CGRN exam 2023/2024 with 100% correct answers

Therapeutic Procedures Achalasia - correct answer 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 - correct answer 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