Hepatobiliary abnormalities associated with total parenteral nutrition

Area of Science:

• Hepatology
• Gastroenterology
• Clinical Nutrition

Background:

• Patients receiving Total Parenteral Nutrition (TPN) frequently develop hepatic dysfunction and biliary tract abnormalities.
• These complications can manifest as hepatocellular injury, intrahepatic cholestasis, acalculous cholecystitis, or cholelithiasis.

Purpose of the Study:

• To review the evidence of liver and biliary tract abnormalities in patients on TPN.
• To discuss the differing presentations in infants and adults and potential multifactorial pathogenesis.

Main Methods:

• Review of clinical, chemical, and morphological evidence of hepatic dysfunction in TPN patients.
• Analysis of reported cases and potential contributing factors to liver disease progression.

Main Results:

• Infants primarily show intrahepatic cholestasis, while adults develop fatty liver early and cholestasis later.
• Biliary tract abnormalities are a risk for both groups; adult changes are usually mild and reversible, but progressive disease occurs.
• Infantile TPN-associated liver disease can be severe, leading to progressive disease and mortality.

Conclusions:

• The pathogenesis of TPN-induced liver disease is likely multifactorial, involving factors like overfeeding, nutrient deficiencies, and bile stasis.
• While TPN-related liver changes are a concern, especially in infants, the exact causal relationship and progression to chronic liver disease require further investigation.
• Therapeutic strategies focus on addressing potential etiologies, such as adjusting glucose loads and promoting gallbladder contraction.