Q: Enteral feeding is always preferred over parenteral feeding (TPN) in ICUs - as enteral feeding also prevents a very dangerous ICU entity - acalculous cholycystitis. What is the mechanism?

Answer: There are 2 synergistic components to this pathophysiology.

1. Bile Stasis: Absence of oral/enteral feeding results in a decrease or absence of cholecystokinin-induced gallbladder contraction.

2. Increase Bile Viscosity: Increased bile viscosity due to fever and dehydration causes acalculous cholycystitis.