CGRN Questions With 100% Correct Answers.

Therapeutic Procedures Achalasia - occurs when nerves of the esophagus do not function properly, resulting in problems swallowing and passing food thru the lower esophageal sphincter (LES) -Sx is only done if pt has no relief from meds or EGD procedures -Sx is a MYOTOMY (open sx or laparoscopic), surgery consists of circular muscle fibers of the LES that are divided. -Laparoscopic Heller's Myotomy is the "most popular" and used "most frequent." Has less morbidity, complications, and better recovery. -Peroral Edoscopic Myotomy (POEM) endoscopic procedure which performs myotomy without surgery. -Steps of the Procedure include: a. find the LES and mark it inject it with dye b. make longitudinal incision with an electrocautery knife c. tunnel the scope into the submucosa space. The tunnel is created beyond the LES into the proximal stomach, exposing the inner circular muscle layer. d. Perform the myotomy about 8 to 10 cm above the GE junction and 2 to 3 cm into the cardia. -Pt's with severe achalasia and failure of myotomy will need to have an esophagectomy, which is last resort and risky. Therapeutic Procedures Billroth I Procedure - the antrum is resected and the duodenum is reanastamosed to the gastric remnant. (ex. Perforated Peptic Ulcer). -not used as much as laparoscopic procedures -Complications include: a. anastomotic and suture leaks resulting in peritonitis and or sepsis -Side effects include: a. dumping syndrome b. diarrhea c. bile reflux gastritisTherapeutic Procedures Boerhaave's Syndrome - the lower thoracic esophagus is completely torn away from the gastric cardia. -some pt's may have vomiting, difficulty breathing, and tachycardia, depending on location of perforation. a. Cervical-neck pain and muscle spasm, cervical motion pain, dysphonia (spasm/tone), hoarseness, cervical dysphagia. b. Thoracic-dysphagia, odynophagia (painful swallowing), dyspnea, cyanosis, and chest discomfort. -Early tx for esophageal perforation incudes: a. stabilize respiratory status b. antibiotics c. volume replacement d. (TPN) Total Parenteral Nutrition e. chest tube drainage -When surgery is necessary, usually the esophagus tear requires sutures. a. The sutured area is reinforced with pleural or intercostal flaps in a thoracic injury b. The sutured area is reinforced with a diaphragmatic flap in the lower esophageal tear Therapeutic Procedures Billroth II Procedure - the distal portion of the stomach and the proximal duodenum are resected, and the jejunum is reanastamosed to the gastric remnant. (ex,Perforated Peptic Ulcer). -not used as much as laparoscopic procedures -Complications include: a. anastomotic and suture leaks resulting in peritonitis and or sepsis -Side effects include: a. dumping syndrome b. diarrhea c. bile reflux gastritisTherapeutic Procedures Endoscopic Mucosal Resection (EMR) - can remove "early stage" cancer that is confined to the mucosal layer without any lymph node involvement.