401207 Health Variations 1: Crohn's Disease Case Study Analysis

This case study assesses a patient, Jordan, diagnosed with Crohn's disease, focusing on his weight loss, pain management, and clinical manifestations. The assignment details the disease's impact on the gastrointestinal tract, including ileum and large intestine involvement, and various forms such as structuring, penetrating, and inflammatory. It explores the pain pathway and the action of morphine, explaining how it blocks opioid receptors to reduce pain. The case highlights clinical manifestations such as abdominal pain, diarrhea, and the development of stenosis, leading to potential bowel obstruction. The study also analyzes the rationale behind administering intravenous fluids like Hartman's and Ringer's solutions to address fluid loss and electrolyte imbalances. References from various studies support the analysis, providing a comprehensive understanding of Crohn's disease and its management.

Case study Assessment on Chrohn Occurrence
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Chrohn disease and weight loss
Chrohn disease is an inflammatory bowel disease that can affect the gastrointestinal
tract. Its manifestation occurs in the GI tract and is often region-specific; it affects the ileum
and larger intestines. The ileocolic Crohn accounts for 50% of all cases being showcased, the
Crohn ileitis often manifests for about 30% of the cases, while the chronic colitis accounts for
the other 30% of the cases. The gastroduodenal Crohn diseases cause inflammation of the
stomach on the duodenum. The jejunoileitis leads to inflammation of spotty patches on small
intestines. This condition attacks any part of the digestive tract hence affects food intake.
Chrohn disease occurrence entails three forms on the GI tract; structuring, penetrating and
inflammatory (Torres, Mehandru, Colombel & Peyrin-Biroulet, 2017).
The occurrence of weight loss is often a typical symptom of inflammatory Crohn bowel
disease and ulcerative state. Weight loss is an indication of malnutrition. It is associated with
aspects such as poor appetite, aversion of food, malabsorption and nutrients loss due to
diarrhea. Rejection of food due to inflammation and diarrhea is a key factor for his skipping
of meals and the ultimate occurrence of weight loss (Feuerstein & Cheifetz, 2017).
Loss of appetite has been observed by 1 in 5 people with Crohn disease and about 1 in
10 people with the ulcerative disease (Prideaux et al., 2012). Appetite issues are often rife
with persons with inflammatory bowel states and get worse during flares. Appetite for food
among these patents can lead to aversion due to associate pain and suffering to be endured,
leading to avoidance of food (Baumgart & Sandborn, 2012). This is the classical case e for
Patient Jordan, the feeling of diarrheal and discomfort is causing the inherent food aversion
occurrence.
Weight loss is often a prevalent issue among persons with Crohn disease. Studies have
shown that about 80% of persons hospitalized experience weight loss, while about 20%-40%
living outside home experience weight loss (Molodecky et al., 2012). Weight loss over 5% in
a month is categorized as a severe state. Patient Jordan has an 8% weight loss decline
signifying serve case over a short period. This is a critical state, signifying the increased state
of his chronic state which might be viewed to be an intense inflammatory state. The long
diagnosis period for Patient Jordan has had long term damage hence the increased severity of
his state affecting the food intake process.
Pain pathway and action of morphine

The pain pathway occurs in the brain, moving signals to the motor cortex downwards to
the spinal cord and the motor nerves. These impulses lead to the development of muscle
contraction. The underlying pain pathways entail relays occurring in the somatosensory
cortex and the hypothalamus region. The thalamic neurons move on the midbrain and engage
on synapse ascending to the pathways of the nerve signals. This offers relief on the analgesia.
Pain can lead to an autonomous response on the nervous system through the medulla leading
top increased heart rate, blood pressure with pain intensity increase. The ascending pain
travels to spin and set off neuropathic process (Kim et al., 2016).
Morphine interaction entails action on the nervous system to lower the pain feeling. It
blocks the binding effect of the opioid receptors thus altering the transmission of nociceptive
signals, pain modulating neurons and offers an inhibition on the nociceptors. Morphine acts
as an agonist on Patient Jordan body acting on the mu and kappa receptors. The mu-opioid
effect is central to the ventral segmental area in the brain. The activation of the morphine
pathway agonist in the delta-opioid receptor in the nucleus leading to a reduction in pain
levels (Pacifici, 2016).
Clinical manifestation and deterioration
Often persons with Crohn disease have developed this state for longer periods before
diagnosis as observed from the patient. The underlying clinical manifestations for Crohn
disease entail abdominal pain occurring on the lower right abdomen, accompanied by
diarrhea. In ileitis occurrence, it leads to a large volume of watery diarrhea and elevated
sessions of bowel movement and defection.
The development of stenosis is positive for the patient. Increased elevation of
abdominal pain is a clinical manifestation of the development of intestinal stenosis. Increased
and persistent vomiting and diarrhea are positive indicators for intestinal stenosis. This can
further deteriorate to obstruction of the bowel (Thrash et al., 2013).
Further, Patient Jordan perianal abscess suggest an abscess around the anal area.
Perianal occasioned are often common among Crohn disease, future contributing to aspects
of swallowing difficulty and upper abdominal pain and vomiting which is currently
experienced by the patient. The observable appearance on Patient Jordan illustrating pale skin
and poor turgor are declining and deteriorating state of the disease displaying and increased

body state increasing loss of iron leading to anemia levels in the body (Hovde & Moum,
2012).
Patient Jordan stricture development leading to bowel obstruction is a key issue related
to the complication of Crohn disease. This can lead to perforation, hemorrhage, and abscess
which may progress to fatal state.
Characteristics of intravenous fluids and rationale
Administered intravenous fluid Hartman is a mixture of sodium chloride, sodium
lactate, calcium chloride and potassium, chloride in water solution. It is an essential element
for fluid replacement and increasing lost electrolytes in the body, further, it is an essential
aspect of metabolic acidosis. Ringer solution is essential for resuscitating fluid occasioned
from blood loss or increased severity and deterioration of Patient Jordan state (Svensen &
Rodhe, 2019).
Ringer’s hart solution is an essential element in most situations. They are slightly
hypotonic and low caloric levels and few side effects. It can distribute through the plasma to
the interstitial within a short duration of time ranging 25-30 minutes. The underlying onsets
entail ions which are crucial in resuscitating Patient Jordan lost fluids. Due to this active
action on the body and it is essential for administering the solution to improve the ionic state
of Patient Jordan due to low intake of food, swallowing and diarrheal signifying a state of
fluid loss in the body as observed from paled skin appearance, fatigue and poor turgor
signifying increased body dehydration state (Messaris et al.,2012).

References
Baumgart, D. C., & Sandborn, W. J. (2012). Crohn's disease. The Lancet, 380(9853), 1590-
1605.
Feuerstein, J. D., & Cheifetz, A. S. (2017, July). Crohn disease: epidemiology, diagnosis, and
management. In Mayo Clinic Proceedings (Vol. 92, No. 7, pp. 1088-1103). Elsevier.
Hovde, Ø., & Moum, B. A. (2012). Epidemiology and clinical course of Crohn's disease:
results from observational studies. World journal of gastroenterology: WJG, 18(15),
1723.
Kim, J., Ham, S., Hong, H., Moon, C., & Im, H. I. (2016). Brain reward circuits in morphine
addiction. Molecules and cells, 39(9), 645.
Messaris, E., Sehgal, R., Deiling, S., Koltun, W. A., Stewart, D., McKenna, K., & Poritz, L.
S. (2012). Dehydration is the most common indication for readmission after diverting
ileostomy creation. Diseases of the colon & rectum, 55(2), 175-180.
Molodecky, N. A., Soon, S., Rabi, D. M., Ghali, W. A., Ferris, M., Chernoff, G., ... &
Kaplan, G. G. (2012). Increasing incidence and prevalence of the inflammatory bowel
diseases with time, based on systematic review. Gastroenterology, 142(1), 46-54.
Pacifici, G. M. (2016). Metabolism and pharmacokinetics of morphine in neonates: A review.
Clinics, 71(8), 474-480.
Svensen, C., & Rodhe, P. (2019). Intravascular volume replacement therapy. In
Pharmacology and Physiology for Anesthesia (pp. 795-813). Elsevier.
Thrash, B., Patel, M., Shah, K. R., Boland, C. R., & Menter, A. (2013). Cutaneous
manifestations of gastrointestinal disease: part II. Journal of the American Academy of
Dermatology, 68(2), 211-e1.
Torres, J., Mehandru, S., Colombel, J. F., & Peyrin-Biroulet, L. (2017). Crohn's disease. The
Lancet, 389(10080), 1741-1755.