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Learning Objectives
Learn aging-associated changes in hepatic function, epidemiology, genetics, pathogenesis, and pathology of common hepatic diseases in older adults.
Understand the prevalence, common clinical presentations, diagnosis, and treatment of hepatotropic viruses, autoimmune liver diseases, chronic fatty liver diseases, and drug-induced injury in older patients.
Appreciate the challenges older persons encounter when living with chronic liver disease, including consideration of liver transplantation in older adults.
Learn the epidemiology, genetics, etiology, and pathogenesis of common biliary and pancreatic diseases in older adults.
Understand the common and atypical manifestations, and tests to diagnose common gallbladder and pancreatic diseases in older patients.
Learn state-of-the-art and emerging treatments for biliary and pancreatic disorders in older population.
Acquire knowledge about the symptoms, diagnosis, and treatment of gallbladder and pancreatic cancers in older adults.
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Key Clinical Points
Older adults are more prone to hepatic injury due to aging-associated changes, including a reduction in regenerative capacity, functional hepatocyte volume, and hepatic blood flow.
Patients with metabolic syndrome are at high risk for developing nonalcoholic fatty liver disease (NAFLD).
Drug-induced liver injury occurs more frequently in older patients and tends to be more severe.
Chronic fatty liver diseases, alcohol-related and non-alcohol-related, are the two most common causes of end-stage liver disease in older patients in the developed world. The advent of direct-acting antiviral agents for the treatment of hepatitis C virus (HCV) has changed the landscape of chronic liver disease.
Age is a major risk factor for gallstones, which are more common among older adults, especially women.
Acute cholecystitis may present atypically in older patients without fever, nausea, vomiting, or severe abdominal pain.
Ultrasound is the initial diagnostic test of choice, and incidental discovery of gallstones is not an indication for treatment. When appropriate, early laparoscopic cholecystectomy is the treatment of choice in older patients.
In the absence of gallstones and alcohol use disorder, the most common cause of acute pancreatitis in older adults is malignancy.
Alcohol use disorder is the most common cause of chronic pancreatitis in older patients.
The significance of alcohol use disorder in patients presenting with alcohol-related liver or pancreatic disease is frequently not recognized, and the opportunity to intervene with treatment of alcohol use disorder is missed.
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The liver and pancreas are remarkable in their ability to preserve function despite advanced age. Older patients are at an increased risk of more severe hepatic injury when exposed to hepatic insults. This increased risk is likely related to the liver’s age-related decrease in regenerative capacity. The aging pancreas can alter its morphology and function, but often times this can be asymptomatic in the older individual. Throughout this chapter we will review the hepatobiliary and pancreatic changes that are known to occur with aging and their pathologic consequences of disease in older patients.
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As will be discussed multiple times in this chapter, most of the therapies available for younger patients are ...