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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