Case Study of Crohns Disease Assignment

Running Head: CASE STUDY WITH GUIDED QUESTIONS
CASE STUDY WITH GUIDED QUESTIONS
Name of the student
Name of the University
Author Note

1
CASE STUDY WITH GUIDED QUESTIONS
Structural and functional changes in Crohn’s disease
Crohn’s disease (CD), also known as “Crohn syndrome” or “regional enteritis”,
is classified as a form of inflammable bowel disease (IBD) which disrupts the
gastrointestinal system of the body. It is an idiopathic, chronic inflammatory condition
mediated via an immunological response that generally affects the colon and distal
ileum, but can occur at any portion of the gastrointestinal (GI) tract (Lee, eun Kwon &
Cho, 2018). The manifestation of this disease occurs through a wide range of
interrelated underlying causes. The specific etiology of CD involves a complex
immune-mediated network and genetic predisposition. The causes of such inflammatory
conditions may emerge from chemical injury (for example, stomach acid), autoimmune
response, infections, and any disease of connective tissues (Lichtenstein et al., 2018).
The morphological changes caused by CD mainly involve a mutual effect of
damaging luminal contents and eviction of noxious agents of humoral cell response,
which leads to decreased motility and gut secretion. Spreading of CD is characterized
by a supposedly healthy egestion. However, there is a rapid penetration of the disease
into the entire stomach lining by a transmural propagation of inflammation that causes
lymphedema, bowel wall thickening as well as enlargement of mesenteric lymph nodes
(Torres et al., 2017). Extensive inflammation also results in bowel obstruction due to
hypertrophic effects on the muscularis mucosae. Such adverse structural changes could
lead to the formation of deep, longitudinal, and transverse ulcerations on the mucosal
lining, thus decreasing the functional ability of the intra-abdominal systems. Overall, the
predominant structural alterations observed in CD are vascular or skip lesions, thick
abscesses, perianal fistula formation, cell wall thickening, fibrosis, and development of
strictures due to myocyte proliferation and collagen deposition (Boyapati, Satsangi &
Ho, 2015).

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CASE STUDY WITH GUIDED QUESTIONS
Several complications associated with CD bring forth significant functional
disabilities in an individual. The domains of life most affected due to CD are cognitive
capacities, mobility and self-care management, interpersonal relationships, activities of
daily living, and social activities (Wilburn et al., 2017). Complications of the disease
often cause functional distress by postprandial abdominal pain, anorexia, nausea,
frequent diarrhea, epigastric discomfort, dysphagia, emesis as well as lactose
malabsorption. Functional limitations can be mediated by emotional hyperactivity,
which is rampant in patients living with Crohn’s disease. The stress-evoked responses in
them have a role in exacerbating the pathogenic conditions by affecting the regulation
of gut motility and increased inflammation (Agostini et al., 2017).
Pain pathway and the role of morphine in altering its conscious
perception
Pain is a physiological process that can be defined as “an unpleasant sensory and
emotional experience associated with actual or potential tissue damage or described in
terms of such damage”. The pain pathophysiology comprises five phases, namely,
“transduction, conduction, modulation, transmission, and perception” (Fornasari, 2014).
Transduction triggers the onset of an action potential by transforming mechanic, thermal
(hot or cold), and chemical (for example, low or high pH) energies which are of
enormous magnitude, and are possibly dangerous. Conduction takes place as the next
step, where “action potentials” reach nociceptor terminals on the spinal cord via the
axons. The third step in the pain process is the transmission, which begins with the
arrival of a nociceptive action potential at the presynaptic terminal, thereby activating
the postsynaptic receptors to depolarize a hot of ions including the second order
neurons. Modulation is the next phase, which involves adaptive pain mechanisms
related to suppression or inhibition of the first 3 phases, achieved through peripheral or