title: Hepatobiliary complications in healthy, intra-abdominally infected, and high-output fistula rats receiving total parenteral nutrition.
abstract: This study examines the pathophysiology of hepatobiliary complications induced by total parenteral nutrition (TPN) by using animal models that underwent cecal ligation to produce intra-abdominal infection and received an enterostomy to mimic a high-output fistula, which causes the interruption of enterohepatic circulation of bile salt. Aspartate transaminase was elevated after TPN (p < .05). Alkaline phosphatase was increased in animals receiving TPN plus an enterostomy (p < .05). Serum albumin was significantly decreased in animals receiving TPN plus undergoing cecal ligation or enterostomy (p < .05). Liver weight and liver protein and water content decreased in animals receiving TPN alone (p < .05). Liver water content increased in animals receiving TPN plus undergoing cecal ligation (p < .05). Liver lipid content increased after TPN and to a significant degree in rats receiving TPN plus undergoing cecal ligation or enterostomy (p < .05). Bile flow diminished after TPN and to a level reaching significance in animals receiving TPN plus undergoing cecal ligation or enterostomy (p < .05). Reduction of bile flow, decrease of biliary cholesterol secretion, and increase of biliary bilirubin secretion, which may be the cause of TPN-induced bilirubinate stones, were most significant in animals receiving TPN plus undergoing cecal ligation (p < .05). In conclusion, TPN can induce hepatic dysfunction and bilirubinate stones, but these complications are more common in animals with associated intra-abdominal infection or high-output fistula.
authors.affiliation: Division of General Surgery, Veterans General Hospital-Kaohsiung, National Yang-Ming Medical College, Taiwan, ROC.
authors.forename: K T
authors.initials: KT
authors.lastname: Mok
mesh_terms: D000410:Alanine Transaminase / Q000097:blood; D000469:Alkaline Phosphatase / Q000097:blood; D000704:Analysis of Variance; D000818:Animals; D001202:Ascitic Fluid / Q000382:microbiology; D001219:Aspartate Aminotransferases / Q000097:blood; D001646:Bile / Q000737:chemistry / Q000378:metabolism; D001663:Bilirubin / Q000097:blood; D001786:Blood Glucose / Q000032:analysis; D002784:Cholesterol / Q000097:blood; D004195:Disease Models, Animal; D004927:Escherichia coli Infections / Q000150:complications; D005402:Fistula; D005705:Gallbladder Diseases / Q000209:etiology* / Q000503:physiopathology; D007081:Ileostomy; D007412:Intestinal Fistula / Q000150:complications*; D008099:Liver / Q000737:chemistry / Q000201:enzymology; D008107:Liver Diseases / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D010289:Parenteral Nutrition, Total / Q000009:adverse effects*; D010538:Peritonitis / Q000150:complications*; D011512:Proteus Infections / Q000150:complications; D011513:Proteus mirabilis / Q000302:isolation & purification; D051381:Rats; D017207:Rats, Sprague-Dawley
chemical_list: D001786:Blood Glucose; D002784:Cholesterol; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D000469:Alkaline Phosphatase; D001663:Bilirubin