Context: An exosome is a type of extracellular vesicle with a diameter of 30 -100 nm and a density of 1.13 -1.19 g/m. Exosomes exist in almost all body fluids and can be secreted and absorbed by most cells. They deliver information and molecules that participate in intracellular communication, thus contributing to the progression of various diseases, such as liver diseases. Evidence Acquisition: In this study we collected and summarized the most important and new data available on the role of exosome in liver diseases by the PubMed search. The study data were collected through searching the related keywords then classified and summarized. Results: In this review, we summarize the research findings regarding the roles of exosomes in liver physiology and pathology, mainly focusing on liver diseases such as viral hepatitis, liver cancer (mostly hepatocellular carcinoma [HCC]), and liver injury caused by other pathogenic factors (alcohol, drugs, hepatotoxins, high-fat diets, parasites, etc.). Conclusions: These studies revealed the involvement of exosomes in various aspects of liver physiology and pathology and in the progress of liver diseases. More importantly, it offers a promising new direction for disease diagnosis and treatment.