Liver and Kidney Transplant Department Research

This week, I worked only in clinical sciences because Dr. Adkins in the Basic Science building was still out of town Tuesday- Thursday. Thus, Monday I spent an hour and a half in transplant, following Kathleen, Dr. Chavin's PA, talking to patients and looking at their conditions. Then, this morning, I attended the weekly "learning meeting" from 7-8. After the meeting, I shadowed Kathleen and the other PA on duty at that time. I took a lot of notes (which I will record and discuss below) and I visited with 2 patients, one of which didn't go well. He said he didn't mind if I was in the room, but then when we started talking, he questioned my age and eligibility. Needless to say, he did not appreciate my presence in the room, so I left. The second patient, on the other hand showed remarkable gratitude towards the hospital and was delighted that a high school student was in the room, learning about medicine. Once I finished visiting with the patients, I talked to Dr. John _____ (I don't know his last name) about my future plans and he explained MELD scoring to me (something discussed in the meeting that morning).

Notes:

• kidney vs. liver: liver must be accepted when transplant procedures occur. If not, person will die. Kidney doesn't have to be accepted like the liver.
• there is a priority process in transplants: doctors looks at mortality rate for certain conditions, survival rates, severity of illness (the higher the patient's score, the sicker)
• Bens Jones Protein Tests- looks at urine vs. dipstick
• Mgas correlates with multiple myeloma: patient has abnormal protein bc white blood cells, must monitor his/her protein levels... could potentially cause nerve pain
• hypercalcemia: high calcium level in the blood
• bone marrow generate blood cells
• plasmapheresis lowers calcium levels
• high PTH= high parathyroid levels... stimulates calcium levels
• blasts- more rapidly new producing cells
• sarcoidosis- inflammation of liver
• lytic lesion: usually comes from a multiple myeloma- colony of plasma cells... lyse the bone, increases the bone density for repair
• bone lesions occurs as a result of hypercalcemia
• mitotic figures are normally seen because of cancer... mitosis is occurring out of control
• can infer that kidney is being accepted when you can see mitosis occurring again
• ATN= acute tubular necrosis: death of tubular cells that allow urine.. kidney transplant might then be necessary
• blue material is a sign of scarring
• creatinine measures the kidney function
• phosphorous levels usually decrease after about a week post op kidney transplant
• MELD scores (Model of End Stage Liver Disease): TIPS jams a tube between portal and hepatic vein
• cirrhosis: blood can't flow through liver properly
• MELD score determines if person will die or not
• 3 part to MELD- 1. INR (International normalized ratio)- generates a number between 0-40 to estimate the probability of person dying 2. Bilirubin- blood levels 3. Creatinine
• more prone to kidney disease can sometimes directly relate to being more prone to liver disease