Causes and Management of Weight Loss in Ulcerative Colitis

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28 Mar 2019
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Answer 1:
In the present case, Eleanor is suffering from ulcerative colitis, which causes inflammation and
ulcers in the inner lining of the colon and rectum. As a result of which, the ulcers developed on
the inner lining male leads to bleeding and production of mucus. Further, according to the case
history, the inflammation affects the whole colon, and the condition is known as pancolitis. The
common symptoms associated with this condition include loss of appetite and weight loss. This
is reflected in the present clinical intervention, as Eleanor has lost 9 kg in the past two weeks.
According to a report, the indication of weight loss is because of malnutrition condition (Chiba,
Tsuda, Komatsu, Tozawa & Takayama, 2016). As such, the body is not getting efficient calories
to meet the routine requirement and thus results in significant weight loss.
Apart from appetite, other significant reasons for weight loss include structural changes
(inflammation), resulting in (Lemberg & Day, 2015):
 Food aversion which causes nausea like symptom and gives inner feeling to avoid food
intake. Further, the aversion is also resulting due to the association of food eating with
pain.
 Malabsorption of nutrients due to inflammation in the inner lining of the colon. This is
also affected because of disturbance in the gastrointestinal tract that leads to upset and
poor absorption.
 Increase in utilization of calories by the body, in response to fighting the disease.
 Loss of nutrients due to internal bleeding and diarrhea.
Functional changes - According to the report of Irwin, Raehtz, Parameswaran & McCabe (2016),
the pharmacological reason associated weight loss of appetite is linked with increased
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biosynthesis of the inflammatory signal. This includes tumor necrosis factor alpha (TNF-α) and
interleukins. These biomarkers were also linked with the poor nutritional status that further
reduces the appetite signaling and ultimately results in weight loss. Additionally, it is also
reported that the inflammation in the colon and rectum leads to changes in hormonal levels (ref).
For example, changes in the level of leptin and ghrelin are associated with appetite signaling,
lack of which ultimately results in reduced caloric intake (Lemberg & Day, 2015).
Apart from the structural and functional changes, existing of inflammation flares, pain in the
gastrointestinal tract, depression and frustration due to conditions, and lack of interest in eating
habits are also responsible for significant weight loss. Soon after the diagnosis of the condition,
measures must be taken to increase their food intake frequency or adoption of total parenteral
food intake is necessary (Dorofeyev, Rassokhina & Dorofeyeva, 2017). These measures are
important to control deep weight loss and minimize concerned symptoms.
Answer 2:
Inflammation is the key cause of pain in this case. The pain pathway is mainly mediated by the
N-methyl D-aspartate receptors, which causes underlying central sensitization. This is mainly
responsible for the cross-organ sensitization between the inflamed colon and rectum.
Furthermore, the capsasin and nociceptive ion channels are responsible for inducing the
neuropathic pain and ultimately resulting in pain (Jonefjäll, Simrén, Lasson, Öhman & Strid,
2018). In the present case, the complication involves extends beyond the splenic flexure and
thus includes pancolitis. This is characterized with mucosal inflammation, where self-immunity
is fighting against foreign pathological infection.
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