Postoperative jaundice and total parenteral nutrition-associated hepatic dysfunction.
Postoperative jaundice and TPN-induced hepatic abnormalities represent clinical situations that stem from multiple and frequently overlapping insults to the liver. The pattern of LFT abnormalities and appropriate imaging studies provide clues to the diagnosis. Greater insight into the molecular basis of cholestasis has shed light on the possible common pathways for the hepatic derangements that are seen in diverse situations. TPN-related hepatic dysfunction most likely involves a combination of nutritional deficiencies, hormonal imbalances, excessive calories, and possibly bacterial overgrowth in the small bowel. Growing clinical evidence points to a high incidence of severe liver disease in chronic TPN-dependent patients. Careful monitoring of patients is warranted in these circumstances and combined transplantation of the liver and small bowel may be the only possibility for long-term survival for such patients with progressive liver disease.
Chung
Chuhan
C
Division of Gastroenterology and Hepatology, Northwestern University Medical School, 676 North St. Clair Street, Suite 880, Chicago, IL 60611, USA.
Buchman
Alan L
AL
D000758:Anesthesia / Q000009:adverse effects; D002764:Cholecystitis / Q000209:etiology; D002779:Cholestasis / Q000209:etiology; D006461:Hemolysis; D006801:Humans; D007565:Jaundice / Q000209:etiology*; D008099:Liver / Q000187:drug effects; D008107:Liver Diseases / Q000209:etiology*; D010289:Parenteral Nutrition, Total / Q000009:adverse effects*; D011183:Postoperative Complications / Q000209:etiology*