What causes TPN induced cholestasis?

When a child has to be on total parenteral nutrition for a long time, they run the risk of developing TPN-associated cholestasis. Cholestasis is a medical condition when bile, a digestive juice, doesn’t flow correctly from the liver.

What is parenteral associated cholestasis?

PNAC is defined as cholestasis that is associated with a prolonged duration of parenteral nutrition administration (usually >2 weeks). 6. The presentation of PNAC (elevated concentrations of conjugated bilirubin, serum bile acids and transaminases) is identical to that of other cholestatic liver diseases.

Why does TPN cause jaundice?

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.

Why does TPN cause liver damage?

Chronic cholestasis in TPN-associated liver disease is associated with significant secondary copper overload. The steatosis may reflect unbalanced lipid turnover; carnitine and choline deficiency have each been postulated. Steatohepatitis can occur, but the incidence of progression to cirrhosis is not clear.

Does TPN cause high bilirubin?

Disturbances of bilirubin metabolism such as jaundice or pigment gallstone formation occur during total parenteral nutrition (TPN). We have studied the effects of TPN on bile flow and bile acid secretion and on the hepatobiliary transport of bilirubin in rats.

Can TPN cause high bilirubin?

The biliary excretion of bilirubin monoconjugates and bilirubin diconjugates was significantly increased (+72% and +78%, respectively). This provides evidence for enhanced production of the pigment. Serum concentration of total bilirubin was enhanced in the TPN rats (+240%).

Why does TPN damage the liver?

Nutrient Deficiencies. Patients who begin TPN because of severe protein malnutrition (Kwashiokor) may develop hepatic steatosis because of decreased very low density lipoprotein synthesis.

Why is TPN bad for the liver?

Fatty liver is usually a more long-term complication of TPN, though over a long enough course it is fairly common. The pathogenesis is due to using linoleic acid (an omega-6 fatty acid component of soybean oil) as a major source of calories.