Nutritional Deficiencies

GENERAL PRINCIPLES Any condition that blocks bile excretion (at the level of the liver cell or the biliary ducts) is defined as cholestasis. Laboratory evidence of cholestasis includes elevated ALP and bilirubin.

• Nutritional deficiencies result from fat malabsorption.

• Fat-soluble vitamin deficiency (vitamins A, D, E, and K) is often present in advanced cholestasis and is particularly common in patients with steatorrhea.

DIAGNOSIS

Clinical Presentation

• Characteristic manifestations of vitamin deficiencies are discussed in Chapter 2, Nutrition Support.

• Patients with steatorrhea may give a history of oily, foul-smelling diarrhea that sticks to the toilet bowl or is difficult to flush.

Diagnostic Testing

• 25-Hydroxyvitamin D serum concentrations reflect the total body stores of vitamin D. Vitamin D deficiency in the setting of malabsorption and steatorrhea is a good surrogate clinical marker for total body concentrations of other fat-soluble vitamins.

• Stool can be tested for fecal fat. Both spot tests and 24-hour collections can be done.

TREATMENT

Medications

Vitamin supplements, given orally or parenterally, are given to correct deficiencies.