Fish Oil for Patients With Liver Disease Due to Parenteral Nutrition

Inclusion Criteria: * Clinically stable patients on home TPN with PNALD with persistently elevated bilirubin (\>1.5 times \> normal) for at least 3 months despite standard treatment with ursodeoxycholic acid (15-30 mg/kg or at least 500 mg/d orally), changes in TPN (reduction to 25 kcal/kg/TPN day with Intralipid 0.25 g/kg) , and antibiotics (Metronidazole 500 mg bid and Ciprofloxacin 500 mg bid) * male or female,equal or over 18 years of age * on stable TPN regimen equal or over 3 days/week * on a stable drug regimen for equal or over 3 months prior to randomization, which will not changed for the study duration if these drugs are ursodeoxycholic acid given for PNALD or others affecting glucose and lipid metabolism Exclusion Criteria: * Not receiving lipid emulsion as part of TPN * Allergy to fish, egg , soy, and peanuts * Liver disease of other etiology (e.g. excessive alcohol intake \>20g/d, viral hepatitis, auto-immune or drug-induced, hemochromatosis, alfa 1-antitrypsin deficiency, Wilson's disease) * Complications of chronic liver disease, such as recurrent variceal bleeding, ascites, encephalopathy or any other reason contraindicating a liver biopsy * Severe hemorrhagic disorders * Sepsis - Inflammatory processes * Taking medications that precipitate steatohepatitis (e.g. corticosteroids, methotrexate, or amiodarone) * Pregnancy, lactation * Fluid restriction - Omegaven is more dilute than Intralipid.