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Irish Journal of Medical Science (1971 -)

, Volume 188, Issue 1, pp 109–117 | Cite as

The hepatobiliary complications of malnutrition and nutritional support in adults

  • Andrew McNeiceEmail author
  • Ryan Scott
  • Gerard Patrick Rafferty
  • William Jonathan Cash
  • Graham Blake Turner
Review Article
  • 123 Downloads

Abstract

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.

Keywords

Cholestasis Gallstones Hepatobiliary Hypoalimentation Intestinal failure-associated liver disease Intestinal transplantation Parenteral nutrition Steatosis 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

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Copyright information

© Royal Academy of Medicine in Ireland 2018

Authors and Affiliations

  • Andrew McNeice
    • 1
    Email author
  • Ryan Scott
    • 1
  • Gerard Patrick Rafferty
    • 2
  • William Jonathan Cash
    • 1
  • Graham Blake Turner
    • 2
  1. 1.Regional Liver UnitRoyal Victoria HospitalBelfastN. Ireland
  2. 2.Intestinal Failure TeamBelfast City HospitalBelfastN. Ireland

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