Parenteral nutrition is considered as a life-saving therapy in patients with intestinal failure. It has been observed that liver disease is one of the leading causes of morbidity and mortality in patients receiving long-term total parenteral nutrition (TPN). The patient is characterized by steatosis initially, which can evolve to steatohepatitis, which will progress to cholestasis of varying severity. Studies showed multifactorial etiology of parenteral nutrition related liver disease. 

Evidence suggested that provision of excess calories in the TPN solution, along with lipids administered >1 g/kg appear to increase the risk of parenteral nutrition related liver disease. Other factors including nutrient deficiencies and nutrient toxicities are also implicated in the pathogenesis of liver disease, along with sepsis and the lack of enteral stimulation. 

The non-pharmacological therapy for TPN-related liver disease consists of enteral stimulation, appropriate composition of TPN, and prevention of excess carbohydrate and lipid calories. While, pharmacological management approaches includes ursodeoxycholic acid and antibiotic therapy that reduce the risk of bacterial translocation and sepsis. Early referral for transplantation should be done in patients with evidence of portal hypertension. 

Source: Raman M, Allard JP. Parenteral nutrition related hepato-biliary disease in adults. Appl ]Physiol Nutr Metab. 2007 Aug;32(4):646-54. doi: 10.1139/H07-056. PMID: 17622278.