Disorders of the Hepato-Biliary System in the Elderly

  • Nages Nagaratnam
  • Kujan Nagaratnam
  • Gary Cheuk


Several physiological, functional and structural changes occur in ageing. Liver volume decreases with age so does the blood flow. Pseudocapillarisation occurs in the liver sinusoidal endothelial cells resulting in thickening and reduction in the number of fenestrations which has a significant impact on the hepatic lipoprotein metabolism. There is an age-related reduction in blood flow and liver mass resulting in impaired drug metabolism which may be reduced by 40–50 % in old age. The liver function in the elderly is well maintained even though the livers of the elderly are characterised by reduced capacity and adaptive responsiveness. When challenged, however, it may not be able to increase significantly beyond the baseline.

The following diseases are discussed: viral hepatitis and chronic liver disease which includes alcohol liver disease (ALD), non-alcoholic fatty liver disease (NAFLD), autoimmune hepatitis(AIH), drug-induced hepatitis(DILI), primary biliary cirrhosis (PBC) and hereditary haemochromatosis (HH). The exact pathogenesis of alcoholic liver disease is complex and implicates alcoholic metabolism and secondary mechanisms. A genetic susceptibility as predisposing factor for ALD has emerged. Older age, obesity, diabetes, hypertension, high triglycerides and/or insulin resistance is associated with more advanced stages of NAFLD. One reason for the low rate of diagnosis in the elderly is because AIH was incorrectly considered to be a disease of young age. Genetic polymorphisms of drug-metabolising enzymes such as P450 together with age and gender are risk factors for DILI. In PBC clinical observations support a combination of genetic susceptibility and environmental triggers such as infection, chemicals and smoking to have a causative role.


Hepato-biliary system Age-related changes Pathophysiology Chronic liver disease Autoimmune hepatitis Non-alcoholic fatty liver disease Hereditary haemochromatosis 


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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Nages Nagaratnam
    • 1
  • Kujan Nagaratnam
    • 2
  • Gary Cheuk
    • 3
  1. 1.Sydney Medical School (Westmead)The University of SydneyNorth RocksAustralia
  2. 2.Norwest Specialist Medical GroupBella VistaAustralia
  3. 3.Blacktown-Mt Druitt HospitalBlacktownAustralia

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