Review article: hepatobiliary complications associated with total parenteral nutrition

Parenteral nutrition is often associated with hepatobiliary complications. Hepatic steatosis, intrahepatic cholestasis and biliary sludge are the most frequent. Cholestasis predominates in infants, steatosis in adults, and biliary sludge in both. Other less frequent complications are steatohepatitis and gallstones. All hepatobiliary complications are more likely to occur after extended periods of total parenteral nutrition, and are prevented by the concomitant consumption of nutrients by the enteral route. The pathogenic causes are multiple and only partially known. They include lack of gastrointestinal stimuli for biliary secretion and gall-bladder motility, abnormalities in bile acid metabolism, the presence of sepsis, and the potentially unfavourable effects of individual components in the total parenteral nutrition formulae, including an excess of calories. Each potential mechanism and its clinical relevance is discussed in this review.