In advanced liver fibrosis where hepatocytes are largely destroyed, AST, ALT, and LD levels are typically:

• A. Elevated
• B. Normal
• C. Decreased
• D. Not detectable

Answer: (B)

With advanced liver fibrosis, most hepatocytes are destroyed and replaced by scar tissue, so there are far fewer liver cells left to release enzymes into the blood when injury occurs. AST and ALT are released mainly from hepatocytes during cell damage, so when the hepatocyte population is greatly reduced, their serum levels tend to stay within the normal range rather than rise dramatically. LD is less specific to the liver and, in the setting of extensive chronic damage, does not show a marked elevation either. In short, severe, chronic loss of liver cells means these enzyme levels are typically normal, despite significant liver disease.