Abstract
Recent studies indicate that long-term total parenteral nutrition (TPN) induces gallstone formation and acalculous cholecystitis in humans. Cholecystectomy is hazardous for these patients because they frequently have multiple medical problems and have undergone numerous abdominal operations. The present study was designed to develop a method to prevent TPN-induced gallbladder disease. The authors tested the hypothesis that a single daily intravenous infusion of cholecystokinin-octapeptide (CCK-OP) will prevent TPN-induced gallbladder stasis. Eleven prairie dogs received TPN for 10 days. Six of these animals were given a daily infusion of CCK-OP. Control animals were fed ad lib. Each animal's bile salt pool was labeled with intravenous 3H-cholic acid 16 hours prior to acute terminal experiments. The ratio of gallbladder to hepatic bile 3H-cholic acid specific activity (Rsa) provides an index of gallbladder stasis. A Rsa of less than 1.0 indicates gallbladder stasis. TPN animals had a Rsa of 0.54 +/- 0.13 (p less than 0.01 vs. controls), indicating stasis of bile in the gallbladder. Daily CCK-OP infusions resulted in a Rsa of 0.92 +/- 0.10 (p less than 0.05 vs. TPN without CCK-OP), indicating that TPN-induced gallbladder stasis is prevented by daily CCK-OP. Control animals had a Rsa of 1.03 +/- 0.06. The cholesterol saturation indices of gallbladder and hepatic bile were not increased by TPN or CCK-OP. These data indicate that 1) TPN induces gallbladder stasis but does not increase bile lithogenic index; and 2) daily injections of CCK-OP prevent TPN-induced gallbladder stasis.
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- Allen B., Bernhoft R., Blanckaert N., Svanvik J., Filly R., Gooding G., Way L. Sludge is calcium bilirubinate associated with bile stasis. Am J Surg. 1981 Jan;141(1):51–56. doi: 10.1016/0002-9610(81)90011-8. [DOI] [PubMed] [Google Scholar]
- Anderson D. L. Acalculous cholecystitis--a possible complication of parenteral hyperalimentation: report of a case. Med Ann Dist Columbia. 1972 Jul;41(7):448–450. [PubMed] [Google Scholar]
- Barth R. A., Brasch R. C., Filly R. A. Abdominal pseudotumor in childhood: distended gallbladder with parenteral hyperalimentation. AJR Am J Roentgenol. 1981 Feb;136(2):341–343. doi: 10.2214/ajr.136.2.341. [DOI] [PubMed] [Google Scholar]
- Bickerstaff K. I., Moossa A. R. Effects of resection or bypass of the distal ileum on the lithogenicity of bile. Am J Surg. 1983 Jan;145(1):34–40. doi: 10.1016/0002-9610(83)90163-0. [DOI] [PubMed] [Google Scholar]
- Carey M. C. Critical tables for calculating the cholesterol saturation of native bile. J Lipid Res. 1978 Nov;19(8):945–955. [PubMed] [Google Scholar]
- Doty J. E., DenBesten L., Roslyn J. J., Pitt H. A., Kuchenbecker S. L., Porter-Fink V. Interaction of chenodeoxycholic acid and dietary cholesterol in the treatment of cholesterol gallstones. Am J Surg. 1982 Jan;143(1):48–54. doi: 10.1016/0002-9610(82)90128-3. [DOI] [PubMed] [Google Scholar]
- Doty J. E., Pitt H. A., Porter-Fink V., DenBesten L. The effect of intravenous fat and total parenteral nutrition on biliary physiology. JPEN J Parenter Enteral Nutr. 1984 May-Jun;8(3):263–268. doi: 10.1177/0148607184008003263. [DOI] [PubMed] [Google Scholar]
- Hutton S. W., Sievert C. E., Jr, Vennes J. A., Duane W. C. Inhibition of gallstone formation by sphincterotomy in the prairie dog: reversal by atropine. Gastroenterology. 1982 Jun;82(6):1308–1313. [PubMed] [Google Scholar]
- Messing B., Bories C., Kunstlinger F., Bernier J. J. Does total parenteral nutrition induce gallbladder sludge formation and lithiasis? Gastroenterology. 1983 May;84(5 Pt 1):1012–1019. [PubMed] [Google Scholar]
- Meyer P. D., Den Besten L., Gurll N. J. Effects of cholesterol gallstone induction on gallbladder function and bile salt pool size in the prairie dog model. Surgery. 1978 May;83(5):599–604. [PubMed] [Google Scholar]
- Petersen S. R., Sheldon G. F. Acute acalculous cholecystitis: a complication of hyperalimentation. Am J Surg. 1979 Dec;138(6):814–817. doi: 10.1016/0002-9610(79)90302-7. [DOI] [PubMed] [Google Scholar]
- Pitt H. A., King W., 3rd, Mann L. L., Roslyn J. J., Berquist W. E., Ament M. E., DenBesten L. Increased risk of cholelithiasis with prolonged total parenteral nutrition. Am J Surg. 1983 Jan;145(1):106–112. doi: 10.1016/0002-9610(83)90175-7. [DOI] [PubMed] [Google Scholar]
- Pitt H. A., Lewinski M. A., Muller E. L., Porter-Fink V., DenBesten L. Ileal resection-induced gallstones: altered bilirubin or cholesterol metabolism? Surgery. 1984 Aug;96(2):154–162. [PubMed] [Google Scholar]
- Roslyn J. J., Berquist W. E., Pitt H. A., Mann L. L., Kangarloo H., DenBesten L., Ament M. E. Increased risk of gallstones in children receiving total parenteral nutrition. Pediatrics. 1983 May;71(5):784–789. [PubMed] [Google Scholar]
- Roslyn J. J., DenBesten L., Pitt H. A., Kuchenbecker S., Polarek J. W. Resident research award. Effects of cholecystokinin on gallbladder stasis and cholesterol gallstone formation. J Surg Res. 1981 Mar;30(3):200–204. doi: 10.1016/0022-4804(81)90148-7. [DOI] [PubMed] [Google Scholar]
- Roslyn J. J., Pitt H. A., Mann L. L., Ament M. E., DenBesten L. Gallbladder disease in patients on long-term parenteral nutrition. Gastroenterology. 1983 Jan;84(1):148–154. [PubMed] [Google Scholar]
- Roslyn J. J., Pitt H. A., Mann L., Fonkalsrud E. W., DenBesten L. Parenteral nutrition-induced gallbladder disease: a reason for early cholecystectomy. Am J Surg. 1984 Jul;148(1):58–63. doi: 10.1016/0002-9610(84)90289-7. [DOI] [PubMed] [Google Scholar]
- Roslyn J., DenBesten L., Thompson J. E., Jr Effects of periodic emptying of gallbladder on gallbladder function and formation of cholesterol gallstone. Surg Forum. 1979;30:403–404. [PubMed] [Google Scholar]
- Shuman W. P., Gibbs P., Rudd T. G., Mack L. A. PIPIDA scintigraphy for cholecystitis: false positives in alcoholism and total parenteral nutrition. AJR Am J Roentgenol. 1982 Jan;138(1):1–5. doi: 10.2214/ajr.138.1.1. [DOI] [PubMed] [Google Scholar]
- Whitington P. F., Black D. D. Cholelithiasis in premature infants treated with parenteral nutrition and furosemide. J Pediatr. 1980 Oct;97(4):647–649. doi: 10.1016/s0022-3476(80)80033-3. [DOI] [PubMed] [Google Scholar]