Ulcerative Colitis Assessment Answers

ULCERATIVE COLITIS

Question 1

Ulcerative colitis ensues in genetically susceptible individuals and indicated by chronic inflammation of the inner lining of the colon. When susceptible people are exposed to the environmental activators inflammation takes place. It may lead to swelling, ulcers, and irritation in the large intestine as a result of inflammatory processes affecting the inner lining. Other symptoms include diarrhea, abdominal pain, bleeding along with stools, pus and mucus secretion with stools, fever, exhaustion and intersex weight loss. Eleanor in the given case study lost her 9 kg weight in a week. She has been diagnosed with ulcerative colitis and feels a loss of appetite. There are several processes responsible for weight loss during disease progression (Elsherif et al., 2014). Ulcerative colitis is an autoimmune and inflammatory disease which leads to in widespread catabolism in the patients body (Elsherif et al., 2014). Moreover, there is accompanying malabsorption of micro and macronutrients during disease progression Generally resting energy expenditure is augmented throughout acute flares of disease and proinflammatory cytokine produce an anorexic influence in the patients (Elsherif et al., 2014). The inflammatory ulcerative colitis is connected with the variations of several metabolic hormones which include adiponectin, leptin, as well as ghrelin which can impact satiety. Moreover, these patients usually suffer from gastrocolic reflex and diversity of indications such as pain frequently related to food ingestion which leads to food avoidance (Conrad,Roggenbuck, amp Laass, 2014). Epithelial wall dysfunction and destruction in impacts the absorption and transport of nutrients which leads to malnutrition. This may result in electrolytes as well as water loss passively in the intestinal lumen. This causes an increased acceptance of antigens from the lumen and thus augmented inflammation of mucous mempane takes place. This inflammation leads to the expression of enzymes such as nitric oxide synthase and cyclooxygenase besides the expression of toll-like receptors. As a result of this enhanced creation of nitric oxide takes place (Mourad et al 2017). This leads to a prolonged production of proinflammatory cytokines which cause mucosal inflammation and wall dysfunction (Mourad et al., 2017). Another cause of nutrient malabsorption is permeation of neutrophils crypts responsible for the destruction of epithelial cells (Martini et al, 2017). The damage of epithelial cells junctions results in loss of barrier activity (Martini et al., 2017). The intercellular connection rises in ulcerative colitis because of up-regulation of E-cadherin-catenin protein complex in inflammatory mucosa in the bowel. This causes epithelial cell death through apoptosis and leads to the inflammation (Conrad,Roggenbuck, amp Laass, 2014).

. The apoptosis in epithelial cells causes damage of crypts. The apoptosis of T84 cells through Fas ligand pathway causes declined resistance in trans epithelial cells and heightened flux of small molecules however limited flux of big molecules. As such processes, the process of absorption of micro and macronutrients is reduced in the body which leads to weight loss.

Question 2

Fig Source https//aneskey.com/acute-pain/

Pain is the discrimination of deleterious stimulus along the central and peripheral nervous system along the pain (Kesavan,2015). As shown in the figure above there is a poadcast of noxious stimuli in the boundary of the pain which triggers the receptors known as nociceptors which sense pain. Based on the existence of myelin as well as axon radius different and afferent fibers can be distinguished(Kesavan,2015). The afferent fipes transmit impulses speedily and the defferent fipes are unmyelinated with a smaller radius than afferent fipes. The impulse is transmitted along the afferent that is sensory fipes along the dorsal nerve root. The afferent nociceptive fipe synapse at the spinal cord in substantia gelatinosa represented as grey horn. It is organized in layers. It additionally triggers spinothalamic region which is the most central ascending path. In the pain, the sensation of pain is established in the thalamus and directed to the cerepal cortex region for concluding activity. The pain sensation is also handled in the midpain, hypothalamus besides limbic region. The midpain part is also known as periaqueductal grey comprises of afferent fipes associated with painstem. The nociceptive poadcasts are repressed through substantia gelatinosa. This designates the complete pathway of pain. Morphine being opioid actions on CNS and triggers opioid receptors(Kesavan,2015). Opioid receptors cause transmission and regulation of pain. The stimulation of opioid receptors cause adenylatecyclase inhibition and decreases intracellular cAMP, elevation of efflux of K besides hyperpolarisation of nerve mempanes. This leads to consequences such as the opening of voltage-gated calcium channels and peaks in the discharge of presynaptic transmitters leading pain management(Kesavan,2015).

Question 3

Eleanor had several admission in the hospital because of her disease. She was facing acute exacerbations due to ulcerative colitis. She underwent 14 episodes of diarrhea per day with pus and blood beside severe pain in the abdomen (Conrad,Roggenbuck, amp Laass, 2014).. She had fecal inconsistency, pus and mucus in stools and fatigue, weakness and anorexia. She faced abdominal cramps and severe pain. She lost 9 kg weight in two weeks as she was feeling no appetite. She felt exhausted and worn-out to do her daily tasks. Her colonoscopy examination indicated the development of pseudopolyps. Her MRI scan revealed that she developed pancolitis. Her gastroenterologist advised him for total colectomy and ileostomy. Her capillary refill is very poor and urinary output is less. She has painful and descended abdomen. The mucus along with pus in the stool is a prospective symbol of infection in the patient (Conrad,Roggenbuck, amp Laass, 2014). Inflammation of colon lining produced open wounds which secreted of mucus and pus. The less consumption of food and incessant diarrhea resulted in weakness as well as fatigue in ulcerative colitis. She has been advised surgery which indicates that her disease has become advanced enough to be controlled by medicines and diet alone (Conrad,Roggenbuck, amp Laass, 2014).. Her weight loss and inability to perform daily activities show that her quality of life has been reduced as a result of ulcerative colitis.

Question 4

Intravenous fluid she was infused with was Hartmans solution which is indicated with a reduction in blood circulation, defilements of the acid-base equilipium, and several other signs. For Eleanor Hartmanns solution was prescribed 1000 ml every 6 hours. It is isotonic with pH 5.0- 7.0 solution. The osmolality of this sol. is 278mOsmol/L. The high calcium in this solution can be expelled by the renal system. It can be used as a source of electrolytes as well as water. The patient who comes across the hurdles and complications like weight loss because of malabsorption of food and nutrients this solutions provides relief. This fluid can help in reinstating the electrolyte stability in the body because it comprises manifold electrolytes besides several alkalizing mediators such as sodium lactate. It aids in conserving the pH of the system. The Hartmanns solution is also a source of bicarbonate used in metabolic acidosis cure which is linked with the dehydration due to K deficiency. The Ca constituent helps in preserving cell mempane integrity, the penetrability of capillaries and working of the nervous system. This solution is indicated in complications such as hypotension, electrolyte as well as fluid misbalance and persistent and recurrent infections.

References

Conrad, K., Roggenbuck, D., amp Laass, M. W. (2014). Diagnosis and classification of ulcerative colitis.Autoimmunity reviews,13(4-5), 463-466.

Elsherif, Y., Alexakis, C., ampMendall, M. (2014). Determinants of weight loss prior to diagnosis in inflammatory bowel disease a retrospective observational study.Gastroenterology Research and Practice,2014.

Kesavan, K. (2015). Neurodevelopmental implications of neonatal pain and morphine exposure.Pediatric annals,44(11), e260-e264.

Martini, E., Krug, S. M., Siegmund, B., Neurath, M. F., amp Becker, C. (2017). Mend your fences the epithelial barrier and its relationship with mucosal immunity in inflammatory bowel disease.Cellular and Molecular Gastroenterology and Hepatology,4(1), 33-46.

Mourad, F. H., Barada, K. A., ampSaade, N. E. (2017). Impairment of small intestinal function in ulcerative colitis role of enteric innervation.Journal of Crohns and Colitis,11(3), 369-377.

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