Ulcerative Colitis: Structural and Functional Changes

This document discusses the structural and functional changes in ulcerative colitis, including the impact on weight loss. It also explores the pain pathway and management of pain in ulcerative colitis. The document further examines the clinical presentations and treatment options for advanced ulcerative colitis, as well as the benefits of Hartman's solution and methylprednisolone in managing the disease.

ULCERATIVE COLLITIS
Institutional Affiliation
Student’s Name

Question 1
Ulcerative colitis is a disease that is as a result of inflammation of the colon and in
extension the rectum. Inflammation occurs just as any other part of the body and is a result of
body response to harmful stimuli including pathogens such as bacteria. In ulcerative colitis case,
there are many structural and functional changes that occur as the disease progresses. These
changes result in the observable and many other unobservable symptoms. In the case of Eleanor
for example, some of these structural changes that led to loss of weight of the patient include the
fact that the MRI performed showed she had pancolitis. Pancolitis is the inflammation of the
entire colon. Previous colonoscopy had also revealed that Eleanor had pseudopolyps. These are
areas of scarring tissue in the colon hence structural features of the disease. As stated by Lustosa
et al. (2017), scarring tissue results from persistent ulceration of the colon because of increased
inflammation.
These structural changes affect health and lead to weight loss because the colon can no
longer absorb nutrients and electrolytes essential for growth and maintenance (Lugovskoy,
2017). The scarred parts of the colon have decreased motility and are rigid in cases of ulcerative
colitis. This results into malabsorption as the colon is responsible for the final stages of digestion
and absorption. Ulcerative colitis therefore leads to functional changes of the colon as water and
electrolytes cannot be absorbed efficiently. As stated by Borowiack et al. (2016), the
malabsorption of electrolytes leads to water loss from the intestinal epithelial cells lining the
colon as there is a high luminal concentration of these electrolytes. The lack of absorption of
water by these cells also leads to increased luminal watery content hence the presentation of
diarrhea and fluid loss leading to dehydration as presented by Eleanor. This has an impact as
whatever she feeds on becomes lost by the persistent diarrhea leading to weight loss.

Eleanor’s ulcerative colitis disease had worsened over time as almost the whole colon
was now inflamed. This has very serious implication on the weight loss as the extent of tissue
damage is proportional to the inflammation. Scarring of the colon over leads to shortening of the
colon as a whole and the structural appearance of the colon typically consisting of valves and
folds is compromised leading to a lead pipe colon. The lead pipe colon therefore has a lesser
surface area to absorb water leading to dehydration. The colon’s elasticity and motility is also
jeopardized by the disease. Fulminant colitis is a severe form of ulcerative colitis which can
result into dangerous complications such as toxic megacolon
Question 2
Pain is a type of stimuli that causes physical discomfort. There are various types of pain.
Pain can either be somatic or visceral. It can either be superficial or deep. When it comes to
duration of the unpleasant stimuli, pain can either be acute or chronic pain. The pain caused by
ulcerative colitis and being experienced by Eleanor can be best described as deep visceral pain
since it is originating from colon, a visceral organ. The pain pathway consists of various
components that interconnect and transmit information to the brain for a person to perceive the
pain (Emmett et al., 2017). The spinal cord is linked to receptors of pain in the body which
transfer the stimuli to the brain for perception (Senturk et al, 2016).
Visceral pain as in the case of Eleanor results from mechanical and chemical activation of
nociceptors located in the colon. The pain is transmitted via sensory innervation to the dorsal
horn of the spinal cord which is connected to the thalamus for processing the information and
perception. Morphine is an opioid that alters pain perception and is used in management of pain.
It does so by activating descending nerve fibers from the mid brain that control the endogenous
opioid containing interneurons within the dorsal horn of spinal cord. Some of the pain relieving

neurotransmitters that are stimulated include enkephalins, endorphins and dynorphins. Morphine
also inhibits afferent transmission of pain by binding to mu-opioid receptors in the dorsal horn of
the spinal cord
Question 3
Eleanor has an advanced ulcerative colitis which is manifested by serious clinical
presentations. For example she has experienced more than 14 episodes of diarrhea. This could
have resulted from increased loss of electrolytes and water which cannot be absorbed from the
diet as the colon is diseased. The presence of blood in stool indicates severity and may be the
result of rampant ulcer formation and scarring in the colon. As stated by Bhattacharyya et al.
(2016), dry skin and poor turgor indicates severe dehydration from loss of water and fluids
within the body.
The slow capillary fill indicates low blood volume and this is also reflected by the
abnormally low blood pressure. Her urinary output has decreased showing the deterioration of
the disease as most of the fluids taken is lost in stool and the nephrons are compensating by
reabsorbing more water in the proximal and distal tubules hence a low urine output. The
increased loss of appetite also show increased severity as it symbolizes increased ulceration in
the colon making the patient not desire food (Pollak et al, 2015). She is also easily fatigued and
is unable to complete daily activities. This characterizes the fact that she has anemia which is
characterized by low hemoglobin levels that carry oxygen throughout the body.
Question 4
Hartman’s solution was ordered for Eleanor. It contains a mixture of electrolytes that help
improve fluid balance within the body of dehydrated patients. It contains a mixture of sodium

chloride, sodium lactate, potassium chloride and calcium chloride in water. It is used for
replacing fluids and electrolytes in patients who have low blood volume and pressure. As a result
of dehydration, Eleanor’s blood volume was lower than normal as indicated by her low blood
pressure. She had lost poor skin turgor and her capillary refill was slow hence the infusion was
done for over 6 hours as she needed a lot of fluid and electrolyte to sustain body fluid balance
back to normal.
Methylprednisolone was also ordered as a result of the increased signs of inflammation.
The patient was in deficit of important electrolytes that are essential for growth and maintenance
of proper biological processes. An imbalance in these electrolytes such as calcium, sodium and
potassium has dire consequences and can lead to altered homeostasis (Kim et al, 2017). The
replacement of these electrolytes was therefore of importance. The Hartman’s solution contains
all these electrolytes as opposed to normal saline hence was the preferred solution.

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