Clinical Challenges in Transplant Surgery: Nutcracker Syndrome & Post-Op Liver Transplant Patient

Behind The Knife: The Surgery Podcast

Science, Health & Fitness, Medicine, Education

4.8 • 1.4K Ratings

🗓️ 27 January 2022

⏱️ 23 minutes

🔗️ Recording | iTunes | RSS

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Summary

In this episode we will explore two challenging transplant surgery cases. In the first, we discuss Nutcracker syndrome and the unique ethical questions that accompanied a living donor case. In the second, we examine a perplexing post-operative development in a complicated liver transplant patient.

Learning Objectives
· Understand the presentation and general treatment strategies for renal nutcracker syndrome
· Discuss protocol and ethical considerations for living donor renal transplants
· Review portal hypertension physiology, clinical manifestations, and options for treatment

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Transcript

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0:00.0	Behind the Night, the Surgery Podcast, relevant and engaging content designed to help you
0:12.0	dominate the day.
0:22.5	Hello everyone, welcome to another episode of Behind the Knife with the Transplant Surgery
0:26.9	team of the University of North Carolina at Chapel Hill. Today we will be discussing
0:31.3	two challenging transplant cases.
0:33.9	I'm Megan Lombardi, a third-year General Surgery resident.
0:37.8	I'm Sasha McHughan, I'm a second-year General Surgery resident.
0:40.5	I'm Gide Levede, I'm on the fourth-year General Surgery Residence.
0:44.2	I'm Alex Toledo, one of the Transplant Surgery attendings, the director of the surgical director
0:49.8	of the Kidney Transplant Program and professor of surgery here at UNC.
0:54.6	I'm David Gerber, the Georgia of Sheldon Distinguished Professor of Surgery and the Chief
0:58.9	of the Division of Transplantation.
1:01.3	So our first case is a middle-aged female who has really no significant past medical
1:06.7	history besides a questionable kidney stone and no intrepidominal operations ever with
1:13.8	a relatively normal social history, some occasional alcohol, distant tobacco history and no significant
1:20.6	family history for any type of kidney disease who originally presented to her PCP in 2017
1:27.2	with left flank pain.
1:29.0	She was also have a vein interment in hematuria which was worse with exercise and had never
1:33.6	had that before.
1:35.7	She was having a lot of pain in the left flank like we said that was interfering with her daily
1:41.1	life.
1:42.1	She was rating it greater than 5 out of 10 and so she originally presented to a tertiary
	...

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