Role of parenteral nutrition in preventing malnutrition and decreasing bacterial translocation to liver in obstructive jaundice

Abstract

Surgery in patients with obstructive jaundice is associated with significant infectious complications probably due to impaired immune function and malnutrition. Total parenteral nutrition (TPN) may alleviate malnutrition but may also promote bacterial translocation (BT) from the gut. To elucidate if TPN can prevent malnutrition without promotion of BT in obstructive jaundice, 40 dogs underwent laparotomy for tissue sampling and placement of a central venous line and were allocated into one of four groups: I (PO-control) received dog chow and water ad libitum; II (PO-CBDL) underwent ligation of common bile duct (CBDL) and was fed dog chow; III (TPN-control) received TPN; and IV (TPN-CBDL) underwent CBDL and received TPN. Body weight, blood samples for liver function tests and bacterial culture, and tissues from liver and mesenteric lymph nodes (MLN) for quantitative bacterial culture and for histology were obtained prior to and 2 weeks after the experiment. The incidence of BT to MLN was 40% in the PO-CBDL and TPN-CBDL animals, which was significantly different from the other two groups (0%; p < 0.05). The incidence of BT to liver was 70% (7/10) in the PO-CBDL animals, which was significantly higher than that in groups I, III, and IV (0%, 20%, 20%, respectively) (p < 0.05). The PO-CBDL animals showed a significant decrease in body weight and prealbumin compatible with malnutrition, whereas the TPN-CBDL animals showed a significant increase in alkaline phosphatase and a consistent cholestasis on histology. The data suggest that TPN can prevent jaundice-associated malnutrition and decrease BT to liver but should be administered cautiously because it may precipitate cholestasis.

Síndrome de la respuesta inflamatoria sistémica experimental inducida por Zymosan A, su regulación con Celecoxib®

“…Los diferentes estudios realizados concluyen que, entre otros, los principales estímulos para la activación de la iNOS son: Productos derivados de las bacterias (LPS, Mucho se ha investigado sobre el papel que podría jugar el NO en el fenómeno inflamatorio, otorgándole últimamente un efecto protector, si bien, el balance final de su actividad, los diferentes caminos en los que se encuentra implicado, y los efectos que pudiese ejercer, aún no están completamente dilucidados y conducen a la controversia (69,76,208,209,255,306,343) . Entre los efectos beneficiosos parecen demostrados los siguientes (2,19,23,45,71,75,77,108,167,168,180,224,290,303,309) (Tabla I):…”