As described earlier, bile is produced in the liver,
then stored and concentrated in the gallbladder until it is released to
aid in digestion. When the flow of bile is impaired the resulting condition
is called cholestasis, and it indicates a problem in the hepatic and biliary
systems. Cholestasis is the most frequent indication of hepatobiliary
disease in patients on TPN.
Patients with SBS experience a high frequency of gallstone
formation, or cholelithiasis. This is a result of the diminished amount
and concentration of bile salts caused by the malabsorption of bile acids
and dietary fat. Biliary sludge or gallstones are found in approximately
50% of patients receiving only TPN for three months. Some authorities
have recommended that patients who are dependent on TPN, or who have had
extensive small intestine resection, undergo a prophylactic cholecystectomy
(surgical removal of the gallbladder).
Progressive liver damage is the most serious complication
of prolonged TPN, particularly in children. Patients on long-term TPN
can develop fat in the liver due to excessive caloric intake. Progressive
cholestasis and liver damage can lead to cirrhosis,
which can ultimately progress to liver failure and result in a very poor
prognosis.
This information
is provided as a general educational service
and is not intended to recommend any particular treatment plan
or to replace the advice of physicians. It is important that patients
seek and rely on the advice of a healthcare professional
about their individual medical conditions.
