The ageing liver

Ageing decline

Again the liver function declines with age, but for most people it doesn't reach a level where their life is affected. Patients with chronic liver disease are more likely to notice the function becoming irreversibly deficient.

Chronic liver diseases

Patients with 3 of 5 of the following states are said to have "metabolic sydrome": Central obesity, high blood pressure, high blood sugar, high serum triglycerides, and low serum high-density lipoprotein (HDL). These patients often have type 2 diabetes. Although this is not well known to the public, many of these "metabolic syndrome" patients experience a gradual accumulation of fat in the liver, leading to inflammation and eventually scarring (cirrhosis). At the inflammatory stage this is known as NASH: non-alcoholic steatohepatitis.

Chronic excessive alcohol consumption can cause chronic alcoholic steatohepatitis. With time this may lead to irreversible cirrhosis.

Chronic infection with viral hepatitis (e.g. hepatitis C) can similarly cause chronic hepatitis, with subsequent cirrhosis.

In some patients the immune system attacks the kidney and causes chronic inflammation. This is known as auto-immune hepatitis. Again this can lead to cirrhosis in the long-term.

The impact on care

Exogenous drugs (medications) are only safe if the body can remove them at a sufficient rate, and a patient with deranged liver function tests (LFTs) might no longer be suitable to take certain medications. Patients with renal (kidney) impairment are similarly unsuitable for certain treatments. Some patients have both renal AND hepatic insufficiency.