Comprehensive Case Study: Managing Ulcerative Colitis Symptoms

This case study focuses on a patient, Eleanor, suffering from ulcerative colitis, a chronic inflammatory disease affecting the lower colon and rectum. The analysis covers the disease's impact on her health, including significant weight loss due to poor nutrient absorption, inflammation, and reduced appetite. The study also addresses pain management, evaluating the use of morphine and alternative agents like corticosteroids. Critical conditions indicated by dark-colored urine, low hemoglobin levels, and irregular vital signs are discussed, along with the administration of Hartmann's solution for rehydration. The case study further justifies the intravenous route of administration and emphasizes the importance of managing fluid loss and maintaining electrolyte balance. Desklib provides access to similar solved assignments and past papers for students.

Runn1ing Head: Health Variation 1
Health Variation
Student Name
28 Mar 2019

Ulcerative Colitis 2
1. The patient Eleanor, is suffering from ulcerative colitis, which is a chronic inflammatory
disease. The affected region includes lower colon and rectum, where ulceration is lining in the
colonic mucosa layer. This results in the formation of the lesion which leads to inflammation at
the basal portion of the mucosal layer, the crypts of lieberkuhn (Pravda, 2016). This reason is
also known as retrosigmoid area of the bowel, however, in the present case, the patient is
suffering from total colitis. The inflammation in the submucosal and mucosal layer is responsible
for pain. Furthermore, this complication also leads to disturbance in the gastrointestinal tract
after ingestion of food. All these factors were responsible for reduced appetite and absorption of
nutrients. As a consequence of this, significant weight loss (9 kg loss in two weeks) was
observed in this case. Other possible factors responsible for weight loss include (Thompson et
al., 2016):
 Poor absorption of nutrients, YouTube inflammation, irritation, and pseudopolyps
formation in the colonial mucosal layer.
 Narrowing of colon diameter, due to ulcerative condition, which causes difficulty in GI
tract and food passage.
 Loss of calories due to the internal mechanism of the body to cope up with ulcerative
colitis. This also accompanies internal bleeding issues.
 Loss of nutrients due to inflammation and diarrhea.
 Section of tumor necrosis factor-alpha (TNF-α) is responsible for suppressing the
appetite.

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 Changes in the level of hormone, especially leptin and ghrelin that are associated with
reduced signaling for hunger or appetite. This further results in the reduced intake of
food.
Other possible factors that also account for weight loss include poor health management of
Eleanor. Brief, these includes:
 No specific measures where are considered to control diarrhea and dehydration condition.
 Lack of dietary measures which must include intake of small and frequent meals,
avoiding fiber and fat foods. Also, there are no instructions for intake of energy-rich
foods, which can compensate for the caloric requirement of the body.
 No specific intake of vitamins and minerals, to compensate for the nutrient loss. These
factors are also responsible for the increased basal metabolic index, which in turn is
responsible for the significant weight loss.
 Increased level of stress, as well as frustration in Eleanor, is also responsible for the
significant reduction in weight.
 In addition to this, other routes of food administration should also be prescribed to
Eleanor, which can compensate for the caloric loss.
2. Pain is a continuous perception of stimulus that is transmitted via the nervous system. In the
present case, the inflammation and flares in the colon region is detected as a stimulus in the
cerebral cortex and are perceived as conscious pain. The type of sensation is known as visceral
pain and is mediated via nociceptors. Since this is the case in which internal mucosal damage
happens, high-intensity stimuli are transmitted in the form of chemical stimulus to the

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nociceptors (Rizopoulos, Papadaki-Petrou & Assimakopoulou, 2018). Morphine is a potential
neuromodulator substance that can alter the pain pathway. It delays the nervous transmission by
down regulation of the opioid μ receptors and inhibits the transmission. As a result of this, the
impulses of stimulus from the inflammatory colon is reduced.
However, it is important to note that according to the report of Giudici, Scaringi, Martino, Ficari,
& Bechi (2017), the use of morphine in the present case should be intended for short-acting and
immediate relief purpose. The reason is linked to the fact that morphine causes side effects like
constipation and reduced motility of the gut region. Thus, the long term use of morphine has the
potential to elevate the pain and deteriorate the condition to a significant extent. The alternative
agents that can relieve the pain include corticosteroids and COX-2 inhibitors, which is relevant
for pain management in the present case (Giudici et al., 2017).
3. The foremost critical condition is reflected with dark colored urine. This reflects that the
excretion of waste material out of the body is not adequate. Furthermore, the dark color
represents the presence of bile salts in urine which reflects damage in the liver. Additionally,
according to Gong et al. (2015) dark colored urine also signifies the extent of dehydration and
this indicates for taking necessary action to rehydrate Eleanor.
The hemoglobin level is 86 g/L, which shows excessive blood loss due to internal bleeding. The
reason is also associated with the presence of blood and mucus in stool, which shows a sign of
infection in the mucosal layer. Furthermore, it shows that Eleanor is suffering from severe
infection, which is reflected by the increased erythrocyte sedimentation rate, which in the clinical
manifestations appears as 31.3 mm/hr. The significant level of stress is also affecting the present
condition of Eleanor. For example, the blood pressure level is 90/50 mm/Hg, which indicates a

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low blood pressure condition due to excessive blood loss in internal bleeding. Likewise, the
breathing rate and heartbeat rate is also irregular, which is 25 breath/min and 120 beats/min,
according to the given clinical manifestation.
4. The IV fluid provided to Eleanor is Hartmann's solution, which aims to rehydrate and control
the hypovolemic state by maintaining the volume of circulating blood. This is an isotonic fluid
(pH=5.5 to 6.3), which will maintain the ion level by supplementing sodium chloride (6g) and
potassium chloride (0.3 g) in the solution of 1000ml. In the present case, the patient is also
suffering with diarrhea and hemorrhage which is responsible for the fluid loss in the body. This
reason is important to pay attention which measures to rehydrate the body. Hartmann's solution
is more important in this case to compensate for the fluid loss.
Selecting the intravenous route of administration is justified in the present case. The reason is
linked with the fact that the administration of sterile solution may lead to irritation in the gut and
this can elevate the pain. Furthermore, the bioavailability of the solution will be higher if the IV
route is preferred. Also, it is important to note that the solution container must be used for a
single time purpose and that no air embolism should occur during the administration (Lander,
2019).
References:
Giudici, F., Scaringi, S., Di Martino, C., Ficari, F., & Bechi, P. (2017). Rationalisation of the
surgical technique for minimally invasive laparoscopic ileal pouch-anal anastomosis after
previous total colectomy for ulcerative colitis. Journal of minimal access surgery, 13(3), 188.

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Gong, Y., Liu, L., He, X., Zhao, H., Yang, J., Li, L., Lu, A., Lin, Y. & Jiang, M. (2015). The
th17/treg immune balance in ulcerative colitis patients with two different chinese syndromes:
dampness-heat in large intestine and spleen and kidney yang deficiency syndrome. Evidence-
Based Complementary and Alternative Medicine, 2015, 72-75.
Lander, A. (2019). Intravenous fluid and electrolyte management in children and young
people. Surgery 1(2), 10-15.
Pravda, J. (2016). New Onset Ulcerative Colitis: Case Analysis and Correlations to
Pathogenesis. J Inflam Bowel Dis & Disord, 1(114), 2.
Rizopoulos, T., Papadaki-Petrou, H., & Assimakopoulou, M. (2018). Expression profiling of the
transient receptor potential vanilloid (TRPV) channels 1, 2, 3 and 4 in mucosal epithelium of
human ulcerative colitis. Cells, 7(6), 61.
Thompson, K. D., Connor, S. J., Walls, D. M., Gollins, J., Stewart, S. K., Bewtra, M., Baumblatt,
G.L., Holubar, S.D., Greenup, A.J., & Girgis, A. (2016). Patients with ulcerative colitis are more
concerned about complications of their disease than side effects of medications. Inflammatory
bowel diseases, 22(4), 940-947.