Which laboratory pattern is most consistent with liver dysfunction?

• A. Elevated albumin with low ammonia and normal INR
• B. Low albumin, high ammonia, elevated INR/PT, increased bilirubin, low platelets
• C. High AST and ALT with normal bilirubin
• D. Normal liver tests with no abnormalities

Answer: (B)

Liver dysfunction disrupts synthesis, detoxification, and bile processing. Albumin is produced by the liver, so low albumin reflects impaired synthetic function. The INR is prolonged because clotting factors are made in the liver, so an elevated INR indicates impaired coagulation. Ammonia is normally converted to urea in the liver, so high ammonia shows poor detoxification. Bilirubin clearance and conjugation also occur in the liver; increased bilirubin points to impaired excretion/processing. Platelets can drop in liver disease due to portal hypertension causing splenic sequestration. The pattern with low albumin, high ammonia, elevated INR, increased bilirubin, and low platelets best demonstrates widespread liver dysfunction affecting synthesis, detoxification, and excretion.