In cirrhosis, which laboratory pattern is typical?

• A. Ammonia high and TPAG low
• B. Ammonia low and TPAG high
• C. Enzymes elevated with normal TPAG
• D. TPAG high and ammonia high

Answer: (A)

In cirrhosis, the liver’s ability to detoxify waste and to synthesize proteins is compromised. Ammonia, a byproduct of gut bacteria metabolism, is normally cleared by the liver and converted to urea. When liver function is damaged and portal hypertension causes shunting, ammonia buildup in the blood occurs, often contributing to hepatic encephalopathy. At the same time, the liver’s capacity to synthesize proteins drops, so total plasma proteins (including albumin) fall. This combination—high ammonia due to impaired detoxification and low TPAG due to reduced hepatic protein synthesis—is a typical pattern in cirrhosis. Other patterns are less characteristic because they either imply preserved synthetic function, or reflect different liver conditions.