Functional changes that led to Jordan’s weight loss.

Structural and functional changes in the disease process that led to Jordan’s weight loss.

Crohn disease is a condition that causes inflammation of the digestive system, which affects the body’s ability to digest food, absorb nutrients, and eliminate waste. It’s described as a chronic condition meaning that it is an ongoing and life-long disease.

Crohn’s disease affects the digestion system in the body, which is responsible for the digestion of food, absorption of minerals, and elimination of the waste. When food is consumed through the mouth, it goes to the stomachthrough the esophagus, whereby digestive juices break it down. The partly digested food moves through the small intestines where absorption of nutrients from the food takes after further break down of the food. The waste products then move to the large intestines for liquid absorption, the solid waste moving to the rectum. Failure to completion of this process may lead to bodyweight loss.

Inflammation patch may be small, only a few centimeters across or extend a distance along part of the gut. Ongoing inflammation and bowel healing may cause scar tissue to form narrowing the section of the bowel, making it difficult for food to pass through and may cause a blockage if severe; this is called strictures. This can result in body weight loss since the digestion of food and absorption of nutrients in the body can be hindered.

In rare cases, inflammation deep in the bowel wall or even severe blockage caused by stricture may lead to a perforation of the bowel hence resulting in a hole. Through this hole, the contents of the bowel can leak. This condition is symptomized by severe abdominal pain, fever, and nausea and vomiting. The leak at some incidences may result in the formation of an abscess. The vomiting in the patient is also another cause of body growing weak since food is not digested after being consumed.

Some Crohn patients may develop a fistula, which is an abnormal passageway connection one internal organ to another or the outside surface of the body. Most fistulas start in the walls of the intestine and may connect the bowel to parts, particularly around the anus. When the inflammation in the Crohn disease spreads through the whole thickness of the bowel wall then continues to tunnel through the layers of the tissues, a fistula is formed. This can lead to the uncontrollable passage of waste products from the body hence resulting in body weakness (Crohn’s and Colitis UK, 2018)

Pain pathway and how Morphine alters the conscious perception of pain.

Pain is the conscious perception of a stimulus that causes tissue damage meaning that the presence of the stimulus has to be detected in the tissue the information about the tissue damage relaying to the cerebral cortex where it is consciously perceived as pain. Small patches of each peripheral tissue are connected to regions of the cerebral cortex by a three-neural pain pathway to enable the conscious perception of pain.

The first-order neuron carries information to the spinal cord from the periphery where it synapses with the second-order neuron, which relays information to several sites in the brain whereby some of the brain sites are involved in the automatic nervous system reflex response to injury. Conscious perception of tissue damage is transmitted through the third-order neuron where information is relayed to the cerebral cortex creating awareness to an individual of the pain. To ensure that most tissues in the body are connected to the cerebral cortex, large numbers of the three-neural relays are arranged in parallel.

Morphine activates opioid receptors and produces a strong analgesic effect. Morphine profoundly reduces the emotional reaction of pain perception. Morphine significantly reduces the nociceptive related activities and discriminant ability of neural ensemble between noxious and innocuous stimuli in the lateral pain pathway (University of Western Sydney, 2017).

The clinical manifestation that may indicate the deterioration of Jordan’s condition

The distended abdomen, tender mass in his right lower abdominal quadrant, and audible bowel sounds are a result of criticisms caused by inflammation and the healing in the bowel, which may cause scar tissue to form. This makes it difficult for food to pass through and, if severe, may cause a blockage. It may also lead to the narrowing of the intestines.

The skin was pale and dry with poor turgor. Crohn’s causes skin problems. The illness itself caused tiredness and fatigue, from the weight loss associated with flare-ups or surgery and also diarrhea. Loss of appetite due to the body not absorbing nutrients from the food he ate because of the inflammation in the gut.

The change of health over time with Jordan shows his condition is deteriorating. A patch of inflammation may have extended a distance along the gut as well as affecting the lining of the bowel and may also penetrate deeper, causing abscesses and fistula. Crohn’s can affect any part of the gut but mostly is likely to develop in the ileum or the colon. The areas of inflammation are often patchy, with sections of the normal gut in between. The inflammation in Jordan may have resulted in the body’s inability to digest food, absorb nutrients, and eliminate waste (Kroesen, 2019).

Characteristics of the intravenous fluid and its rationale

This solution is often used for fluid resuscitation after a loss of blood due to either surgery or injury. It’s used to balance the chemical imbalance that occurs with acute fluid loss. Patients hospitalized with severe acute colitis and fail to respond adequately to intravenous corticosteroids, infliximab, which is given by intravenous infusion, is available to them. This agent blocks the immune system’s production of Tumour Necrosis Factor; a pro-inflammatory cytokine implicated Irritable Bowel Syndrome. Intravenous corticosteroids care for patients with acute flares who are too sick or intolerant due to side effects. They are used for moderate-to-severe active inflammatory bowel disease providing significant suppression of inflammation and rapid relief symptoms (Lim, 2016).

Ustekinumab is a fully human immunoglobulin G1_K monoclonal antibody targeting the standard p40 subunit of the cytokines IL-12 and IL-23 involved in the pathogenesis of CD⁶¹. Its administration is as a single intravenous loading dose titrated to patients and followed by eight weekly 90mg subcutaneous doses for maintenance. Vedolizumab inhibits blocking on the surface of lymphocytes hence preventing lymphocytes from migration into the small intestines. Biological drugs are effective in selected patients even as the first line of therapy for treatment, hence the medical officer is ordering for the administration of the fluid into Jordan (Engel, 2016).

Hartman’s solution

This solution is a mixture of potassium chloride, sodium chloride, calcium chloride, and sodium lactate when putting in water. The solution was for treating people who had low blood pressure in a procedural way of replacing the electrolytes and fluids (Lee et al. 2015). The sodium lactate solution would also be used in treating metabolic acidosis and washing of the eye in the cases of chemical burn. This solution was used among prisoners as a way of preventing criminal cases as a way of rehabilitating the criminal prisone

References

Kroesen, A. J. (2019). Early Surgery in Inflammatory Bowel Diseases Is a Better Option than Prolonged Conservative Treatment. Visceral Medicine, 35(6), 355-358.Asthana AK, Intestinal ultrasound in inflammatory bowel diseases. J Gastroenterol Hepatol 2016; 31 Supp 1:21-2.

Beaugeria L, Seksik P, Nikon Larmurier I, et al. Predictors of Crohn’s disease. Gastroenterology 2006; 130(3):650-6.

Crohn’s and Colitis UK. Crohn’s disease edition 7b. 2016, 2017, 2018.

Lee, Y. M., Kang, B., Lee, Y., Kim, M. J., & Choe, Y. H. (2015). Infliximab’s “top-down” strategy is superior to “step-up” in maintaining long-term remission in the treatment of pediatric Crohn disease. Journal of pediatric gastroenterology and nutrition, 60(6), 737-743.Engel T, Kopylov U. Ustekinumab in Crohn’s disease: evidence to date and place in therapy. Ther Advances Chronic Dis 2016; 7(4):208-14.

Edition, F. (2017). Australian Guidelines for General Practitioners and Physicians.Lim WC, Wang Y, Macdonald JK, Hanauer S. Aminosalicylates for induction of remission or response in Crohn’s disease. Cochrane Database Syst Rev 2016; 7:CD008870.

Loly c, Belaiche J, Louis E. Predictors of severe Crohn’s disease. Scand J Gastroenterol 2008; 43(8):948-54.

Shergill, A. K., Lightdale, J. R., Bruining, D. H., Acosta, R. D., Chandrasekhara, V., Chathadi, K. V., … & Fisher, D. A. (2015). The role of endoscopy in inflammatory bowel disease. Gastrointestinal Endoscopy, 81(5), 1101-1121.

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