A person who is receiving total parenteral nutrition (TPN) is at risk for a disorder of the gallbladder. A person at high risk may benefit from more aggressive management to target risk factors.


Types of gallbladder dysfunction:

(1) acalculous cholecystitis

(2) cholecystitis associated with sludge and/or cholelithiasis

(3) decreased emptying with distention


Risk factors:

(1) ileal disease and/or ileal resection

(2) short bowel syndrome

(3) duration of TPN > 3 weeks

(4) no oral intake

(5) prolonged fast

(6) pre-existing gallbladder disease

(7) administration of narcotics or anticholinergic drugs


Risk reduction:

(1) providing some oral intake

(2) administration of cholecystokinin (CCK) under selected circumstances

(3) avoidance of narcotics and anticholinergic agents


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