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Cholestasis Associated With Long-Term Parenteral Hyperalimentation

Cholestasis Associated With Long-Term Parenteral Hyperalimentation Abstract Three infants receiving long-term parenteral hyperalimentation developed obstructive jaundice characterized by parallel elevations of total and direct bilirubin with normal serum enzyme determinations. Two infants died from complications of their primary surgical lesion while the third survived with complete reversal of the hepatic involvement. Liver specimens in two patients revealed a unique form of hepatitis having parenchymal cholestasis and periportal infiltration with a marked eosinophilic myelopoiesis. The histologic findings are compatible with complications of a bile secretory defect. Deficiency of a specific amino acid, essential to the formation of normal bile salts, or long-standing intestinal obstruction, could predispose to abnormal or inadequately conjugated bile salts interfering with micelle formation and the normal flow of bile into the canaliculus. References 1. Dudrick SJ, Rhoads JE: New horizons for intravenous feeding . JAMA 215:939-949, 1971.Crossref 2. Filler RM, et al: Long-term parenteral nutrition in infants . N Engl J Med 281:589-594, 1969.Crossref 3. Gerda BIM, Babson SG: Peripheral intravenous alimentation of the small premature infant . J Pediatr 79:494-498, 1971.Crossref 4. Heird WC, et al: Intravenous alimentation in pediatric patients . J Pediatr 80:351-372, 1972.Crossref 5. Hays DM, et al: Diagnosis of biliary atresia: Relative accuracy of percutaneous liver biopsy, open liver biopsy and operative cholangiography . J Pediatr 71:598-607, 1967.Crossref 6. DiSant Agnese PA, Blanc WA: A distinctive type of biliary cirrhosis of the liver associated with cystic fibrosis of the pancreas . Pediatrics 18:387-409, 1956. 7. Ladd WE: Congenital obstruction of bile ducts . Ann Surg 102:742-751, 1935.Crossref 8. Johnson J, Albritton WL, Sunshine P: Hyperammoniemia complicating parenteral nutrition in infants. Read before the 41st Annual Meeting of the American Pediatric Society, Atlantic City, NJ, 1971. 9. Asch MJ, Shaw KNE, Hays DM: Evaluation of different nitrogen sources in high calorie parenteral alimentation therapy. Read before the Twentieth Annual Meeting of the Section on Surgery of The American Academy of Pediatrics, Chicago, 1971. 10. Ghadimi H, et al: Biochemical aspects of intravenous alimentation . Pediatrics 48:955-965, 1971. 11. Popper H: Cholestasis . Annu Rev Med 19:39-56, 1968.Crossref 12. Soper RT, in discussion, Asch MJ, Huxtable RF, Hays DM: High calorie parenteral therapy in infants and children . Arch Surg 104:434-437, 1972.Crossref 13. Peden VH, Witzleben CL, Skelton MA: Total parenteral nutrition . J Pediatr 78:180, 1971.Crossref 14. Johnson JD, Albritton WL, Sunshine P: Hyperammoniemia accompanying parenteral nutrition in newborn infants . J Pediatr 81:154-161, 1972.Crossref 15. O'dell GB: "Physiologic" hyperbilirubinemia in the neonatal period . N Engl J Med 177:193-194, 1970. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Cholestasis Associated With Long-Term Parenteral Hyperalimentation

Touloukian, Robert J.; Downing, S. Evans
Archives of Surgery , Volume 106 (1) – Jan 1, 1973
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References (15)

Publisher
American Medical Association
Copyright
Copyright © 1973 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1973.01350130060013
Publisher site
See Article on Publisher Site

Abstract

Abstract Three infants receiving long-term parenteral hyperalimentation developed obstructive jaundice characterized by parallel elevations of total and direct bilirubin with normal serum enzyme determinations. Two infants died from complications of their primary surgical lesion while the third survived with complete reversal of the hepatic involvement. Liver specimens in two patients revealed a unique form of hepatitis having parenchymal cholestasis and periportal infiltration with a marked eosinophilic myelopoiesis. The histologic findings are compatible with complications of a bile secretory defect. Deficiency of a specific amino acid, essential to the formation of normal bile salts, or long-standing intestinal obstruction, could predispose to abnormal or inadequately conjugated bile salts interfering with micelle formation and the normal flow of bile into the canaliculus. References 1. Dudrick SJ, Rhoads JE: New horizons for intravenous feeding . JAMA 215:939-949, 1971.Crossref 2. Filler RM, et al: Long-term parenteral nutrition in infants . N Engl J Med 281:589-594, 1969.Crossref 3. Gerda BIM, Babson SG: Peripheral intravenous alimentation of the small premature infant . J Pediatr 79:494-498, 1971.Crossref 4. Heird WC, et al: Intravenous alimentation in pediatric patients . J Pediatr 80:351-372, 1972.Crossref 5. Hays DM, et al: Diagnosis of biliary atresia: Relative accuracy of percutaneous liver biopsy, open liver biopsy and operative cholangiography . J Pediatr 71:598-607, 1967.Crossref 6. DiSant Agnese PA, Blanc WA: A distinctive type of biliary cirrhosis of the liver associated with cystic fibrosis of the pancreas . Pediatrics 18:387-409, 1956. 7. Ladd WE: Congenital obstruction of bile ducts . Ann Surg 102:742-751, 1935.Crossref 8. Johnson J, Albritton WL, Sunshine P: Hyperammoniemia complicating parenteral nutrition in infants. Read before the 41st Annual Meeting of the American Pediatric Society, Atlantic City, NJ, 1971. 9. Asch MJ, Shaw KNE, Hays DM: Evaluation of different nitrogen sources in high calorie parenteral alimentation therapy. Read before the Twentieth Annual Meeting of the Section on Surgery of The American Academy of Pediatrics, Chicago, 1971. 10. Ghadimi H, et al: Biochemical aspects of intravenous alimentation . Pediatrics 48:955-965, 1971. 11. Popper H: Cholestasis . Annu Rev Med 19:39-56, 1968.Crossref 12. Soper RT, in discussion, Asch MJ, Huxtable RF, Hays DM: High calorie parenteral therapy in infants and children . Arch Surg 104:434-437, 1972.Crossref 13. Peden VH, Witzleben CL, Skelton MA: Total parenteral nutrition . J Pediatr 78:180, 1971.Crossref 14. Johnson JD, Albritton WL, Sunshine P: Hyperammoniemia accompanying parenteral nutrition in newborn infants . J Pediatr 81:154-161, 1972.Crossref 15. O'dell GB: "Physiologic" hyperbilirubinemia in the neonatal period . N Engl J Med 177:193-194, 1970.

Journal

Archives of Surgery – American Medical Association

Published: Jan 1, 1973

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