GERD - CMPP Exam 6 Latest Update -

GERD - CMPP Exam 6 Latest Update - Actual Exam Questions and 100% Verified Correct Answers Guaranteed A+

80% of all peptic strictures are secondary to ___ - CORRECT ANSWER: GERD

For Pts with 2 or more episodes per week and/or severe symptoms interfering with quality of life... - CORRECT ANSWER: Step 1: PPI once or twice daily for 8 weeks in addition to diet and lifestyle modifications

Step 2: If symptoms controlled, step down to lower dose PPI, then eventually to H2 or lifestyle modifications alone

How are PPIs more effective than H2 blockers? - CORRECT ANSWER: act on final

pathway of acid rather than specific receptor

Relieve symptoms and heal esophagitis in 85-90% of patients

How can GERD be classified? - CORRECT ANSWER: by endoscopic appearance

How do long-term use of PPIs cause infection? - CORRECT ANSWER: Chronic

suppression of acid Raises concern for increased risk of enteric infections including GI bugs (Salmonella, Campylobacter) and infectious diarrhea Allows more colonization of the upper GI tract

How do peptic strictures form? - CORRECT ANSWER: Usually results from the healing process of ulcerative esophagitis related to uncontrolled GERD Collagen deposited during healing phase of esophagitis which contract over time and narrow the lumen

more commonly at GEJ

How do PPIs affect Ca absorption? - CORRECT ANSWER: Hypochlorhydria (low HCl

levels due to PPI) Theoretically reduces calcium absorption = decreased bone density

How do PPIs cause kidney disease? - CORRECT ANSWER: PPIs are known to cause

Acute Interstitial Nephritis (AIN)

Weak association seen in some studies associating PPI use with increased risk of incident CKD, CKD progression, and end-stage renal disease (ESRD)

How do you diagnose barrett's esophagus? - CORRECT ANSWER: Endoscopy 1 / 2

Sensitivity of endoscopy to detect Barrett's depends on the length of the mucosa involved

How do you diagnose peptic strictures? - CORRECT ANSWER: endoscopy - can be

both diagnostic and therapeutic barrow swallow - if suspicion for complex stricture

How do you manage post-op dysphagia? - CORRECT ANSWER: liquid diet for 2-12

weeks If persists more than 12 weeks, barium swallow to evaluate placement of fundoplication (may need dilation)

How do you manage post-op Gas-Bloat Syndrome? - CORRECT ANSWER:

simethicone tablets (Gas-X), avoid carbonation, metoclopramide (Reglan) to promote gastric motility

may be if large wrap done or wrap is too tight

How do you treat dysplasia + Barrett's? - CORRECT ANSWER: Endoscopic eradication with radiofrequency ablation (RFA), photodynamic therapy or endoscopic mucosal resection (EMR) is recommended for HIGH GRADE dysplasia Esophagectomy in severe cases

How do you treat GERD + Barrett's ? - CORRECT ANSWER: Step-up' therapy not

appropriate

Should start with standard dose of PPI

Goal of treatment:

Control symptoms Patients with long-segment Barrett's can have more difficult to treat symptoms May need PPI QAM, H2 blocker QPM or PPI BID

NOTE: this approach is to control symptoms but has not been proven to prevent

progression to cancer

How do you treat peptic strictures? - CORRECT ANSWER: Endoscopic Dilation of

stricture May require multiple, progressive attempts

NO ROLE FOR STENTING

Medication Treatment with acid reduction (PPI or H2 blockers) is needed to prevent recurrence, regardless of GERD symptoms

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