GASTROENTEROLOGY ARTICLE OF THE WEEK
February 16, 2006
Buchman AL, Iyer K, Fryer J. Parenteral nutrition-associated liver disease and the role for isolated intestine and intestine/liver transplantation. Hepatology 2006;43:9-19.
1. Typical histologic findings in PNALD include
a. marked cholestasis in adults
b. Steatosis, often mixed macro and microvesicular
c. Findings of steatohepatitis, which usually predict progression to fibrosis
d. Ballooning of hepatocytes
2. Criteria for intestinal transplantation include
a. impending or overt PN-associated liver failure
b. <3 feet of small bowel remaining
c. Thrombosis of 2 or more major central venous channels
d. Frequent central line sepsis
e. Malnutrition
d. Frequent severe dehydration
True or False
3. Serum transaminases become elevated by 1.5 to 3x ULN during the initial 1-3 weeks of TPN, this is usually a transient phenomenom, particularly if serum bilirubin remains normal
4. About 20% to 25% of adults on PN for over 1 year develop chronic liver disease, the incidence increases over time.
5. Metronidazole, to treat bacterial overgrowth, is usually associated with improvement in steatosis and liver tests.
6. Choline deficiency may be a possible cause of hepatic steatosis and abnormal liver tests in patients taking long-term PN
7. Administration of >50 kcal/kg/day as dextrose usually leads to hepatic steatosis
8. Patients with severe PN-associated cholestasis should receive manganese and copper-free PN solutions