Approximately one-third of patients with inflammatory bowel disease (IBD) are estimated to develop signs of liver injury over the course of their disease. These abnormalities may be mild and transient, or they may reflect clinically significant liver disease or complications related to IBD therapy. In addition to the most prevalent liver diseases, consideration should also be given to IBD-related causes, including immune-mediated liver diseases and drug-induced liver injury. The pathogenesis of liver diseases associated with IBD is multifactorial and involves chronic inflammation, shared autoimmune mechanisms, and the effects of therapy, including its impact on metabolic disturbances. In routine clinical practice, it is essential to distinguish conditions that require further investigation and to implement appropriate management. The aim of this review is to provide a practical overview of liver involvement in patients with IBD, focusing on the hepatotoxicity of medications used in contemporary IBD therapy.