Western Sydney University: Case Study of Eleanor Brown and UC (401207)

This case study analyzes the case of Eleanor Brown, who is suffering from ulcerative colitis (UC). The assignment addresses the gastrointestinal disorder, its causes, and associated symptoms like bloody diarrhea, weight loss, and low blood pressure. It examines the physiological changes due to UC, including inflammation and its impact on nutrient absorption. The study explores the pain pathway and the use of morphine for pain management. It also analyzes Eleanor's low blood pressure, high heart rate, and blood test results, highlighting the severity of her condition. Furthermore, the assignment details the use of Hartman's solution to replenish fluids and electrolytes lost due to diarrhea. The solution provides a comprehensive overview of the case, integrating medical knowledge with patient-specific information.

Running head: CASE STUDY ON ELEANOR BROWN
Case Study on Eleanor Brown
Name of the Student
Name of the University
Author Note

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Question 1
The term ulcerative colitis (UC) is the gastrointestinal disorders that is associated with
the inflammation induced ulcers in the rectum and sigmoid colon of the GI tract. Patients
with UC generally have the problems of lesions in the colon which is resulted due to the
pathogenic, inflammatory and genetic factors. Not only this, such inflammation can also
occur due to the humoral immunity induced macrophage activities and T-lymphocytes
associated immune response. So, it can be said that, such inflammation can create structural
and functional changes in the colon and in the mucosal membrane of the large intestine
specifically in the crypt of Liberkuhn (Hall, 2015). Due to this, small erosions in the sigmoid
colon, rectum may be observed. However, if this problems are kept untreated, then it can
create major problems such as ragged ulceration, tissue destruction of that region, necrosis,
bleeding, pus formation. Due to this, structural changes, there various functional changes
also take place. For example, alteration in the absorption process of colon, internal bleeding
in the visceral muscles of colon, large intestines, severe spasm and muscle cramping, lowered
transit time of the colon, uncontrolled diarrhoea or defecation and so it can be said that it is
associated with the loss of necrotized absorption-associated colonic surfaces. Moreover,
blood and pus is also associated with the ulceration and hence blood is also released through
the stools. Further, it is observed that, the loss of lumen cells of the colon mask its
functionality of water reabsorption from the colon and that is the reason for watery diarrhea
( Hall, 2015). In the case study is observed that, the Eleanor is suffering from UC along with
watery and bloody diarrhoea and it may possible that, the above depicted changes is also
present in case of Eleanor. The weight loss of Eleanor may be due to her diarrhoea as through
the stools and water a huge amount of important micro nutrients are released from her body
and she has lost her appetite, the replenishment of the nutrients are not occurring at all. The

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loss of colonic lumen in UC, also reduce the absorption capacity of the essential nutrients and
hence weight loss continues. In Addition, high rate of inflammation, will also contribute to
the weight loss by the process of tissue catabolism. The loss of muscle tone also promote
watery diarrhoea and loss of electrolytes ( Alipour et al., 2015)
Question 2
The general pain pathway is a combination of complex interplay of nervous system of
human body. Morphine is well known for its pain masking nature in various visceral pain. In
UC, inflammation related pain is responsible for activation of nociceptors of pain pathway.
During the inflammation of UC, the receptors of that region are activated and those electrical
signals of the pain are then transmitted to the relevant nerve fibres of the pathway. The
electrical signals are then travelled to the spinal cord through the peripheral nerve bundles.
Then the CNS amplify this signals and transmits to the higher centres of the nervous system
of the body (Vermeulen et al., 2014). In this case it is observed that, patient is given
morphine which is a widely used drug for pain management of UC. Morphine mainly causes
hyperpolarization of the of the cells of inflamed region of colon and as a result release of NTs
are reduced from the presynaptic region. The enhanced efflux of potassium contributes to the
hyperpolarization of the neurons and reduces the pain sensation. Moreover, the reduced
amount of calcium influx also reduce the release of NTs from the nerve endings which are
present in the pain transmission pathways. Therefore, by such ways morphine reduces the
pain sensation (Basso, Bourreille & Dietrich , 2015).
Question 3
From the case study of Eleanor, it is noted that, she has low blood pressure
that is almost 90/50 mm hg. During the bloody diarrhoea, she had lost a huge amount
of blood and it may cause such low pressure of blood. Moreover, the heart rate of the

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patient is high than the normal one and it also indicates that the due to blood loss the
heart has to enhance its work load to supply adequate oxygen to all the region. Due to
the blood loss, the patient also developed anaemia and her lower haemoglobin level
supports that fact. The increased level of WBC count in the blood of the patient
suggested that, the inflammation in colon is enhancing day by day as increased WBC
count is associated with inflammation ( Vong et al., 2015). Therefore, the routine
blood test of the patient showed that, ESR and CRP is higher than the normal one and
it is the result of increase inflammation in the colon. So it can be said that, the
condition of Eleanor’s UC is not good at all (Seong, 2015).
Question 4
From the medication list of Eleanor, it is observed that, she has prescribed intravenous
injection of Hartman’s fluid along with other intramuscular drugs. The Hartman’s solution is
also known as Sodium lactate solution or ringer’s lactate solution and it contains calcium
chloride, sodium chloride, potassium chloride and water. So, it is evident that, this solution
will replenish the essential ions in the body. It is generally used in the treatment of
dehydration. In this case study it is observed that, the patient has lost a huge amount of fluid
from her body due to diarrhoea and they are not replenished yet. Hence, the this is very
effective to prescribe her this solution for gaining the lost micronutrients. This salt reuptake
will help the patient gain all the micronutrients. However, the main reason of giving this
solution in an intravenous manner is to complete the process in a quick manner. As injecting
into the vein will carry the solution directly to the heart and from their it will circulate to all
the organs in a quick and effective manner ( Soltanifar et al., 2014). As the patient has lost
her appetite, the intravenous drug delivery will help the maintenance of normal physiological
activity as soon as possible.

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References
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