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Inicio Gastroenterología y Hepatología Aumento de la litogenicidad biliar tras la administración conjunta de nutrició...
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Vol. 24. Núm. 7.
Páginas 321-326 (enero 2001)
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Vol. 24. Núm. 7.
Páginas 321-326 (enero 2001)
Acceso a texto completo
Aumento de la litogenicidad biliar tras la administración conjunta de nutrición parenteral total y octreótida. Un modelo de formación de cálculos de palmitato cálcico
Increased bile lithogenicity after simultaneous total parenteral nutrition and octreotide. a model of calcium palmitate gallstones
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J.M. Rodríguez Santiagoa, E.M. Targaronab,
Autor para correspondencia
13882ets@comb.es

Correspondencia: Dr. E.M. Targarona. Servicio de Cirugía General. Hospital de la Santa Creu i Sant Pau. Avda. Pare Claret, 167. 08025 Barcelona
, E. Rosc, J. Martínezc, E. Pocac, M. Velac, J. Massód, A. Nadale, C. Marcoa, M. Triasb
a Servicio de Cirugía General. Hospital Mutua de Terrassa. Universidad de Barcelona
b Servicio de Cirugía General. Hospital de la Santa Creu i Sant Pau
c Institut de Malalties Digestives. Institut d'Investigacions Biomèdiques August Pi-Sunyer (IDIBAPS). Hospital Clínic. Universidad de Barcelona
d Servicio de Farmacología Clínica. Hospital Clínic. Universidad de Barcelona
e Laboratorio de Patología. Hospital Casa de Maternitat. Hospital Clínic. Universidad de Barcelona
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Resumen

La estasis vesicular y la formación de cálculos son alteraciones conocidas tras la administración prolongada de la nutrición parenteral y del tratamiento con octreótida. La administración conjunta de ambos tratamientos, por ejemplo en las fístulas intestinales, puede potenciar estos efectos nocivos de ambos fármacos en la función hepatobiliar. En este estudio se ha valorado el riesgo en la formación de litiasis vesicular y alteraciones hepáticas durante el tratamiento con nutrición parenteral total y octreótida por separado y de forma conjunta. Para ello se estudiaron 32 conejos New Zealand distribuidos en 4 grupos durante un período de 2 semanas: 14 controles, seis alimentados con nutrición parenteral total, seis con dieta oral y administración de octreótida y otros seis a los que se administró nutrición parenteral total y octreótida. Al finalizar las 2 semanas se canuló el conducto hepático, se realizó la colecistectomía y una cuña de tejido hepático para su estudio histológico. Se determinó el volumen vesicular y en la bilis hepática y vesicular se valoraron los lípidos biliares, la bilirrubina, el calcio y las proteínas totales, y se llevó a cabo el examen microscópico de la bilis. Se analizó la composición química de los cálculos. Los resultados sugieren que, en nuestro modelo experimental, la administración de nutrición parenteral y octreótida de forma conjunta presenta un efecto aditivo en la estasis vesicular y en la litogénesis biliar. La administración de estas 2 terapias puede ser un modelo de la formación de cálculos de palmitato cálcico en estos animales.

Gallbladder stasis and gallstone formation are well-known complications of both fasting-associated total parenteral nutrition (TPN) and long-term treatment with octreotide. Additive noxious effects to hepatobiliary function may develop when both therapies are given together as treatment of enteric fistulae. The aim of this study was to assess the risk of gallstone formation during treatment with TPN and octreotide separately and in combination. We studied four groups of New Zealand rabbits (n = 32) during a 2-week intervention period: 14 chow-fed controls; 6 fasted and TPN-fed; 6 chow-fed and administered octreotide, and 6 fasted and treated with both TPN and octreotide. After treatment, the bile duct was cannulated and the gallbladder and liver tissue were obtained for histological analysis. Hepatic and gallbladder bile were retrieved for microscopic examination and measurement of biliary lipids, bilirubin, calcium, total protein, and cholesterol nucleation time. The chemical composition of gallstones was also analyzed. The results of the study suggest that simultaneous administration of these two therapies in rabbits has additive effects on gallbladder stasis and bile lithogenicity. The administration of both treatments can play an important role in the formation of calcium palmitate gallstones in these animals.

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Copyright © 2001. Elsevier España, S.L.. Todos los derechos reservados
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