Eleanor Brown Case Study: Ulcerative Colitis Progression and Clinical Manifestations

Case study
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Eleanor Brown case study
Question 1
The case study describes a 48-year-old client who was diagnosed with ulcerative colitis 17
years back while she was 31 years old. This disease has been managed with a combination of
diet, medication and medical monitoring all along however it has been having periods of
remission and exacerbation which has led Eleanor to have frequent hospital admissions. The
disease has been progressing, four years back a colonoscopy was performed which revealed that
she has developed pseudopolyps and this time around her gastroenterologist requested for an
MRI which revealed that it has developed to pancolitis. The structural and functional changes of
the disease as it was progressing it led to weight loss where Eleanor reported a loss of 9
kilograms for the past two weeks prior to her hospital admission. Structurally ulcerative colitis
begins as primary lesions that are inflamed at the base of the crypts of Lieberkühn in the
rectosigmoid area of the bowel. Often the lesions affecting the mucosal areas extends laterally
causing large denuded areas. The mucosa becomes edematous, hyperemic and friable at the same
time the mucosa ulceration starts to occur as well. Destruction of the mucosa leads to bleeding,
cramping pain and urge to defecate. This is followed by chronic inflammation characterized by
narrowing and loss of the colon’s normal haustra. Finally, the pseudo polyps develop.
Pseudopolyps are masses of scar tissue normally develops from granulation tissue during the
healing phase in a repeated cycle of ulceration (Carton, 2017). Levels of some metabolic
hormones including leptin and ghrelin are associated with the chronic inflammation of the tissues
due to the structural changes as the disease progress. Hormone level alterations can affect satiety.
Appetite is reduced leading into less food consumption thus the client becomes malnutritional.
The mucosal; and intestinal bleeding due to mucosa destruction leads into nutritional losses.

When the micro and macronutrients are lost the client becomes malnutritional hence the weight
loss. Diarrhea can also lead to water weight loss (Kumpf, 2014) The pseudo polyps lead to
alterations of the intestines due to the loss of absorptive mucosal surfaces and rapid colonic
transit time. The macro and micronutrients are not given enough time a condition called
malabsorption. Lastly, client experiences symptoms including sensation of abdominal bloating,
anorexia and cramping pain. Anorexia decreases the client's appetite while the cramping pain can
be equated to the pain experienced during ingestion of food and can lead to food avoidance
rendering the patient malnutritional.
Question 2
The pain pathway involves detection of stimulus and relaying the information to the cortex
where it will consciously be perceived as pain (Uddin, 2015). The pain pathway includes; first
order neuron pathway, second order neuron and the third order neuron which is thalamocortical
tract. High-intensity stimuli activates the nociceptors. The stimuli travel through the axon of the
first order neuron which terminates in the spinal cord’s posterior horn. The spinothalamic
neurons receive the pain information and the information is relayed to the hypothalamus through
the ascending pathway of the spinal cord. The thalamocortical neurons receive the information
and pass it to the cerebral cortex. When morphine is administered it travels to the brain where it
binds the opiate receptors that is mu or kappa receptors. Which are along the pain pathway this
leads to analgesia (Kwon, Altin, Duenas & Alev, 2014). The activation of the presynaptic mu
receptors by the morphine causes the inhibition of calcium ion channel this prevents the release
of neurotransmitters. Morphine is an opioid receptor agonist, and this blocks the synaptic