Liver Disease Secondary to Intestinal Failure

Abstract

IFALD is a common and potentially life-threatening condition for patients with SBS requiring long-term PN. There exists the potential for decreasing its incidence by optimizing the composition and the rate of infusion of parenteral solutions, by advocating a multidisciplinary approach, and by early referral for intestinal-liver transplantation to ensure long-term survival of patients with SBS.

Intestinal transplantation: The anesthesia perspective

“…IFALD is defined as persistent elevation of serum transaminases 1.5 times the upper limit of normal in the presence of short bowel syndrome [6]. Early stage of IFALD is characterized by steatosis or abnormal accumulation of lipids in hepatocytes.…”

“…Intermediate stage shows steatohepatitis or release of reactive oxygen radicals and other proinflammatory mediators causing cellular membrane dysfunction and increased mitochondrial permeability. In advanced IFALD, there are hepatocytes ballooning, bile duct proliferation, and cirrhosis [6].…”

Chyme Reinfusion for Small Bowel Double Enterostomies and Enteroatmospheric Fistulas in Adult Patients: A Systematic Review

“…Patients with intractable high outputs may require periods of nil per mouth, intravenous fluid therapy, medications to slow transit and reduce secretions, and potentially prolonged periods of support with parenteral nutrition (PN) . PN is associated with substantial economic costs as well as potential secondary complications including liver dysfunction, central line–related complications, and metabolic complications such as hyperglycemia . Alternative or an adjunctive approach to the management of these patients is desirable.…”

Nutritional management of a complicated surgical patient by means of fistuloclysis

“…The deranged liver enzymes were thought to be owing to prolonged PN support, as well as ongoing sepsis. 15 His PN regimen included a fish oil-containing lipid emulsion. Lipids were restricted to < 1 g/kg and he was started on cyclic PN over 18 hours.…”

“…His oral intake was encouraged in an attempt to optimise the enteral route, in order to improve his deteriorating liver function tests (Table IV). 15 The patient underwent a fistulogram on day 93 in order to delineate the anatomy of the gastrointestinal tract. The fistulogram showed approximately 60 cm of small bowel distal to the most distal fistula with colon in situ and no distal defects or obstructions.…”