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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.


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

Hepatic complications of TPN

● 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)


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


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

Micro description

● Ductopenia is common, more common in patients with low stage fibrosis
● Perivenular fibrosis frequently seen with high-stage portal fibrosis
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

● Usually periportal steatosis, rarely progresses to fibrosis and cirrhosis

Micro images

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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