What is parenteral nutrition-associated cholestasis (PNAC)?

• A. A benign skin condition
• B. A hepatic infection
• C. A condition of impaired secretion of bile or biliary obstruction that may occur in adults receiving long-term PN
• D. A type of pancreatitis

Answer: (C)

Parenteral nutrition-associated cholestasis is a cholestatic liver condition that can develop in adults on long-term parenteral nutrition, reflecting impaired bile formation or bile flow and, in some cases, biliary obstruction. When enteral feeding is minimal or absent, the lack of gastrointestinal hormonal stimulation (like cholecystokinin) leads to gallbladder stasis and reduced bile excretion, allowing bile to accumulate in the liver and ducts and causing conjugated hyperbilirubinemia. This is a hepatic biliary problem linked to PN, not a skin condition, an infection, or pancreatitis.