401207 Health Variations 1: Perioperative - Crohn’s Disease Case Study

This case study analyzes a 25-year-old male, Jordan, diagnosed with Crohn’s disease, focusing on the structural and functional changes in his digestive tract, the role of morphine in pain management, and the clinical manifestations indicating the deterioration of his condition. The study highlights the impact of structural abnormalities on bodily functions, leading to symptoms like diarrhea, abdominal cramps, and weight loss. It discusses morphine's effectiveness in blocking pain through opioid receptors and the use of intravenous fluids, specifically Hartman's solution, to address dietary deficiencies resulting from the disease. The case emphasizes the importance of timely and appropriate treatment to prevent the worsening of Crohn’s disease symptoms.

Running Head: HEALTH VARIATIONS
Topic: Case Study
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Introduction
Crohn’s disease is a type of inflammatory bowel disease which refers to the
intermittent episodes of abdominal cramping and diarrhea. It causes inflammation in the
digestive tract and often leads to weight loss fatigue and vomiting and nausea. In the current
case, Jordan is a 25 years old male diagnosed with Crohn’s Disease.
1. Structural and Functional Changes
The structural and functional wellbeing of digestive tracts is crucial for the health of
the individual. The structural abnormalities often lead to functional decline; as a result,
human experience unhealthy life. The structural changes in inflammatory bowel disease
mainly occur due to issue in the digestive tract. Hence the distal ileum is the most prevalent
issue in IBD. Furthermore, the inflammation or thickness of the intestine wall is also one of
the kinds of inflammatory bowel disease. In the current case, Jordan was experiencing
diarrhea, abdominal cramp, and weight loss and diagnosed with Crohn’s disease. The
complete medical assessment of the Jorden’s reports suggests multiple changes in the
structure of digestive tracts, which further leads to weight loss. The structure changes of
inflammatory disease were large patches of inflamed mucosa and submosca throughout his
small bowel and colon. He was also diagnosed with the bowel obstruction in his terminal
ileum. The dry and pale skin were the other symptoms due to the structural issues. The
structural abnormalities were inhibiting the organs from functioning well. The relationship
between structural and functions are consistent. The structural wellbeing of the digestive
system promotes better functioning. In contrast, the structural abnormalities disturb the
functional system as well (Nair et al., 2016).
The functional changes which have been observed in Jordan’s case were dysfunction
of food consumption and water intake. The digestive system was not processing appropriately
to absorb the food. As a result, Jordan was experiencing nausea and vomiting. The inflamed

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digestive tract was not adequately performing its function. Diarrhea or lack of food
consumption and vomiting were reducing the weight of the Jordan. Due to Crohn’s disease,
the sleep cycle was also disturbed. Furthermore, Jordan was not able to appropriately walk
and perform daily activities. The work-life was also reported to be disturbed. Apart from
these, Jordan was experiencing multiple pain.
The functions of the entire body were disturbed due to structural issues. All these
structural abnormalities were contributing to weight loss in Jordan’s case. Literature suggests
that structural abnormalities in the digestive system not merely affect the function of that
particular organ, but also disturbs the entire body functions (Nair et al., 2016).
2. Role of Morphine in determining the Pathways to alter the Conscious Perception
of Pain
Morphine is a very effective painkiller for reducing pain in multiple body areas. In
particular, it is effective in blocking the pain due to Crohn’s disease. Morphine found to be
more effective painkiller in contemporary medicines. The recent data suggested the
effectivity of morphine in pain reduction and led to a better condition of the patients. It is
effective because it directly effects on opioid receptors (GCPR), which regulates pain in the
nervous system. Opioid receptors are widely distributed in the brain, spinal cord, digestive
tract. These receptors respond to encephala, which control body pain.
Morphine mimics the compound to block pain artificially. Morphine binds the opioid
receptors that generate the series of events, and GCPR activates g-protein. It also triggers
more conduction through potassium channels and minimizes the conduction through calcium
channels and adenylate cyclase. In this way, the nervous system controls the body’s
signalling system that transmits pain. The robust evidence-based studies have been carried
out on patients with Crohn’s disease (Morrone et al., 2017). The results of the studies
recommended the morphine three most effective medicine for blocking pain. A few

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contradictory studies also reported that morphine as a least effective painkiller due to its side
effect (Long, Barnes, Herfarth, & Drossman, 2012), but the ratio of such studies were very
limited. Therefore, it can be concluded that morphine is an effective medicine for relieving
abdominal pain.
3. The Clinical Manifestation indicates the deterioration of Jordan’s Condition
The clinical manifestation that deteriorates the Jordan Crohns or inflammatory bowel
is comprised of a cluster of symptoms. Such as diarrhea, abdominal pain, weight loss, nausea
or billing vomiting, fatigue, mails, tenderness, abdominal gurgling & rumbling, and dark
colour urine. The medical examination showed right lower abdominal quadrant and audible
bowl sound, pale and dry skin, cold extremities, capillary and flat neck veins. Medical Officer
reported bowel obstruction in terminal inflamed mucosa & submucosa throughout his small
bowel and colon. The above symptoms have a history of gradual development.
This early sign and symptoms of the Crohn’s disease were observed in the age of 17.
Currently, Jordan is 25 years old and still suffering from acute pain and Crohn’s disease.
Unfortunately, the lack of proper treatment by medical officers and surgeon lead to
deteriorating the condition of Jordan. The issues needed medical attention but tried to manage
by consulting doctors and nutrients. No improvement in Jordan’s condition has been
observed despite having invasive treatments. According to recent studies, the timely
treatment for an early sign and symptoms for Crohn’s disease must be taken (Ha, & Khalil,
2015). In some other studies, the delayed treatment and inappropriate treatments worsen the
condition of the patients.
4. Characteristics of Intravenous Fluid and Rational for Administration.
The intravenous fluid is a liquid substance used to fulfil the water, sugar and salt
(Barkas, Liberopoulos, Kei & Elisaf, 2013). The intravenous fluid injected through a vein to
those patients who cannot consume oral food. Intravenous food is available in many types

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and forms. In Jordan’s case, the 100 ml Hartman compound sodium was used to fulfil diet
deficiency. The Hartman solution is a mixture of sodium lactate, sodium chloride, potassium,
calcium and chloride. It is used for multiple purposes such as relapsing electrolytes & fluids
among patients with low blood pressure, low blood volume and metabolic acidosis
(Kammermeier, 2016). The fluid is injected through veins.
In the current case as Jorden was suffering from weight loss. He was not consuming
many diets due to diarrhea and vomiting, as his intestine and bowel tract was not functioning
correctly. To fulfil the diet deficiency, 100 ml Hartman compound solution was injected in
his body. The literature is enriched with the evidence-based studies reflects the effectivities of
intravenous fluid for the management of Crohn’s disease affects (Barkas, Liberopoulos, Kei
& Elisaf, 2013). The robust studies also indicate the effectiveness of intravenous fluid in
weight gain among the patients of Crohn’s disease (Kammermeier, 2016).

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References
Barkas, F., Liberopoulos, E., Kei, A., & Elisaf, M. (2013). Electrolyte and acid-base
disorders in inflammatory bowel disease. Annals of Gastroenterology, 26(1), 23–28.
Ha, F., & Khalil, H. (2015). Crohn’s disease: a clinical update. Therapeutic Advances in
Gastroenterology, 8(6), 352–359. https://doi.org/10.1177/1756283X15592585
Kammermeier, J., Morris, M. A., Garrick, V., Furman, M., Rodrigues, A., Russell, R. K., &
BSPGHAN IBD Working Group (2016). Management of Crohn’s disease. Archives of
Disease in Childhood, 101(5), 475–480. https://doi.org/10.1136/archdischild-2014-
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Long, M. D., Barnes, E. L., Herfarth, H. H., & Drossman, D. A. (2012). Narcotic use for
inflammatory bowel disease and risk factors during hospitalization. Inflammatory
Bowel Diseases, 18(5), 869–876. https://doi.org/10.1002/ibd.21806
Morrone, L. A., Scuteri, D., Rombolà, L., Mizoguchi, H., & Bagetta, G. (2017). Opioids
Resistance in Chronic Pain Management. Current Neuropharmacology, 15(3), 444–
456. https://doi.org/10.2174/1570159X14666161101092822
Nair, V. A., Beniwal-Patel, P., Mbah, I., Young, B. M., Prabhakaran, V., & Saha, S. (2016).
Structural Imaging Changes and Behavioral Correlates in Patients with Crohn’s
Disease in Remission. Frontiers in human neuroscience, 10, 460.
https://doi.org/10.3389/fnhum.2016.00460