Inflammation Case Study

Case Presentation
Chris Shomni is a 25-year-old male in a stressful, professional position. He was recently diagnosed with
ulcerative colitis (UC) after developing abdominal pain and cramping and bloody diarrhea intermittently
(though more frequently recently) over the last several weeks. He has lost 10 pounds in the last 4 weeks
and has complained of nausea and fatigue. A colonoscopy demonstrated the presence of significant
inflammation and ulcers in the colon and rectum. No strictures, perforations, or areas of paralysis of the
colon were noted. Biopsy and further evaluation of the colonoscopy confirmed the presence of UC and
ruled out Crohn's disease. He has no family history of inflammatory bowel disease. Assessment of the
skin revealed the presence of erythema nodosum lesions, which are characteristic of UC. Laboratory
testing further identified the presence of lowered red blood cell (RBC) and hemoglobin levels, elevated
platelet count, and normal white blood cell (WBC) count. Serum total protein and albumin levels were
low.

Diagnosis of UC was made with complications of anemia and hypoalbuminemia. Mr. Shomni was also
demonstrating impaired nutrition as a result of impaired nutrient absorption and diarrhea and anemia
secondary to inflammation of the bowel and loss of fluid, protein, and RBCs. Pain from inflammation and
abdominal cramping was present, but not significant, and he was at risk for fluid volume deficiency. It
was determined that the bowel needed to be rested, that bowel resection surgery was not indicated at
this time, and that inflammation must be reduced. Mr. Shomni was admitted to the hospital to begin
treatment for inflammation, rest the bowel, reduce his diarrhea, and balance his fluid and electrolyte
levels.

Overall goals of treatment for Chris include controlling colon inflammation, ensuring adequate nutrition
and hydration, and relieving pain and diarrhea. With control of inflammation and diarrhea, it is expected
that the anemia and hypoalbuminemia will resolve. Pharmacologic intervention included
aminosalicylates containing 5-aminosalicylic acid (5-ASA) to control inflammation. Corticosteroids to
reduce inflammation will only be used if Chris has an exacerbation of his UC and his disease becomes
severe and nonresponsive to 5-ASA. If Mr. Shomni does not respond sufficiently to the 5-ASA or
corticosteroids, the use of immunomodulators such as 6-mercaptopurine (6-MP) or monoclonal
antibodies such as infliximab (Remicade) may have to be introduced in the future. With chronic
inflammatory bowel disease, at some point in his life Mr. Shomni may need to have surgery for a
colostomy or ileostomy because tissue damage to the intestinal tract may be so severe that it no longer
functions.

Chris was discharged after 3 days with new medications and instructions to avoid enteric and time-
released medications, an understanding of dietary changes to limit high-fiber food intake, strategies for
stress reduction, and actions to be taken should early signs and symptoms of an inflamed or infected
bowel be evident.
Case Analysis
Inflammatory bowel disease encompasses two primary inflammatory processes: ulcerative colitis and
Crohn's disease. UC is a chronic inflammatory disease with symptoms that may range from mild to
severe. Chris’ case provides a classic example of chronic inflammation with symptoms, including
abdominal pain and cramping, bloody diarrhea, weight loss, nausea, and fatigue. Clinical symptoms
included significant inflammation and ulcers in the colon and rectum evident during his colonoscopy and
erythema nodosum lesions on his skin. Primary treatment regimens were directed at reducing and
controlling Mr. Shomni’s colon inflammation, relieving pain and diarrhea, and enhancing his nutrition
and hydration status.

Questions
1. This case study notes that a colonoscopy demonstrated the presence of significant
inflammation. What would the examiner actually have seen that supports this conclusion?
Answer:

2. This case study also notes that Mr. Shomni may need to have surgery for a colostomy or
ileostomy at some point in his life because tissue damage to the intestinal tract may be so
severe that it no longer functions. How would you explain the cause of this damage?
Answer: