Health Variation: Ulcerative Colitis Case Study

Running head : HEALTH VARIATION
Name of the Student
Name of the University ‘
Author Note

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HEALTH VARIATION
Question 1:
The case study represents ulcerative colitis of a 48 years old lady, Eleanor Brown who
was suffering from the severe ulcerative colitis since the age of 31. The case study suggested that
from the last two weeks she was experiencing exacerbation and she was feeling fatigue along
with diarrhea secreting pus, blood. In the last two week, she lost her 9kg of weight and feeling
too ill to eat. Moreover, she complained that the she was unable to perform her daily activities.
From the case study, it was observed that the weight loss of the patient is clearly due to the loss
of appetite as a result of ulcerative colitis. As discussed by Plenderleith, (2015), ulcerative
colitis is an autoimmune disease which usually begins in the rectum and either it remains
localized or extended proximally. The structural and functional changes of the gastrointestinal
tract led to the appetite loss. GI tract of the human body is guarded by the mucous layer which
provides a physical layer in between commensals and host-microbial cells. The disruption of the
tight junction of the cell layers give rise to the inflammation observed in the case study. The
disruption facilitates the permeability of the epithelial layers and microbes can reach to the
epithelial cell of intestine triggers the uptake of luminal antigens and induction of NF-kB (Mora-
Buch et al., 2016). The induction of this pathway induces the production of the proinflammatory
cytokines (interleukins) and TNF-α. The activation of these cytokines induces the CD4 T cell-
mediated production of IL4 and IL3 (Russell et al., 2016). According to Magnusson et al.
(2016) IL3 is associated with the destruction of epithelial barrier which further recruited more
immune cells and crypt abscess along with pseudo polyps developed which is an indication of
the ulcerative colitis. The intestine shows multiple ulceration, especially sub mucosa shows
intense inflammation. These structural changes in the intestine facilitate the acids of the GI tract
to interact with the epithelial cells. The destruction of the mucosal barriers induces efflux of H+

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HEALTH VARIATION
ion which causes watery diarrhea with blood and pus (Mora-Buch et al., 2016). Because of the
inflammation patient loss of appetite and since normal mucosa absorbs food, patients with
inflammation failed to absorb intake food which led to the weight loss as observed in this case
study.
Question 2:
As observed in this case study, Eleanor Brown was suffering from pain due to ulcerative
colitis. As discussed by Hillman (2017), pain is associated with ulcerative colitis where visceral
pain is associated with the inflammatory responses of the GI tract. The inflammation induces the
activation of sensory neurons (nocireceptor) and indirectly responded to the chemical released by
damaged tissue. These nerve endings have transient receptor potential which turns into transduce
a variety of noxious stimuli into receptor potential which initiate action potentials. The potential
then transmitted to spinal cord by ascending pathway called spinothalamic tract from which the
signal transmitted to the brain stem (thalamocortical) which conveys the information to the
cerebral cortex where sensation of pain can register. Cerebral cortex prompts the action to reduce
the pain. In the current context, Eleonor was prescribed with the morphine for reduction of the
sensation of pain. As discussed by Hillman (2017), Morphine is a drug of the opiate family
which is frequently used in the ulcerative colitis to reduce the sensation of pain in the patient.
Morphine attached to four major receptors such as delta, kappa, mu and nocireceptor and
induced hyperpolarization of the inflamed cells and reduction of the presynaptic neurotransmitter
released due to pain sensation (Stein, 2016).Morphine also facilitates the cessation of the calcium
ion and reduces the release of the neurotransmitters from the nerve endings located in the pain