title: Hepatobiliary, renal and bone complications of intestinal failure.
abstract: Abnormal liver function tests in patients with intestinal failure (IF) may be due to the underlying disease, IF or the treatments given (including parenteral nutrition (PN)). PN-related liver disease in children usually relates to intrahepatic cholestasis and in adults to steatosis. Steatosis may be consequent upon an excess of carbohydrate, lipid or protein, or upon a deficiency of a specific molecule. Pigment-type gallstones are common in adults and children with IF; these develop from biliary sludge that forms during periods of gallbladder stasis. Ileal disease/resection, parenteral nutrition, surgery, rapid weight loss and drugs all increase the risk of developing gallstones. Gallstone formation may be prevented by reducing gallbladder stasis (oral/enteral feeding or prokinetic agents), altering bile composition, or by means of a prophylactic cholecystectomy. Calcium oxalate renal stones are common in patients with a short bowel and retained functioning colon and are consequent upon increased absorption of dietary oxalate; they are prevented by a low-oxalate diet. An osteopathy may occur with long-term parenteral nutrition.
authors.affiliation: Digestive Disease Centre, Leicester Royal Infirmary, Windsor Building, Leicester, LE1 5WW, UK. jeremy.nightingale@uhl-tr.nhs.uk
authors.forename: Jeremy Mark Darby
authors.initials: JM
authors.lastname: Nightingale
mesh_terms: D001847:Bone Diseases / Q000209:etiology*; D002129:Calcium Oxalate / Q000378:metabolism; D042882:Gallstones / Q000209:etiology* / Q000517:prevention & control; D006801:Humans; D007669:Kidney Calculi / Q000209:etiology*; D008107:Liver Diseases / Q000209:etiology*; D010288:Parenteral Nutrition / Q000009:adverse effects; D012778:Short Bowel Syndrome / Q000150:complications*
chemical_list: D002129:Calcium Oxalate