Copyright ©The Author(s) 2019.
World J Gastroenterol. Apr 21, 2019; 25(15): 1817-1827
Published online Apr 21, 2019. doi: 10.3748/wjg.v25.i15.1817
Table 1 Morphological and functional aging of the liver
Reduced liver weight
Reduced blood flow to the liver
Loss of metabolic function
Loss of detoxification
Decreased growth factor expression
Table 2 Conditions to consider when determining therapeutic options
Decreased cardiac functionUse of endoscopic therapy
Use of beta-blockers
Increase in blood pressure caused by molecular targeted agent
Decreased renal functionUse of contrast medium
Use of interventional radiology for hepatocellular carcinoma
Rapid change in circulation dynamics
Decreased respiratory functionAspiration pneumonia
Ease of electrolyte abnormalitiesHigher risk of using diuretics
DementiaDifficulty in differentiating hepatic encephalopathy from dementia and cerebrovascular diseases
Aging of gut microbiotaHepatic encephalopathy
Loss of bone densityOsteoporosis
Risk of fall-related injury
Loss of muscle volumeSarcopenia
Risk of fall-related injury
Dry skinPruritus
Hand–foot syndrome caused by molecular targeted agent
Table 3 The complications and management of liver cirrhosis in elderly patients need careful considerations
ComplicationsManagement (general)Considerations should be given in elderly patients
AscitesSodium restrictionsElectrolyte abnormalities
Anti-mineral corticoidChanges in circulation dynamics
FurosemideBody weight
TorasemidePulse and blood pressure
Albumin infusionVerification of blood biochemistry and urinalysis
Hepatic encephalopathyOptimization of bowel movementDiarrhea
LaxativesFrequent diarrhea that causes electrolyte abnormalities
Branched-chain amino acidsSkin troubles from frequent defecation
Synthetic disaccharide lactuloseDehydration
RifaximinCardiac stress and fluctuation of electrolytes
Intravenous drip infusion of Fischer solution
Gastrointestinal bleeding/varicesNon-selective beta-blockersArrhythmia
Fluctuation of blood pressure
Cardiac failure
Endoscopic therapyAspiration pneumonia
SarcopeniaRisk of fall-related injuryNutritional monitoring (serum markers including the albumin, cholesterol level)
Muscle volume
Administration of branched-chain amino acid preparations
Skin symptomsSkin moisturisersLikely to have dry skin
Bile saltsFrequently suffer from wound infections and persistent skin inflammation
RifampicinNalfurafine hydrochloride
Hepatocellular carcinomaUse of phase contrast for the diagnosisRenal function
Surgical therapyCardiac function
Transarterial chemotherapyBone marrow function
Needle guided local therapy
Molecular targeted therapiesHistory of cerebral bleeding,
Renal function
Cirrhotic cardiomyopathyCardiac function
Spontaneous bacterial peritonitisSarcopenia
Hepato-renal syndrome
Acute and chronic kidney injury
HyponatremiaFurther clinical trials and information from retrospective studies are necessary