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IFALD – TPN liver disease — RACP Paediatrics MCQ

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ModerateGIIFALD – TPN liver diseaseRACP Paediatrics

A 2-year-old with short bowel syndrome on long-term TPN develops progressively rising conjugated bilirubin, elevated GGT, and hepatomegaly. What is the most likely complication?

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Correct answer: E — Intestinal failure-associated liver disease

IFALD (intestinal failure-associated liver disease, formerly PNALD) is a major cause of morbidity in children on long-term TPN. Risk factors include prematurity, sepsis, lack of enteral feeding, and soybean-based lipid emulsions. Management includes maximising enteral feeds, using fish oil-based lipid emulsions (SMOFlipid/Omegaven), preventing line sepsis, and multidisciplinary intestinal rehabilitation.

Reference: RCH Melbourne – 2023 – SBS CPG; RACP Paediatric Curriculum – GI