologists, American Society of Clinical Pathologists, American Society of Nephrology, American Society of Transplant Surgeons, American Society of Transplantation, Clinical Immunology Society, Florida Medical Association, New York Academy of Sciences, Pan American Medical Association, Southern Medical Association, and United States and Canadian Academy of Pathology
Disclosure: Nothing to disclose.

G Patricia Cantwell, MD, Associate Clinical Professor, Department of Pediatrics, University of Miami; Director of Pediatric Critical Care Medicine, Miller School of Medicine, Jackson Children's Hospital
G Patricia Cantwell, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Emergency Physicians, American Heart Association, American Trauma Society, National Association of EMS Physicians, Society of Critical Care Medicine, and Wilderness Medical Society
Disclosure: Nothing to disclose.

Medical Editor

Casimir F Firlit, MD, PhD, Consulting Staff, Department of Urology, Cardinal Glennon Children's Hospital
Casimir F Firlit, MD, PhD is a member of the following medical societies: American Academy of Pediatrics, American College of Surgeons, American Medical Association, American Society of Transplant Surgeons, American Urological Association, and Illinois State Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine.com, Inc
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Managing Editor

Brian F Gilchrist, MD, Chief, Division of Pediatric Surgery, Tufts-New England Medical Center; Associate Professor, Department of Surgery, Tufts University School of Medicine
Disclosure: Nothing to disclose.

CME Editor

Ron Shapiro, MD, Professor of Surgery, University of Pittsburgh; Director, Kidney, Pancreas, and Islet Transplantation, Thomas E Starzl Transplantation Institute, University of Pittsburgh Medical Center
Ron Shapiro, MD is a member of the following medical societies: American College of Surgeons, American Society of Transplant Surgeons, Association for Academic Surgery, Central Surgical Association, and Society of University Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Stuart M Greenstein, MD, Professor of Surgery, Albert Einstein College of Medicine; Consulting Surgeon, Department of Surgery, Division of Transplantation, Montefiore Medical Center
Stuart M Greenstein, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Surgeons, American Society of Transplant Surgeons, American Society of Transplantation, Association for Academic Surgery, International College of Surgeons, Medical Society of New Jersey, National Kidney Foundation, New York Academy of Sciences, and Southeastern Surgical Congress
Disclosure: Nothing to disclose.

 
 
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