Two significant metabolic diseases of the liver are Wilson disease (WD) and α1-antitrypsin deficiency (AATD). WD is defined as an autosomal recessive disorder caused by mutations in the ATP7B gene of copper metabolism, leading to copper accumulation in multiple organs, notably the liver and brain, with ensuing injury giving way to hepatic and neuropsychiatric symptoms. AATD is also a genetic disorder but is distinguished by the production of a defective protease inhibitor, which leads to hepatic and pulmonary injury. This review of WD and AATD addresses their respective epidemiologies, genetics, pathophysiologies, diagnoses, differential diagnoses, managements, complications, and prognoses. Figures show the pathophysiology, clinical presentation, and liver histology of WD; suggested approaches to the diagnosis of WD, suspected WD, and family screening of first-degree relatives of WD patients; monitoring therapy in WD disease; schematic representation of the α1-antitrypsin (AAT) mechanism of action and polymerization of the Z mutation variant; pathophysiology and clinical presentation of AATD; periodic acid–Schiff–positive diastase-resistant globules in AATD; and suggested approach to AAT diagnosis and management. Tables list the causes of low ceruloplasmin, medications used in WD, and AAT variants and risk of disease. This review contains 12 highly rendered figures, 3 tables, and 167 references.