Inducing positive nitrogen balance and weight gain in patients fed exclusively parenterally was documented first by Dudrick et al. in 1968. Since that time, total parenteral nutrition (TPN) has become commonplace both in acutely ill patients and in those with severe chronic gastrointestinal disease. Clear nutritional benefits accrue, but certain complications associated with TPN have become apparent. In the following discussion we review clinical, biochemical, and pathophysiologic abnormalities of the hepatobiliary system associated with TPN, particularly hepatic dysfunction and gallbladder disease and their management.