Case Study: Perioperative Management of Ulcerative Colitis Condition

This case study focuses on the perioperative management of Eleanor, a 48-year-old patient with a history of ulcerative colitis, who is experiencing an acute exacerbation. The analysis covers the structural and functional changes contributing to her weight loss, the pain pathway and morphine's effect on pain perception, clinical manifestations indicating deterioration of her condition, and the rationale behind intravenous fluid administration. The case study highlights the complexities of managing ulcerative colitis, including the impact of inflammation, medication, and potential complications like pseudopolyps and pancolitis. The treatment plan involves addressing electrolyte imbalances and dehydration through intravenous fluids like Hartmann's solution, while also considering the long-term effects of the disease and its management on the patient's overall health. Desklib provides access to this and many other solved assignments.

Running Head: HEALTH VARIATION 1- PERIOPERATIVE
Health Variation 1- Perioperative
Name
Institutional Affiliation

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Question 1. Describe the structural and functional changes in the disease process that
led to Eleanor’s weight loss?
Structural, as well as functional changes in the weight loss of Eleanor, is due to
various reasons as it could be subsidised through the number of diverse processes. As
structural changes are concerned, increased in the amount of the colonic sulphate-decreasing
bacteria in ulcerative colitis, may result in a higher amount of the poisonous gas of hydrogen
sulphide. Compound N-butyrate which is the short-chain of fatty acid may get oxidised via
the beta-oxidation pathway into the gas carbon dioxide as well as ketone bodies (Bullock &
Manias, 2013). So it is observed that the N-butyrate aids supply of nutrients to this mucosal
epithelial barrier. Readings have anticipated that the hydrogen sulfide imparts a significant
role in damaging the beta-oxidation pathway by interfering this short chain acetyl-CoA
dehydrogenase, which is an enzyme inside this pathway. This process disrupts the eating
behaviour and hence results in weight loss (Craft et al. 2015).
Moreover, weight loss in Eleanor which are the consequences of the primary
physiological disruption which are functional changes, linked with this disease may perhaps
be considered as the marker of the disease action (Elsherif et al. 2014). Resting energy
spending has been demonstrated to be amplified during the acute flares of ulcerative colitis
because pro-inflammatory cytokines may exert the anorexic influence. The inflammatory
condition in the ulcerative colitis has been associated with the alterations in stages of the
number of the metabolic hormones comprising leptin, adiponectin, as well as ghrelin which
can upset satiety. Subsequently, in the main while, they might try to escape eating with the
intention to elude pain perceptions or the unpleasant abdominal symptoms (Nurgali, 2014).
Some medications as well as nutrient deficiencies may cause taste alterations and may lead to

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loss of appetite (Nurgali, 2014). Moreover, these disease courses are related to the
malabsorption of equally macronutrients as well as micronutrients (Hwang et al. 2012).
Lastly, patient like Eleanor suffering from chronic ulcerative colitis may suffer from
an enhanced gastrocolic reflex in addition to a variety of the symptoms comprising pain
which is frequently associated with the ingestion of the food that may lead to escaping of the
meal (Nurgali, 2014). Alterations of digestive function across the life span. Chronic
malnourishment subsequently from the suboptimal enteral consumption because of the
condition anorexia in addition to abdominal discomfort, along with increased losses because
of the protein-losing enteropathy, so is deliberated to be the main etiologic reason of the
weight loss. Moreover, malabsorption of the food is infrequently seen if the patient with
ulcerative colitis has had a widespread intestinal resection (Bullock & Manias, 2013).
Question 2. Explain the pain pathway and how Morphine alters the conscious
perception of pain
In the pain pathway Nociceptive stimuli trigger the nerve endings; then first-order
neurons depolarise to fire action potentials. A (myelinated) delta fibres synapsis with release
glutamate onto second-order neurons, while C (unmyelinated) fibres release neuropeptide
neurotransmitters. These primary afferent nociceptors conduct nerve impulses to the spinal
cord (so if rise from the skull, then transmit directly to medulla oblongata of the brain stem).
So in the spinal cord, the primary afferent nociceptors lay off in the dorsal horn of the grey
matter. Then release chemical transmitter substances substance P and somatostatin, along
with glutamic acid or aspartic acid. Pain is then perceived by the somatosensory area of the
brain.
Morphine is an opiate drug, work together with the opioid receptors, in addition, alter
the conscious perception of pain as by the similar mechanisms as of the enkephalin, such that
hyperpolarisation of the interneurons as well as depressing the further discharge of the

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transmitters linked with the conduction of the pain (Kendroud & Bhimji, 2017). Furthermore,
morphine can also interrelate with the opioid receptors set in the specific supra-spinal
structures, in addition, stimulate the supra-spinal structure. Adrenergic drugs which may
relate with the definite receptors may likewise alter the conscious perception of pain as it has
been proposed that the morphine cooperates with the present adrenergic system and develop
analgesia (Richards et al. 2015).
Question 3. Identify the clinical manifestations that may indicate the deterioration of
Eleanor’s ulcerative colitis condition and explain why these may occur.
In the contemporary situation, Eleanor is experiencing more frequent episodes of
diarrhea with the blood as well as pus comprising with the severe pain in the lower part of the
abdomen. Moreover, she is also suffering from the sensation of the abdominal bloating in
addition to cramping pain. She has also lost her appetite which is resulting in weight loss and
exhaustion. The huge number of the pseudopolyps are also developed in Eleanor’s
descending as well as the sigmoid colon. Furthermore, MRI scan also revealed that she had
also developed the pancolitis.
Similarly, examination revealed that she also has a painful plus distended abdomen.
Her skin was dry, pale as well as cool when coming in contact. Her capillary refill is also
slow in addition to flat neck veins. Eleanor also states that she has condensed urinary. So
these conditions indicate that her clinical symptoms are deteriorating. According to studies,
there is an increasing prevalence of the structural damage as well as anorectal dysfunction in
the patients who are on corticosteroid treatment, immunosuppressant as well as anti-TNFs, in
addition, a relationship of the structural damage linked with the anorectal dysfunction. So
ulcerative colitis is the disease with the progression in patients (Campos et al. 2018).

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Question 4. Explain the characteristics of the intravenous fluid that was ordered for
Eleanor and the rationale for the administration of the IV fluid relating to Eleanor’s
specific fluid balance.
Intravenous fluid that was ordered for Eleanor was Hartmann's solution which is
available in the form of sodium lactate solution having the physical features such as pure,
colourless, considerably syrupy liquid, mixed with the water (Richards et al., 2015).
Hartmann's solution is being used for the intravenous fluid as well as an electrolyte
replacement. It may also be used as the basis of the bicarbonate in further management of the
mild to less severe metabolic acidosis related to the dehydration or linked with the potassium
insufficiency. It may also utilize as a vehicle for the intravenous drug distribution if the
desired medications are well-matched with the specific solutions. In Sodium lactate, Lactate
is gradually metabolised to the bicarbonate and the water. This response is determined by the
cellular oxidative action. In the usual biological circumstances, change of the sodium lactate
to the bicarbonate needs around 1 - 2 hours (Severs et al. 2014). The rationale for the
administration of the IV fluid relating to Eleanor’s specific fluid balance was that the
numerous electrolyte intravenous as well as glucose solution is used for reestablishing the
desired electrolyte equilibrium in addition to giving energy as well as water for the hydration
(Hoorn, 2017). The amalgamation of the numerous electrolyte as well as sodium lactate
which is alkalinising agent may offer electrolyte balance, in addition, normalise the body pH
of the normal acid-base balance in the biological system.

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