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 bi liary sludge in both. Other less frequent complications are steatohepatitis and gallstones. All hepatobiliary complications are more likely to occur a fter extended periods of total parenteral nutrition, and are prevented by t he concomitant consumption of nutrients by the enteral route. The pathogeni c causes are multiple and only partially known. They include lack of gastro intestinal stimuli for biliary secretion and gall-bladder motility, abnorma lities in bile acid metabolism, the presence of sepsis, and the potentially unfavourable effects of individual components in the total parenteral nutr ition formulae, including an excess of calories, Each potential mechanism a nd its clinical relevance is discussed in this review.