Gastroenterology 1993 Jan;104(1):286-301

Hepatobiliary complications of total parenteral nutrition

Quigley EM, Marsh MN, Shaffer JL, Markin RS
Department of Internal Medicine, University of Nebraska Medical Center, Omaha.

Abstract
The relationships between various hepatobiliary disorders and the administration
of total parenteral nutrition (TPN) were reviewed and, in particular, the role
of TPN in their pathogenesis was critically evaluated. Several clinical and
pathological entities including steatosis, steatohepatitis, cholestasis, and
cholelithiasis have been commonly linked to TPN, and instances of chronic
decompensated liver disease have been reported. However, it is concluded that it
is often difficult to extricate the effects of TPN on hepatobiliary function
from many other hepatotoxic factors that may be operative in these patients.
Thus, whereas considerable evidence exists to support a role fro carbohydrate or
calorie excess in TPN solutions in the pathogenesis of steatosis, a loss of
enteric stimulation and not TPN per se may be the primary factor in the
development of cholestasis, biliary sludge, and gallstones. The apparent
predilection of infants to TPN-related cholestasis may be based on the relative
immaturity of the neonatal biliary excretory system