achilles
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Ten days after undergoing liver transplantation, a patient's levels of gamma-glutamyl transferase (GGT), alkaline phosphatase, and bilirubin begin to rise. Which of the following is the most appropriate next step in diagnosis?
A. Measurement of preformed antibody levels
B. Ultrasound of biliary tract and Doppler studies of the anastomosed vessels
C. Liver biopsy and determination of portal pressures
D. Liver biopsy and more detailed liver function tests
E. Liver biopsy and trial of steroid boluses
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| oct
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the lab looks like a biliary obstruction.B?
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| mesh
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good question achilles..........i too think its B.........
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| aimhigh
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E?
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| Rasul
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B. Narrowed lumen, blood flow obstruction in anastomosed vessels and possible obturation somewhere in biliary tract due to technical complications of operation causes elevation of GGT, alk. phosph. and bilirubin
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| jvo_md
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B...is the right answer
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| achilles
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the right answer is B-ultrasound.
aimhigh, rasul has already given the correct explanation.
keep posting questions guys.
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| aimhigh
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Thanks, guys  ! What dragged me to choice E is the time given in the question stem. Do you think 10 days post-op might be a bit longer for obstruction? Could you please explain to me why you chose obstruction instead of subacute rejection? Tx
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| amygdalaa
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I think rejection may not pose as increased ALP and GGT.
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| achilles
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for aimhigh,
for all other solid organ transplants, deterioration in function in 10 days would suggest acute rejection and appropriate biopsies would be done to confirm the diagnosis. in the case of liver antigenic reactions are less common and technical/mechanical problems involving the biliary tract and blood vessels are more common. they are therefore the first reasons to be looked for when we have such a problem after liver transplantation.
after this reason has been ruled out, only then we would go for a liver biopsy.
hope that helped aimhigh.
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" it's not whether you get knocked down, it's whether you get up"
" i have miles to go before i sleep "
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| aimhigh
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Thank you so much, Achilles! I did not realize the difference between liver and other organs in terms of transplants.
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| infliximab
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GOOD INFO
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