Introduction

The liver undergoes several age-related changes, but these rarely lead to clinically noticeable changes on their own. However, liver diseases are not rare in the elderly and are becoming more commonly diagnosed. The older liver is more susceptible to drugs and other toxins. The clinical manifestations of liver disorders reflect changes in liver physiology and the elderly person's decreased ability to compensate for various metabolic, infectious, and immunologic insults. Gallstones, gallstone pancreatitis, acute cholangitis, acalculous cholecystitis, retained stones in the common duct, gallbladder fistulas, gallbladder polyps, and jaundice are discussed in Ch. 112. Liver cancer is discussed in Ch. 113.

Symptoms and Signs

In an elderly patient with liver disease, the presentation may be nonspecific and the symptoms and signs ambiguous. Fatigue, malaise, anorexia, and mild weight loss are typical in elderly patients with viral hepatitis, primary biliary cirrhosis, or hepatocellular carcinoma. Hepatic encephalopathy is often initially missed because early symptoms (eg, a disturbance in sleep pattern or mild confusion) may be attributed to dementia.

Prognosis

The complications of end-stage liver disease are the same in elderly and younger patients. However, the prognosis of liver diseases is worse in the elderly because of their diminished capacity to recover from complications and their inability to tolerate the toxic accumulations and other manifestations of liver disease. For example, the complications of cirrhosis and portal hypertension (eg, variceal hemorrhage, ascites, hepatic encephalopathy) portend a dismal clinical outcome in the elderly. An elderly patient may survive a variceal hemorrhage only to die of a myocardial infarction or pneumonia precipitated by the hemorrhage.