Perioperative Health Variations: Ulcerative Colitis Case Study Report

This case study focuses on Eleanor Brown, a 48-year-old patient with a history of ulcerative colitis since age 31, managed with infliximab. The case details her progression to pancolitis, characterized by abdominal pain, weight loss, and fatigue, leading to a colonoscopy revealing pseudopolyps. The study discusses the pathophysiology of ulcerative colitis and pancolitis, including the mechanisms of pain and the rationale for using morphine for pain management. It also explains the use of Methylprednisolone and Hartman's solution in her treatment, emphasizing the importance of intravenous administration to bypass the liver's first-pass effect and ensure rapid absorption. The case highlights the complexities of managing ulcerative colitis and its complications in the perioperative setting.

Running Head: HEALTH VARIATIONS 1 - PERIOPERATIVE
HEALTH VARIATIONS 1 – PERIOPERATIVE
Name of the student:
Name of the university:
Author note:

1HEALTH VARIATIONS 1 - PERIOPERATIVE
Table of Contents
Question 1-.................................................................................................................................2
Question 2-.................................................................................................................................3
Question 3-.................................................................................................................................3
Question 4 –...............................................................................................................................4

2HEALTH VARIATIONS 1 - PERIOPERATIVE
Question 1-
Eleanor Brown who is 48 years old now had ulcerative colitis at the age of 31.
Ulcerative colitis is referred to as a disease that damages the large intestine and colon
associated with swelling and irritation. Patient suffering from ulcerative colitis have frequent
episodes of diarrhoea often with pus or blood (Conrad, Roggenbuck & Laass, 2014). For
colitis she has been taking infliximab, along with a combination of specific diet and medical
monitoring. Infliximab is a tumour necrosis factor (TNF) blocker, which is used to treat
moderate to serious colitis or Crohn’s disease (Casteele et al., 2015). Due to frequent
episodes of diarrhoea with blood, a colonoscopy is performed which stated that she has
developed pseudo polyps. Pseudo polyps are bulging commonalities of scar tissue developed
from tissue granulation occurred during the treatment of ulcerative colitis (Plenderleith,
2015). In Ms Brown, the pseudo polyps is observed in her sigmoid and descending colon. She
has been also suffering from feeling of abdominal blotting and cramps. Due to this her doctor
suggested a MRI scan. Result of the test showed that she has Pancolitis. Pancolitis is an
ulcerative colitis that involved the entire large intestine. Symptoms observed in patient
suffering from pan colitis are abdominal pain, cramps, urgency to empty bowel, fatigue and
fever and weight loss (Bullocks & Manias, 2017 pp.437 – 476). It is more serious form of
ulcerative colitis and is common in patient suffering from ulcerative colitis for a longer
period of time. In patient suffering from pancolitis weight loss is common. Along with that
fatigue is also observed with severe abdominal pain (Plenderleith, 2015). In case of Eleanor
Brown, she has lost 9 kilograms of her weight in two weeks and also have a feeling of
fatigues, due to which she is unable to perform her daily activities properly. In ulcerative
colitis or pancolitis, function of the large intestine is hindered, due to which foods are not
absorbed by the intestine. Loss of appetite is also observed in patient suffering from
pancolitis (Hillman, 2017). Due to intestine malfunction and loss of appetite, body does not

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get enough calories according to the need of the body, which leads to weight loss (Bullocks
& Manias, 2017 pp.695 – 699). Hence in the case of Ms Brown, she has suffered from weight
loss due to the incapability of large intestine to function properly because of ulcerative colitis
which is turned into more severe infection, pancolitis.
Question 2-
Ulcerative colitis is an infection of large intestine and colon which is caused due to
the long term infection of ulcers or sores in the lining of digestive tract. Patient suffering
from ulcerative colitis often have abdominal pain and cramps caused due to inflammation in
the innermost lining of intestine (Conrad, Roggenbuck & Laass, 2014). It is caused due to the
action of sensory innervation. Sensation of pain is occurred by the sensitization of local
sensory afferent neurons. The signal is transmitted by these neurons to the central nervous
system, where the signal is amplified and transmitted to the neurons of the CNS (Central
Nervous Treatment) causing pain (Plenderleith, 2015).
To minimise the abdominal pain in patient morphine is prescribed often. Morphine is
an opioid pain medication extracted from plants and animals. It acts directly to the brain and
minimise the feeling pain. In case of Ms Brown, Morphine 15mg is introduced
intramuscularly. Morphine when consumed, it interacts with the opioids receptor in the
central nervous system and hence, interneurons are hyperpolarized among the dorsal cord. It
also act as receptor of K and decreases the release of P receptors which is responsible for pain
perception. Along with that, it also depresses the release of transmitter from nerve endings
which carries nociceptive stimuli associated with the transmission of pain (McDonough,
2017).

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Question 3-
Eleanor is diagnosed with ulcerative colitis at the age of 31. Patient suffering from
ulcerative colitis have diarrhoea associated with blood and pus. In case of ulcerative colitis,
inflammation occurs in the lining of large intestine. Due to the inflammation, bleeding and
pus is associated with diarrhoea. Inflammation in the large intestine and colon is also
responsible for diarrhoea, as the food is not absorbed by the body due to malfunction of the
colon (Nurjali & Wildbore, 2015 pp.774-777). It also gives rise to abdominal pain and severe
cramps. For ulcerative colitis she had been taking infliximab, which is a TNF blocker.
Consumption of TNF blocker for long term causes fever, abdominal pain and fatigue
(Critchlow, 2017). People suffering from ulcerative colitis for a longer period of time, often
develop bulging commonalities of scar tissue in the intestinal lining known as pseudopolyps.
Psuedopolyps gives rise to abdominal blotting, cramps and more frequent episodes of
diarrhoea (Nurjali & Wildbore, 2015 pp.695-699). Such signs and symptoms are also
associated in case of Eleanor Brown. Pseudopolyps is observed in descending and sigmoid
colon (Bullocks & Manias, 2017 pp.437 – 476). If the ulcerative colitis is not cured, it can
lead to pancolitis. Pancolitis is more severe form of ulcerative colitis, when the whole colon
is infected and bloated. Pancolitis leads to more frequent episodes of diarrhoea with blood
and pus and gradual weight loss (Bjerrum et al., 2014).
Question 4 –
In case of Ms Brown, Methylprednisolone 20 mg IVI, Hartman’s solution is ordered.
It is a mixture of sodium lactate, sodium chloride, calcium chloride and potassium chloride. It
is used in the patient who are on fluid diet. It is used in case of patient having low blood
pressure and low blood volume. It is administered intravenously to avoid the liver’s first pass
effect (McDonough, 2017). Hartman’s solution is administered in intravenous way in case of
Ms Brown, as she is not able to consume solid food and is on the fluid diet chart, the

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Hartman’s solution is administered intravenously. In addition by avoiding the first pass effect
of the liver that is absorbing directly into the blood by avoiding the metabolism of drug by
hepatic cells (McDonough, 2017). Hence, by administering the solution in intravenous way in
Ms Brown, it is absorbed directly by the blood more rapidly as compared to the other
administration method and will exert their specific function.

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