LIVER AND BILIARY-TRACT CHANGES AND INJURY ASSOCIATED WITH TOTAL PARENTERAL-NUTRITION - PATHOGENESIS AND PREVENTION

Total parenteral nutrition (TPN), now widely used, is successful in pr eventing and reversing malnutrition in individuals with various diseas es and conditions. However, hepatic and biliary complications of TPN a re encountered in both adult and pediatric patients. Certain complicat ions, such as sepsis and TPN-associated cholestasis, occur more freque ntly in very young infants. Continuing problems commonly seen in adult s are steatosis and steatonecrosis. Reasons for the development of the se complications are multifactorial. Etiologies of hepatic complicatio ns, especially the role of deficiency/excess of nutrients in the patho genesis of hepatobiliary disorders, are summarized. Complications caus ed by the duration of TPN are discussed with emphasis on prevention an d management. Evidence now suggests that prompt enteral feeding, even in minimal amounts, may prevent many of the metabolic complications as sociated with TPN. TPN should be used only in amounts meeting needs an d for a duration essential to survival.