Clinical Case of Ulcerative Colitis

This document is a clinical case study of a patient with ulcerative colitis. It discusses the symptoms, causes, and management of the condition, including the structural and functional changes in the colon. The document also explores the pain pathway and the intravenous solution used for treatment. It provides insights into the pathophysiology of ulcerative colitis and its impact on the patient's health.

Clinical case of ulcerative colitis 1
CLINICAL CASE OF ULCERATIVE COLLITIS
Student’s Name
Institutional Affiliation

Clinical case of ulcerative colitis 2
Question 1
Ulcerative colitis is a severe medical condition that affects the colon. As the name
suggests, it is as a result of inflammation and ulceration of the colon. Early detection of the
condition helps in the management and suppression of the condition as opposed to when it is
detected late. Just like any other part of the body, inflammation of the colon presents with the
characteristic signs of irritation and swelling (Galbraith et al, 2015). It is as a result of the body
response to a harmful stimuli and mainly bacterial infection. As the case of Eleanor, ulcerative
colitis causes several structural and functional changes in the colon as the disease worsens. These
changes have severe consequences that directly lead to weight loss as the case of Eleanor. For
example, an MRI conducted revealed that she had pancolitis.
Pancolitis is the inflammation of the entire colon. The inflammation had spread across
the whole colon and this had negatively impacted her health as the colon is an important part of
the digestive system responsible for the final stages of absorption. Severe inflammation spreads
to the rectum and the colon and rectum eventually become dysfunctional. Because of this
inflammation, defecation becomes painful and the patient may result to skipping meals and not
feeding so as not to defecate leading to a serious weight loss. The pain associated with colonic
ulceration may also affect feeding habits of the patient hence leading to weight loss (Craft et al,
2015). The feeling of bloating is also a big contributor of poor feeding habits linked to weight
loss.
Previous diagnostic tests performed on Eleanor revealed that she had pseudopolyps.
These are areas of scarred tissue. Inflammation of the colon is associated with ulceration. These
ulceration eventually leads to scarring of the tissue. This structural change in the colon has
severe repercussions as the colon cannot absorb water and other nutrients of importance. The

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colon is responsible for water and electrolyte absorption. However when it is scarred by the
worsened condition, these functions are affected and may lead to weight loss as important
nutrients cannot be absorbed. Electrolytes are also important when it comes to body maintenance
and homeostasis and scarring can lead poor health outcomes (Hill & Glew, 2017).
The functional aspects of the colon are severely affected by ulcerative colitis. For
example there is loss of motility of the colon with worsening of the condition. The colon loses its
normal motility in the digestion process and assumes a more rigid phase hence affecting its
digestive and absorptive properties. The lack of absorption of water and electrolytes leads to
severe diarrhea as there is increased watery luminal content. This diarrhea negatively affects
health leading to weight loss. The colon also shortens and loses its structural integrity with
severe inflammation and scarring leading to a characteristic lead pipe colon
Question 2
Pain is an unpleasant form of stimuli caused by injury or an illness. The human body is
composed of a network of sensory nerves that transmit such a sensation to the spinal cord and
brain for processing. Sensory nerves are responsible for sensation while motor nerves are
responsible for movement. As stated by LeMone et al. (2015, there is an interconnection between
sensory and motor nerves that enable the body to react in a reflex mechanism. For example, a
pain sensation on the arm due to a burn causes an individual to react and respond to the stimuli
by moving the arm away from the trigger which in such a case would be a fire. There are
different types of pain depending on where, which part and duration of pain perception on the
body.

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The pain pathway is composed of various players that send the information to the brain
for it to be perceived. The dorsal horn of the spinal cord receives signals of pain through sensory
nerves that are linked to receptors within the body (Borren et al, 2018). Eleanor’s case displays
visceral type of pain as it originates from the colon. Nociceptors in the colon receive chemical
and mechanical activation and the information is relayed to the dorsal horn of the spinal cord
linked to the thalamus for processing. Morphine alters pain perception via activation of
descending pathways from the midbrain that regulate endogenous opioid containing interneurons
in the spinal cord hence releasing pain relieving neurotransmitters.
Question 3
Eleanor worsened condition of ulcerative colitis is indicated by the severity of the
symptoms associated with the disease. She has experienced severe dehydration from fluid loss
through excessive diarrhea. She has for example had more than 14 episodes of diarrhea. This
symptom could have risen from the increased luminal water and electrolytes that cannot be
absorbed by the dysfunctional diseased colon. The increased ulcer formation in the colon from
inflammation can be captured by the presence of blood in stool indicating the severity of the
condition. Severe dehydration is indicated by the dry skin and poor skin turgor. Severe
dehydration signifies low blood volume and can be fatal if not managed by fluid therapy (Dulai,
Sandborn & Gupta, 2016). Low blood volume is indicated by other signs such as slow capillary
refill and low blood pressure.
The perfusion of all other body parts is dependent on blood volume. If it is low, it might
lead to severe complications such as necrosis and infarction (Chandrasekar & Venu, 2015).
Eleanor’s urinary output has significantly reduced indicating increased reabsorption of water by
the nephrons in an attempt to compensate for the increased dehydration. Increased ulceration of

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the colon and loss of blood in stool is of great concern as it may lead to anemic conditions. The
easily fatigability is highly linked to anemia which is caused by decreased hemoglobin levels that
are responsible for transport of oxygen.
Question 4
The intravenous solution ordered for Eleanor was Hartman’s solution. It is effective in
replacing fluid and electrolytes in patients who have low blood volume. Its composition is a
mixture of electrolytes that are of importance in the maintenance of body hemostasis. These
electrolytes include sodium compounds of chloride and lactate, potassium chloride and calcium
chloride. Eleanor’s case of dehydration was severe and therefore needed immediate action to
replace the electrolytes and fluid lost as indicated by slow capillary refill and low blood pressure.
The solution was infused for over 6 hours since the patient was severely dehydrated. A
lower duration of infusion would not be effective to stabilize the patient and these could have
had severe consequences such as shock. This solution was also the best applicable as opposed to
normal saline since it has a wide number of electrolytes that are of importance that could not be
absorbed in the disease process. Infusion acts as a quick and lifesaving procedure in many
clinical cases as its effects are immediate as the solution does not need to be absorbed from the
gastrointestinal system (Schniers et al, 2019).

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REFERENCES
Borren, N. Z., van der Woude, C. J., & Ananthakrishnan, A. N. (2018). Fatigue in IBD:
epidemiology, pathophysiology and management. Nature Reviews Gastroenterology &
Hepatology, 1.
Chandrasekar, V. T., & Venu, N. (2015). So What Is Crohn’s Disease and Ulcerative Colitis?
Pathophysiology of Crohn’s Disease and Ulcerative Colitis. In Inflammatory Bowel
Disease (pp. 15-23). Springer, Cham.
Craft, J., Gordon, C., Huether, S. E., McCance, K. L., & Brashers, V. L. (2015). Understanding
pathophysiology-ANZ adaptation. Elsevier Health Sciences.
Dulai, P. S., Sandborn, W. J., & Gupta, S. (2016). Colorectal cancer and dysplasia in
inflammatory bowel disease: a review of disease epidemiology, pathophysiology, and
management. Cancer Prevention Research, 9(12), 887-894.
Galbraith, A., Bullock, S., Manias, E., Hunt, B., & Richards, A. (2015). Fundamentals of
Pharmacology: An applied approach for nursing and health. Routledge.
Hill, R., Hall, H., & Glew, P. J. (2017). Fundamentals of Nursing and Midwifery: A Person-
Centred Approach to Care.
LeMone, P., Burke, K., Dwyer, T., Levett-Jones, T., Moxham, L., & Reid-Searl, K. (2015).
Medical-surgical nursing. Pearson Higher Education AU.
Schniers, A., Goll, R., Pasing, Y., Sørbye, S. W., Florholmen, J., & Hansen, T. (2019).
Ulcerative colitis: functional analysis of the in-depth proteome. Clinical proteomics,
16(1), 4.