The liver may be involved in systemic diseases that primarily affect other organs. In most cases, the systemic disease should be treated effectively first. Circulatory disturbances can cause liver dysfunction by ischaemia (due to arterial hypoperfusion) and hepatic venous congestion. The liver is a key organ in sepsis, both as source of inflammatory mediators and as a victim of the inflammatory response. An oncological process may affect hepatic function in a number of ways. For example, tumours in and around the liver can affect function by directly reducing the volume of healthy, functioning tissue or by causing biliary obstruction, and portal venous infiltration or hypercoagulability may compromise the liver’s vascular supply. This chapter discusses the liver in systemic disease, including sections on etiology, symptoms, demographics, complications, diagnosis, and treatment.