Health Case Study: Ulcerative Colitis and its Clinical Manifestations

Running head: HEALTH CASE STUDY
HEALTH CASE STUDY
Name of the Student:
Name of the University:
Author note:

1HEALTH CASE STUDY
Question 1
Ulcerative colitis is a chronic gastrointestinal condition which results in inflammation-
induced ulcer formation in the mucosal membrane of the colon – namely the sigmoid colon and
rectum. Such patients posses lesions in the colon, which may caused as a result of a number of
inflammatory, pathogenic and genetic mechanism (Hindryckx, Jairath & D'haens, 2016). These
include hunmoral immunity-induced macrophage activities of inflammation and cytotoxic
manifestations by T-lymphocytes as a part of pathogen-associated immune responses. Hence,
such inflammatory processes result in the structural and functional changes of the colon
characteristic of ulcerative colitis which comprises of inflammation in the large intestine,
namely, at the base of crypt of Lieberkuhn. This results in the formation of minor erosions in the
sigmoid colon, rectum or transverse colon which aggravate into ulcers and abscesses (Sroufe et
al., 2017). Such detrimental structural changes, if left unmanaged, result in the ragged ulceration,
cell atrophy and necrosis, bleeding, pus accumulation , edema, reddening and thickening of the
colonic mucosal layer (Nakagawa et al., 2015). Such processed result in functional changes such
as loss of the absorptive processes of the colon, gastrointestinal bleeding, severe spasms and
cramping, decreased transit time of the colon and hence, uncontrolled defecation. Defecation is
associated with the loss of necrotized absorption-associated colonic surfaces, blood and pus
formed from ulceration coupled with release of stools. Further, loss of functioning lumen of the
colonic mucosa hinders in the characteristic water absorption associated function of the colon
resulting in water loss and watery diarrhea (Craft & Gordon, 2011).
It can be observed that Eleanor is suffering from severe gastrointestinal pain, ulceration,
bleeding and diarrhea, whose underlying mechanism can be attributed to the above discussion.

2HEALTH CASE STUDY
Eleanor’s weight loss can be attributed to the structural and physiological effects of ulcerative
colitis such as bleeding, inflammation and watery diarrhea. Bleeding results in loss of essential
nutrients and tissue components from the body which results in long term weight loss and
hemoglobin induced nutrient transportation (Schniers et al., 2019). The loss of colonic lumen in
ulcerative colitis further hinders its micronutrient absorptive processes hence preventing essential
nutrient uptake by tissues, poor nutritional status and weight loss. The high rates of inflammation
in ulcerative colitis results in tissue catabolism – another causative mechanism of weight loss.
The associated watery diarrhea results in loss of water and electrolytes, loss of muscle tone and
hence the resultant weight loss (Craft & Gordon, 2011).
Question 2
The general pathway of pain is caused due to a complex interplay of nervous system
functioning which is hindered by morphine. Ulcerative colitis in Eleanor, will result in
inflammation which results in activation of nociceptors or microscopic receptors of pain in the
skin. Each of these are interlinked to the spinal cord via nervous fibers. Upon activation of the
nociceptors in the gastrointestinal regions, the electrical signals of pain are transmitted to the
concerned nerve fibers (Chen et al., 2015). Such transmissions travel across the nerve fiber
bundles to the peripheral nerve and to the spinal cord. Neurotransmitters in the dorsal horn of the
spinal cord the relay the impulse to the thalamus of the brain which further transmits the same to
the frontal cortex (associated with Eleanor’s thinking and preoccupation concerning her pain),
limbic system (associated with emotions, hence making Eleanor feel distressed, discomfort and
agitatin due to pain) and somatosensory cortex (results in physiological sensations hence,
compelling Eleanor to perceive her abdominal pain) (Yam et al., 2018). Morphine hinders this