David G. Le Couteur, MD, PhD, Professor of Geriatric Medicine, Centre for Education and Research on Ageing and ANZAC Research Institute, University of Sydney and Concord RG Hospital, Sydney, Australia.
Arthur Everitt, PhD, Associate Professor, Centre for Education and Research on Ageing, and Department of Physiology, University of Sydney, Sydney, Australia.
Michel Lebel, PhD, Associate Professor, Centre de Recherche en Cancérologie de l’Université Laval, Hôpital Hôtel-Dieu de Québec, Québec, PQ.

The liver undergoes substantial changes in structure and function in old age. There are age-related changes in liver mass, blood flow, and hepatocyte and sinusoidal cell morphology. These changes are associated with a significant impairment of many hepatic metabolic and detoxification activities, with implications for systemic aging and age-related disease. For example, the age-related impairment of the hepatic metabolism of lipoproteins predisposes to cardiovascular disease. The age-related decline in the hepatic clearance of most medications causes an increased risk of adverse drug reactions. Many of the beneficial effects of caloric restriction and caloric restriction mimetics such as resveratrol are mediated by their effects on the liver. Increasingly, the liver is seen as having a key role in aging.
Key words: liver, aging, hepatocyte, liver sinusoid, drug metabolism.

David Stell, PhD, FRCS(Gen) and William J. Wall, MD, FRCS(C), Department of Surgery and Multi-Organ Transplant Program, London Health Sciences Centre, London, ON.

The process of aging does not produce changes in the liver that can be described as pathological. The major age-related alterations are a reduction in liver mass and a reduction in total blood flow, neither of which interferes with the liver's normal homeostatic functions. In spite of the liver's resilience, however, the aged liver is more vulnerable to injury from toxins, viruses and ischemia, and its capacity to regenerate is slowed. There also is a decline in liver enzymes with aging that affects metabolic clearance of drugs, a finding that has implications for drug dosing in the elderly.
Key words: liver, aging, function, metabolism, injury.

Dr. Faisal M. Sanai, MD, ABIM, Hepatology Fellow, London Health Sciences Centre, University of Western Ontario, London, ON.
Dr. Cameron N. Ghent, MD, FRCP(C), Consultant Hepatologist, Adjunct Professor, University of Western Ontario, London Health Sciences Centre, London, ON.

Cirrhosis of the liver is highlighted essentially by its portal hypertensive complications. The incidence of these complications in elderly cirrhotic individuals has been rising due to better management of this disease in the younger population. Moreover, improved diagnostic techniques have further contributed to this rising incidence. Early recognition of the cirrhotic complications coupled with aggressive intervention has led to reductions in mortality. Special consideration is given to elderly patients in view of the higher incidence of comorbidity and the variability in disease presentation. We present here a review of cirrhosis and its sequelae in this distinct population group with emphasis on recent trends towards diagnosis and management.
Key words: cirrhosis, portal hypertension, ascites, liver.