Colon Cancer Case Study

Patient Scenario
V.S., 82 year old female is admitted to rehab for colon resection related to colon cancer. Past medical history includes ulcerative colitis x 20+ years, hypothyroidism, hypertension, and dementia. Surgical history includes hysterectomy at age 63. Vital signs T 98.2, P91, BP136/81, R 18, O2 sat 96% room air, and denied any pain on admission. Patient is alert and oriented x1-2, needs frequent redirection. Lungs clear, breathing even and unlabored. S1S2 noted, no murmurs. Abdomen firm and distended, bowel sounds present in all 4 quadrants. Denies any constipation. Staples visible, incision clean, dry and intact. No redness, inflammation or drainage noted. JP drain patent, draining clear yellow fluid. No foul odor detected. Patient
is an assist x1, uses walker to ambulate.
Nature of Immune Dysfunction
The nature of ulcerative colitis falls under the inflammatory bowel diseases and the origin is unknown (McCance & Huether, 2014).
"Ulcerative colitis is a chronic inflammatory disease that causes ulceration of the colonic mucosa..." (McCance & Huether, 2014, p.1440). The destruction of the mucosa leads to inflammation that begins a cascade and release of cytokines that are responsible for the disease symptoms (McCance & Huether, 2014). McCance and Huether described how the different cytokines released from cellular components such as neutrophils, lymphocytes, plasma cells, eosinophils, and mast cells affect the disease (2014). In addition to the cytokines that are released from the white blood cells that react to the inflammation, macrophages are also present. The activated macrophages function to manifest a fever and acute response (McCance & Huether, 2014). The inflammation that is caused ultimately affects the lining of the intestine and damages the barrier, creating a leak into the gut itself (McCance & Huether,
2014).
I believe ulcerative colitis to be a Type IV Hypersensitivity based on the abnormal T cell response.
Type IV hypersensitivity involves the T cells which cause the release and attraction of cytokines that cause mucosal destruction (McCance & Huether, 2014). There are three types of abnormal T cells that are linked to this hypersensitivity: Tc, Tc1 and Tc17. McCance elaborates on the actions of these cells as being seek and destroyers to the body's cellular structure (2014). As these cells are attracted to the tissue, and release toxins that actively destroy the mucosal lining (McCance & Huether, 2014). In response to the destruction of the lining, edema and thickening can result in narrowing areas of the lumen (McCance &Huether, 2014). Also, when the disease is chronic with flare ups and remissions, the repeated remodeling of the colon can manifest into polyps (McCance & Huether, 2014). Ulcerative colitis can be very painful and is a chronic disease that patients have to
endure.
Manifestations and diagnosis
Manifestations of ulcerative colitis have bouts of flare ups and remissions. Manifestations can have varying degrees of symptoms, depending on the severity. Common symptoms are diarrhea, that can include blood or pus, abdominal cramping, often caused by the destruction of the mucosal lining, and the urge to use the restroom (McCance & Huether, 2014). Patients that exhibit diarrhea more frequently may also present with symptoms of "dehydration, weight loss, anemia, and fever" related to the fluid loss (McCance & Huether, 2014, p.1442). Some lab work that is used when testing for this disease process includes, H&H, albumin, and CMP. Reasoning behind these labs is that the patient may exhibit low hemoglobin, low albumin, and low potassium (McCance & Huether, 2014). With severity of the disease comes the severity of the symptoms that can progress from mild to very severe. Also with the alterations in the dysfunction of the immune system can form the risk for other disease processes, including colon cancer (McCance & Huether, 2014). My patient that had the colon resection was affected to the point of cancer, and medication could not treat her anymore.
Treatment and Management
Treatment of ulcerative colitis is dependent on the severity of the disease (McCance & Huether, 2014). "First-line therapy is 5-aminosalicyclic acid (mesalazine) (McCance &Huether, 2014, p.1442). Also used in conjunction with mesalazine are corticosteriods to assist in the suppression of the inflammation that is caused (McCance & Huether, 2014). Other drugs that are taken to help control the manifestations of ulcerative colitis range from immunosuppressive agents, like azathioprine, as well as broad spectrum antibiotics, anti- diarrheals, NSAIDs, and iron supplements for chronic blood loss and to protect against anemia (Diseases and conditions, 2014). The use of combination treatment can help to alleviate symptoms and decrease reoccurrence. When medications fail, the next step is to consult a surgeon to discuss options of resection or colostomy procedure (McCance &Huether, 2014).