Critically ill patients usually manifest evidence of hepatobiliary disease. The liver is frequently affected in patients with multiple organ dysfunction syndrome. Liver dysfunction may occur without concomitant abnormalities of liver enzymes. Multiple drugs can affect the liver, and new syndromes related to hepatic drug toxicity have been described. Patients receiving total parenteral nutrition are at risk for developing hepatobiliary disorders. The mechanisms underlying the hepatic toxicity of total parenteral nutrition continue to be explored. Acute acalculous cholecystitis is a serious complication of critically ill patients that may be difficult to recognize. New insights on diagnosis and management of this condition are described.
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