Considerations of elderly factors to manage the complication of liver cirrhosis in elderly patients

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

Change	Risk
Decreased cardiac function	Use of endoscopic therapy
	Use of beta-blockers
	Increase in blood pressure caused by molecular targeted agent
Decreased renal function	Use of contrast medium
	Use of interventional radiology for hepatocellular carcinoma
	Rapid change in circulation dynamics
Decreased respiratory function	Aspiration pneumonia
Ease of electrolyte abnormalities	Higher risk of using diuretics
Dementia	Difficulty in differentiating hepatic encephalopathy from dementia and cerebrovascular diseases
Aging of gut microbiota	Hepatic encephalopathy
Loss of bone density	Osteoporosis
	Risk of fall-related injury
Loss of muscle volume	Sarcopenia
	Risk of fall-related injury
Dry skin	Pruritus
	Hand–foot syndrome caused by molecular targeted agent

Table 3 The complications and management of liver cirrhosis in elderly patients need careful considerations

Complications	Management (general)	Considerations should be given in elderly patients
Ascites	Sodium restrictions	Electrolyte abnormalities
	Anti-mineral corticoid	Changes in circulation dynamics
	Furosemide	Body weight
	Torasemide	Pulse and blood pressure
	Albumin infusion	Verification of blood biochemistry and urinalysis
Hepatic encephalopathy	Optimization of bowel movement	Diarrhea
	Laxatives	Frequent diarrhea that causes electrolyte abnormalities
	Branched-chain amino acids	Skin troubles from frequent defecation
	Synthetic disaccharide lactulose	Dehydration
	Rifaximin	Cardiac stress and fluctuation of electrolytes
	Intravenous drip infusion of Fischer solution
Gastrointestinal bleeding/varices	Non-selective beta-blockers	Arrhythmia
		Fluctuation of blood pressure
		Cardiac failure
	Endoscopic therapy	Aspiration pneumonia
Sarcopenia	Risk of fall-related injury	Nutritional monitoring (serum markers including the albumin, cholesterol level)
		Muscle volume
		Administration of branched-chain amino acid preparations
Skin symptoms	Skin moisturisers	Likely to have dry skin
	Bile salts	Frequently suffer from wound infections and persistent skin inflammation
	Rifampicin	Nalfurafine hydrochloride
	Anti-histamines
Hepatocellular carcinoma	Use of phase contrast for the diagnosis	Renal function
	Surgical therapy	Cardiac function
	Transarterial chemotherapy	Bone marrow function
	Needle guided local therapy
	Molecular targeted therapies	History of cerebral bleeding,
		Hypertension
		Renal function
Cirrhotic cardiomyopathy		Cardiac function
Spontaneous bacterial peritonitis		Sarcopenia
Hepato-renal syndrome
Acute and chronic kidney injury
Hyponatremia		Further clinical trials and information from retrospective studies are necessary