In-Depth Case Study: Crohn's Disease Management and Treatment Plan

This case study focuses on a 25-year-old male, Jordan James, admitted to the hospital with a history of Crohn’s disease and recent weight loss. The case details the patient's symptoms, including lack of appetite, intestinal pain, diarrhea, and vomiting, leading to malnutrition and dehydration. The analysis explores potential causes of weight loss, such as medication side effects and intestinal bleeding. The case study also discusses the pain pathway and the mechanism of morphine in pain management. Furthermore, it presents the patient's vital signs and pathological test results, revealing abnormalities like low blood pressure, high pulse rate, and elevated WBC count. Finally, it outlines the prescribed treatment, including Hartman’s solution and methylprednisolone, to address electrolyte imbalances and intestinal inflammation. Desklib offers a wealth of similar case studies and solved assignments for students.

Running head: CASE STUDY
CASE STUDY
Name of the Student
Name of the University
Author Note

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Question 1.
Jordan James, a 25 year old man on admission to the hospital informed the doctors
about the issues he has been facing since the last five days. His medical history also informed
the doctors about his Crohn’s disease, which was diagnosed when he was 17 years old.
Among all the other issues he complained about he also mention that he has lost about 7 kg
weight in the past three weeks. Crohn’s disease can be defined as an inflammatory disease
that occurs in the intestine. It can occur in various parts of the intestine. People who have
been suffering from Crohn’s disease always have a tendency of losing weight which can be
due to various reasons. One of the most important reasons for the consistent weight loss
Jordan has been facing is the fact that he could not consume proper food because owing to his
lack of appetite and intestinal pain. This facilitated the malnutrition and as a result, he lost
several kilograms of weight. His intestine could not break down food material uptaken, which
also gave rise to diarrhea and bloating. These problems also led Jordan to avoid consuming
food as he might have thought eating less would stop his diarrhea and other discomforts. He
also could not concentrate on his work properly, which further increased the level of his
frustration, which might also have led him to avoid eating. Infliximab, the medicine which
Jordan has been consuming since 17 years of age causes lack of appetite. Therefore,
consumption of the medicine might have given rise to lack of appetite in Jordan leading to his
weight loss (Casteele et al., 2015). He was also vomiting and felt nauseous, which have also
prevented him from having food. From his symptoms it can also be deduced that intestinal
bleeding was predominant in his case, through which he also lost blood and thus, iron was
also lost. The loss of blood, iron along with continuous vomiting did not allow any absorption
of nutrients and thus, caused extreme loss of weight and weakness. On checking his physical
conditions and vitals the doctors observed that his skin turgor or elasticity was also very low,
which is because of the dehydration he faced. This might have also facilitated his weight loss

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as in cases of severe dehydration, the body weight is decreased up to 5-10% of the total body
weight. These are the most probable reasons for the rapid weight loss that Jordan faced
(Torres et al., 2017).
Question 2.
The Pain Pathway can be defined as the path that is followed internally by the neurons
by which, human body gets the sensation of pain. The pain pathway can be of three orders.
The first order neurons consist of cell bodies in dorsal root ganglion. It has one axon, which
is divided, into two parts; one extends till the periphery of the body and another extends into
the spinal cord. The second order neurons consist of cell bodies in the spinal cord and within
the brain stem. The third order neurons consist of cell bodies present in the thalamus (Alshelh
et al., 2016).
Morphine is an analgesic, which is used to treat extreme pain. It is derived from
opioid. Morphine on entering the blood stream activates G-protein coupled receptor (GPCR),
the opioid receptor present in the brain and the spinal cord. Then it gets bound with
encephalin released from the brain and thus decreases the conduction of nerve impulse
through calcium channel and increases the conduction of nerve impulse through potassium
channel. This event further facilitates the inhibition of adenylyl cyclase. These modifications
that morphine does on entering the system alters the conscious perception of pain (U.S.
National Library of Medicine, 2020).
Question 3.
As already mentioned above, after admission in the hospital the doctors conducted
various vital tests to detect all the anomalies Jordan was having. His blood pressure was
92/52, which is very much lower than the normal range leading to the weakness he was

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experiencing. Jordan’s pulse was 112 beats per minute, which shows much higher pulse rate
than the normal. This condition is also known as sinus trachycardia (Adum & Arora, 2017).
Apart from this, his peripheral pulse was also lower than the normal rate and can be because
of lower blood supply, which also made his peripheries cool. The respiratory rate analysis
showed his breathing rate was 24 breaths per minute, which is also much higher than the
normal range. Jordan’s body temperature was 38.3° C, which is also higher than the normal
temperature showing that he had fever. His oxygen saturation level (Spo2) showed 97%,
which was normal. His weight and height was recorded to be 75 kg and 188 cm respectively,
which was lower than the average weight of 25 years old proving his malnutrition (National
Health Services, 2020). His urine analysis result showed dark coloured urine, which might be
because of the development of liver issues. His pathological tests showed that haemoglobin
level was lower than the normal range showing that he also had a mild anemia. His
haematocrit level was also higher than the normal range. His WBC count was very high than
the normal range hinting towards the presence of infection. His ESR was high as well, which
means presence of inflammation. His C-reactive protein was also higher than normal, which
might hint towards cardiac issues. His albumin concentration was also lower than normal
proving the malnutrition he was suffering from (Bouguen et al., 2015).
Question 4.
Jordan was prescribed with the 1000 mL Hartman’s solution to be incorporated as an
intravenous fluid. The solution is a mixture of potassium chloride, calcium chloride, sodium
chloride, sodium lactate and water. It is generally given to the patients as a supplement of the
electrolytes that are continuously lost in the form of vomiting and diarrhea. It also helps in
raising the blood pressure level. The administration of Hartman’s fluid and the other
medications would help in developing his condition (Medsafe, 2020). Hartman’s fluid as
mentioned above, would increase his blood pressure level and replenish the electrolytes that

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have been lost. The other medications that have been prescribed to him include
methylprednisolone that improves the intestinal inflammation as well as helps in replenishing
the electrolyte level in the human body.

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REFRENCES
Adum, J. P. S., & Arora, R. (2017). Treatment for inappropriate sinus tachycardia. American
journal of therapeutics, 24(5), e574-e578. https://doi.org/
10.1097/MJT.0000000000000335
Casteele, N. V., Khanna, R., Levesque, B. G., Stitt, L., Zou, G. Y., Singh, S., ... & Rutgeerts,
P. J. (2015). The relationship between infliximab concentrations, antibodies to
infliximab and disease activity in Crohn's disease. Gut, 64(10), 1539-1545.
http://dx.doi.org/10.1136/gutjnl-2014-307883
Medsafe. (2020). Hartmann's Solution [Ebook]. Medsafe. Retrieved from
https://www.medsafe.govt.nz/profs/Datasheet/c/compoundsodiumlactateinf.pdf
National Health Services. (2020). Height/weight chart. Retrieved 2 April 2020, from
https://www.nhs.uk/live-well/healthy-weight/height-weight-chart/
Torres, J., Mehandru, S., Colombel, J. F., & Peyrin-Biroulet, L. (2017). Crohn's disease. The
Lancet, 389(10080), 1741-1755. https://doi.org/10.1016/S0140-6736(16)31711-1
U.S. National Library of Medicine. (2020). Morphine. Retrieved 2 April 2020, from
https://pubchem.ncbi.nlm.nih.gov/compound/Morphine

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