Crohn's Disease Case Study: Health Variation and Management

This case study analyzes the health variations experienced by a 25-year-old male, Jordan, diagnosed with Crohn's disease. The study addresses four key questions related to the disease. Firstly, it explores the structural and functional changes in the gastrointestinal tract that contribute to Jordan's weight loss, including inflammation, strictures, malabsorption, and diarrhea. Secondly, it examines the mechanisms of pain in Crohn's disease, such as gut distention, inflammation, and the role of morphine in pain management. Thirdly, the study identifies the clinical manifestations of Jordan's deteriorating health condition, including persistent diarrhea, weight loss, fatigue, and abnormal blood test results. Lastly, it explains the purpose of Hartman's solution administered to Jordan, emphasizing its role in fluid resuscitation to correct fluid imbalances caused by diarrhea and vomiting. The case study draws on research to support the analysis of Crohn's disease and its management.

Running head: HEALTH VARIATION 1
Health Variation
Name
Institution

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Question 1
Crohn’s disease is an inflammatory bowel disease that leads to the inflammation of the digestive
tract thus leading to severe diarrhea abdominal pain, malnutrition, and weight loss (Nurgali &
Wildbore, 2014). This disease affects different structures in the gastrointestinal tract starting
from the mouth to the anus. It is worth noting that it can affect some structures and not others
along the gastrointestinal tract. Research has revealed that several structural changes in the
disease process in Crohn’s disease can lead to weight loss. Firstly, this disease causes the
inflammation of the small intestines thus making it difficult to digest food and absorb the
necessary nutrients. Attack of the ileum may lead to malabsorption which can lead to
malnutrition (Nurgali & Wildbore, 2014). Malnutrition may thus lead to weight loss because the
body lacks the necessary nutrients to grow and maintain the required weight.
It is also indicated from the case study that a medical officer performs a CT scan of Jordan’s
bowel and finds out that he has a stricture. A stricture can be described as the narrowing of the
small intestines due to several inflammations that create a scar on the lining of the intestines.
Strictures restrict the passage of digested food thus leading to malabsorption (Ko, Abraham &
Shih, 2018). As a result, one experiences deficiencies of all or most of the nutrients that are
needed by the body. Individuals like Jordan, therefore, lose weight or find it difficult to maintain
their weights. Histology of the small intestines changes thus leading to partial villous atrophy
(Mourad, Barada & Saade, 2017). These morphological changes affect food absorption thus
leading to loss of weight.
Jordan’s weight loss may also have been affected by functional changes in the disease process.
Crohn’s disease leads to intestinal dysfunctions thus leading to a reduction in the absorption of
amino acids, electrolytes, water, carbohydrates, and all the necessary nutrients. The colon of a

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patient that has Crohn’s disease like Jordan has an altered secretory capacity thus leading to
persistent diarrhea in patients (Mourad et al., 2017). Jordan also reveals that he had been
experiencing persistent diarrhea a week before presenting himself to the hospital. It is reported
that diarrhea leads to the loss of important nutrients and water from the body thus leading to
weight loss. Abdominal bloating and pain as a result of Crohn’s disease can lead to loss of
appetite. This is because the patient may feel that eating will cause them pain. As a result, a
patient experiences malnutrition due to lack of enough nutrients in the body thus potentially
leading to loss of weight.
Question 2
Pain in Crohn’s disease is caused by different mechanisms such as distention of the gut and
severe inflammation of the intestines. According to studies, inflammation leads to sensitization
of the sensory pathways thus causing persistent alterations of the afferent neurons and pain
processing of the central nervous system. The sensory pathways interact with neurons that cross
the white commissure and ascend to higher brain regions (Alexa-Stratulat, Luca & Bohotin,
2016). The pathways then descend to the brainstem to modulate sensory inputs thus inducing a
pain sensation. Most patients that have Crohn’s disease such as Jordan experience anxiety and
depression that are believed to be the central modulating factors of the sensory pathways and
pain processing. As a result, the patient experiences chronic pain that is persistent but wears off
with a reduction in disease activity. Drugs such as morphine act in the brain to modulate pain.
Morphine is an analgesic that helps in altering the conscious perception of pain. Morphine
reduces the magnitude of neuron response, lowers the number of neurons that respond to pain
and shortens the duration of the response (Bullock & Manias, 2013). These three functions of

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morphine lead to the suppression of both affective and sensory dimensions of pain thus altering
the conscious perception of pain.
Question 3
Patients with Crohn’s disease exhibit symptoms such as abdominal bloating, irritable abdomen,
and abdominal pain among other symptoms. Patient deterioration occurs when one experiences
persistent diarrhea that is accompanied by weight loss (Nurgali & Wildbore, 2014). From the
case study provided, Jordan indicates that he has had persistent diarrhea over the past few weeks.
Additionally, he has lost 7kg over the past three weeks. These are indications that Jordan’s health
condition is deteriorating. Fatigue and malaise are also clinical manifestations of a deteriorating
condition in Crohn’s disease. According to the case, Jordan has been unable to get enough sleep
and struggles to keep up with his work demands. Villoria et al. (2017) indicate that fatigue is a
very common symptom of Crohn’s disease and fatigue becomes more common with health
deterioration. His hemoglobin concentration is also below the recommended value indicating
malabsorption of vitamin B12 (Nurgali & Wildbore, 2014). His hematocrit level is slightly
elevated which could be due to dehydration as a result of persistent diarrhea and vomiting.
Jordan has a high blood cell count that in his case is caused by Crohn’s disease. The count is
high due to deterioration. It is also worth noting that his blood albumin is lower than normal.
Another indication of deterioration is the development of strictures which Ko et al. (2018)
believe to be a very common complication of Crohn’s disease.
Question 4
The medical officer in Jordan’s case ordered Hartman’s solution. The purpose of this solution is
to expand the circulatory volume in patients experiencing circulatory compromise. The solution

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therefore basically replaces lost fluids in a process known as fluid resuscitation in cases of
substantial fluid losses due to conditions like diarrhea and vomiting (Naz & Ghosh, 2018). The
solution is made up of chloride ions, sodium ions, potassium ions, calcium ions, and lactate (Naz
& Ghosh, 2018). The administration of this solution must be done carefully to avoid excessive
administration because an overload can lead to heart failure.
Due to Crohn’s disease, Jordan has a reduced absorption of fluids. Additionally, he has lost a lot
of fluids from the gastrointestinal tract due to persistent diarrhea and vomiting. A urinalysis also
indicates that he excretes concentrated dark colored urine. These symptoms imply that his fluid
balance is not ideal and the best way to correct this imbalance is through intravenous
administration of Hartman’s solution. Intravenous administration sends the fluid directly into the
bloodstream (Voldby & Brandstrup, 2016). Additionally, intravenous administration offers a
controlled way of slowly and constantly administering medication over a given period. In
Jordan’s case, he was supposed to receive the medication for over 6 hours.
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References
Alexa-Stratulat, T., Luca, A., & Bohotin, C. R. (2016). VISCERAL PAIN FROM
NEUROANATOMY TO RECEPTORS-FOCUS ON GASTROINTESTINAL
PAIN. Romanian Journal of Neurology, 15(3).
Bullock, S., & Manias, E. (2013). Fundamentals of pharmacology. Pearson Higher Education
AU.
Ko, J. Z., Abraham, J. P., & Shih, D. Q. (2018). Pathogenesis of Crohn's Disease-and Ulcerative
Colitis-Related Strictures. In Interventional inflammatory bowel disease: endoscopic
management and treatment of complications (pp. 35-41). Academic Press.
Mourad, F. H., Barada, K. A., & Saade, N. E. (2017). Impairment of small intestinal function in
ulcerative colitis: role of enteric innervation. Journal of Crohn's and Colitis, 11(3), 369-
377.
Naz, A., & Ghosh, A. (2018). Intravenous fluid therapy in intensive care units. Where do we
stand?. Central Journal of ISA, 2(1), 3-7.
Nurgali, K., & Wildbore, C. (2014). Alterations of digestive function across the life span.
Villoria, A., García, V., Dosal, A., Moreno, L., Montserrat, A., Figuerola, A., ... & Ramírez-
Lázaro, M. J. (2017). Fatigue in out-patients with inflammatory bowel disease:
prevalence and predictive factors. PloS one, 12(7).

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Voldby, A. W., & Brandstrup, B. (2016). Fluid therapy in the perioperative setting—a clinical
review. Journal of intensive care, 4(1), 27.