The hepatobiliary complications of malnutrition and nutritional support in adults

Hepatobiliary complications of hypoalimentation and parenteral nutrition (PN) are widely recognised. Hypoalimentation includes conditions such as anorexia nervosa (AN), obesity malnutrition and liver disease following bariatric surgery. Treatment of the underlying condition causing hypoalimentation...

Full description

Saved in:

Bibliographic Details
Published in:	Irish journal of medical science Vol. 188; no. 1; pp. 109 - 117
Main Authors:	McNeice, Andrew, Scott, Ryan, Rafferty, Gerard Patrick, Cash, William Jonathan, Turner, Graham Blake
Format:	Journal Article
Language:	English
Published:	London Springer London 01-02-2019
Subjects:	Adult Anorexia Nervosa - complications Bariatric Surgery - adverse effects Cholestasis - etiology Family Medicine Fatty Liver - etiology Fatty Liver - pathology Gallstones - etiology General Practice Humans Internal Medicine Intestinal Diseases - complications Intestines - physiopathology Malnutrition - complications Medicine Medicine & Public Health Obesity - complications Parenteral Nutrition - adverse effects Review Article Intestinal failure-associated liver disease Hepatobiliary Intestinal transplantation Gallstones Parenteral nutrition Hypoalimentation Cholestasis Steatosis
Online Access:	Get full text
Tags:	Add Tag No Tags, Be the first to tag this record!

Description
Summary:	Hepatobiliary complications of hypoalimentation and parenteral nutrition (PN) are widely recognised. Hypoalimentation includes conditions such as anorexia nervosa (AN), obesity malnutrition and liver disease following bariatric surgery. Treatment of the underlying condition causing hypoalimentation can result in an improvement in liver dysfunction. Liver function test abnormalities are also commonly found in patients on PN, with the three main complications being steatosis, cholestasis and biliary system sludge/stones. Patients with intestinal failure receiving PN often have multiple possible aetiologies for liver dysfunction (rather than solely caused by the PN); hence, it is now more commonly referred to as intestinal failure-associated liver disease (IFALD). Liver enzyme abnormalities are very common with long-term PN use and do not always help with monitoring progression of IFALD. A systematic approach is required for investigating liver function abnormalities related to PN. The key management in IFALD is through prevention of sepsis, promoting intestinal health and restoring intestinal continuity where possible. A variety of imaging modalities can be used to investigate, and monitor, the liver disease. Most importantly, patients on PN for more than 28 days should be managed in a large centre with experience in managing intestinal failure to minimise the risk of such complications. Early identification of liver dysfunction is essential and, should it progress despite the above measures, early discussion with an intestinal transplant centre should be encouraged.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-3 content type line 23 ObjectType-Review-1
ISSN:	0021-1265 1863-4362
DOI:	10.1007/s11845-018-1836-8