Case Study: Analysis of Jordan's Crohn's Disease and Treatment Plan

This case study presents the case of Jordan, a patient diagnosed with Crohn's disease, detailing his symptoms, diagnosis, and treatment. Jordan experienced rapid weight loss, malabsorption, and food aversion due to the inflammatory condition. The study explores the underlying physiological mechanisms, including the role of nociceptors and opioid receptors in pain pathways, and the impact of the disease on Jordan's vital signs and laboratory results. Jordan exhibited symptoms like hypotension, tachycardia, fever, and anemia, along with abnormal urine analysis and elevated inflammatory markers. The treatment plan includes Hartman’s solution to address fluid and electrolyte imbalances and methylprednisolone to reduce inflammation. The case study references several research papers to support the analysis and treatment strategies.

Running head: CASE OF JORDAN 1
Case Of Jordan
Name of the Student
Name of the University
Author Note

CASE OF JORDAN 2
Question no. 1
In the case study, Jordan was suffering from acute inflammatory disease or Cronh’s disease,
as a result, he had undergone rapid weight loss owing to malnutrition caused by insufficient
uptake of calories. Also there is too much fluid loss from the patient body due to diarrhea or
intestinal bleeding. Besides, individuals with Crohn’s disease have less or poor apetite, they
do not feel the urge to eat(Torres et al, 2017). In this case, Jordan was suffering from
malabsorption and facing difficulty with maintaining his weight even if he consumed food,
since his body was unable to breakdown the food properly, utilizing the nutrients.
Malabsorption often leads to diarrhea or abdominal bloating. Jordan also developed food
aversion which takes place when an individual feels a sensation of pain while
eating(Akobeng et al, 2018). That is why, he used to avoid eating in order to avoid the pain or
unpleasant experience, thus leading to weight loss. Moreover, since Jordan was not being
able to keep up with his work, he remained depressed and refused to eat. The side effects of
medications may have triggered appetite loss in Jordan, since the medications are found to
change the taste sensation of the tongue, making the person less interested in eating. Besides,
the abdominal pain and nausea reduced Jordan’s apetite which resulted in insufficient calorie
intake. Rectal bleeding from ulcer in the intestine leads to deficiency of iron, leading to
anemia followed by severe weight loss and weakness. Jordan was also diagnosed with
perianal abscess or anal fistula which results in the formation of a collection of pus through a
process known as “abdominal sepsis”. As a result, there is reduced absorption of nutients and
calories in the body, which led to malnourishment and subsequent weight loss of
Jordan(Santarpia et al, 2019). Jordan had poor skin turgor due to severe fluid loss from the
body. It was found that, mild dehydration accounts for loss of 5% of the body weight
whereas, severe dehydration accounts for 12-15% of total body weight.

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Question no. 2
The pathway of pain consist of three different orders of neurons which are together involved
in carrying the action potential signal to the brain responsible for pain. The “first order”
neurones are also known as “pseudounipolar neurones”. They have both cell body and
ganglion at the dorsal root region. The “second order” neurons have cell bodies, which are
found in the spinal cord or within the cranial nerves. The cell bodies of the “third order”
neuron lies within the thalamus. The first order neurons contains specialized receptors called
“nociceptors” present at the nerve endings of the primary afferent neuron, also called
unencapsulated cutaneous receptors. These receptors helps in the transduction of the pain
signal when a specific area of the skin gets excited or stimulated.
Morphine usually shows its activity on the opioid receptors, which is a type of “G-protein
coupled receptor”(GPCR) and helps in modulation or alteration of pain sensations in the
nervous system. The opioid receptors are distributed mainly in the brain and spinal cord and
attaches with a compound named “encephalin” to control pain. Morphin imitates the structure
of encephalin and binds itself with the opioid receptors and initiates a series of events. It
activates GPCR , which increases the rate of conduction through potassium channel, and
decreases the speed of conduction of signals through calcium channel, followed by the
inhibition of adenylyl cyclase. Together, these modulations obstructs the successful
transmission of pain signal to the nervous system(Nealon et al, 2018).
Question no. 3
The condition of Jordan was deteriorating on a daily bais. His blood pressure reading shows
92/52 mm/hg, which signifies a sudden drop in his blood pressure owing to hypotension. A
low blood pressure can be detrimental for the body and can make the person feel fatigued,

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tired due to lack of energy. His pulse rate increased to 112 beats per minute which is well
above the normal pulse rate of 60-70 beats per min. This can be a sign of sinus tachycardia.
Moreover, he had weak peripheral pulses which can be caused by reduced blood flow to the
vital organs. His respiratory rate was recorded around 24 breaths per minute which is above
the normal range (20 breath per minute) indicating a panic attack or increased anxiety and
stress. His body temperature was around 38.3oC which clearly indicates that Jordan must be
suffering from fever. Although the oxygen saturation level seemed to be normal, his weight
was below average, since the normal average weight of a 25 years old male having a height
of 188 cm should have been around 82 kilograms. Lastly on performing urinalysis, the
appearance of the urine was dark with a very high specific gravity, around 1035, which can
be a clear indication of renal infection or pyelonephritis. On further pathological examination,
it was found that his haemoglobin level was around 109g/ litre, which indicated that Jordan
might be suffering from moderate anemia. The haematocrit value was 51% which is higher
than the normal range of 35-47%, this is a sign of dehydration. The Erythrocyte segmentation
rate was found abnormally high (26.5mm/hour) which is a sign of inflammation in the body.
The amount of C-reactive protein was found to be about 30.7mg/dl which is higher than the
normal value (20mg/dl). A high value of C-reactive protein can be a sign of inflammation of
the arteries in the heart, which may increase the risk of myocardial infaction. The
concentration of albumin the blood was found to be 30.5g/litre, which is below the normal
range (35-50 g/litre). This can be a clear indication of malnutrition or the patient may be
suffering from a liver disease or inflammatory disease(Chu et al, 2016).
Question no. 4
Hartman’s solution is also called Ringer’s lactate solution. It is a combination of sodium
chloride, potassium chloride, sodium lactate and calcium chloride in water. It is given

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intravenously to the patient’s having low blood pressure, as an alternative for fluid and
electrolytes(Yung, Letton & Keeley, 2017). Being a rich source of bicarbonate, it helps in the
treatment of metabolic acidosis related to dehydration or renal failure. It can also be applied
as a route of intravenous drug delivery. Since Jordan lost the necessary fluids and
electorolytes from his body due to diarrhea, the Hartman’s solution will help in replenishing
and restoring the electrolyte balance in his body.
Methylprednisolone is a class of anti-inflammatory agents called “corticosteroids” which is
used to treat bowel inflammatory disease(Lv et al, 2017). It can be suitable for treating
Jordan, since this drug works well with Crohn’s disease. It supresses the immune system and
lessen the inflammation of the digestive tract. The drugs starts to show its effects within the
fourth week and the dosage is gradually reduced depending on the rate treatment progress and
finally stopped. It can also be used to lower the exhaberation of the inflammatory bowel
disease.

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REFERENCE
Akobeng, A. K., Zhang, D., Gordon, M., & MacDonald, J. K. (2018). Enteral nutrition for
maintenance of remission in Crohn's disease. Cochrane database of systematic
reviews, (8).
Chu, H., Khosravi, A., Kusumawardhani, I. P., Kwon, A. H., Vasconcelos, A. C., Cunha, L.
D., ... & Targan, S. R. (2016). Gene-microbiota interactions contribute to the
pathogenesis of inflammatory bowel disease. Science, 352(6289), 1116-1120.
Lv, J., Zhang, H., Wong, M. G., Jardine, M. J., Hladunewich, M., Jha, V., ... & Cattran, D.
(2017). Effect of oral methylprednisolone on clinical outcomes in patients with IgA
nephropathy: the TESTING randomized clinical trial. Jama, 318(5), 432-442.
Nealon, C. M., Patel, C., Worley, B. L., Henderson-Redmond, A. N., Morgan, D. J., &
Czyzyk, T. A. (2018). Alterations in nociception and morphine antinociception in
mice fed a high-fat diet. Brain research bulletin, 138, 64-72.
Santarpia, L., Alfonsi, L., Castiglione, F., Pagano, M. C., Cioffi, I., Rispo, A., ... & Pasanisi,
F. (2019). Nutritional Rehabilitation in Patients with Malnutrition Due to Crohn’s
Disease. Nutrients, 11(12), 2947.
Torres, J., Mehandru, S., Colombel, J. F., & Peyrin-Biroulet, L. (2017). Crohn's disease. The
Lancet, 389(10080), 1741-1755.
Yung, M., Letton, G., & Keeley, S. (2017). Controlled trial of Hartmann's solution versus
0.9% saline for diabetic ketoacidosis. Journal of paediatrics and child health, 53(1),
12-17.

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