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Liver and intrahepatic bile ducts-nontumor

Hepatitis - noninfectious

Total parenteral nutrition (TPN) related liver disease


Reviewers: Komal Arora, M.D. (see Reviewers page)
Revised: 5 May 2012, last major update May 2012
Copyright: (c) 2004-2012, PathologyOutlines.com, Inc.

General
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● TPN provides support for prematurity, malabsorption, loss of bowel, severe inflammatory bowel disease, necrotizing enterocolitis, congenital gastrointestinal disorders

Hepatic complications of TPN
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● Steatosis and steatohepatitis, usually in adults
● Cholestasis, more common in infants, but also common at all age groups
● Biliary sludge and cholelithiasis in infants and adults
● Liver damage and clinical outcome are more related to underlying disease than to details of TPN
● Infants are more susceptible to TPN-related hepatocellular injury, are more likely to develop fibrosis, and progress to high-stage fibrosis more rapidly than older children and adults (Hum Pathol 2011 Nov 9 [Epub ahead of print], Pediatr Dev Pathol 2004;7:425)

Laboratory
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● Infants have elevated serum alkaline phosphatase, serum bilirubin, ALT, AST

Treatment
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● Begin oral intake (even minimal) as soon as possible, monitor liver function tests, provide balanced TPN, donít overfeed

Micro description
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● Ductopenia is common, more common in patients with low stage fibrosis
● Perivenular fibrosis frequently seen with high-stage portal fibrosis
Infants:
Early - steatosis, canalicular and centroacinar cholestasis, macrophage aggregates
Later (3 months) - portal fibrosis
4 months - variable changes of triaditis, macrophages with lipofuscin, portal fibrosis, marked portal ductular proliferation, micronodular cirrhosis

Adults:
● Usually periportal steatosis, rarely progresses to fibrosis and cirrhosis

Micro images
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Periportal steatosis


Severe cholestasis with bridging fibrosis


Enlarged fibrotic portal tracts with ductular proliferation and mixed inflammation

End of Liver and intrahepatic bile ducts-nontumor > Hepatitis - noninfectious > Total parenteral nutrition (TPN) related liver disease


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