Hepatic diseases in the elderly.

The clinical manifestations of liver disease in the geriatric population reflect both the cumulative effects of longevity on the liver and the generalized senescence of the body's ability to adjust to metabolic, infectious, and immunologic insults. Although liver tests are not significantly affected by age, the presentation of liver diseases such as viral hepatitis may be more subtle in the geriatric population than that of younger patients. Alcoholic liver disease and primary biliary cirrhosis usually are advanced in the elderly. Geriatric patients are at risk for untoward drug side effects because of polypharmacy, alterations in the rate of first pass and phase I metabolism, and decreased capacity of carrier proteins such as albumin.