In hepatocellular injury or cholestasis, which measures may be affected?

• A. Bilirubin and albumin
• B. Platelets and fibrinogen
• C. Amylase and lipase
• D. Insulin and glucagon

Answer: (A)

Hepatic injury and cholestasis mainly affect two aspects of liver function: excretion of waste (bilirubin) and synthesis of blood proteins (albumin). Bilirubin metabolism relies on liver cells to take up bilirubin, conjugate it, and excrete it into bile. When the liver is damaged or bile flow is blocked, this process is impaired, causing bilirubin to accumulate in the blood. This is a hallmark of cholestasis and hepatocellular injury, often evident as jaundice. Albumin is produced by hepatocytes, so liver damage reduces its synthesis. Lower serum albumin reflects impaired synthetic function and can contribute to edema in chronic liver disease.

Amylase and lipase come from the pancreas, not the liver, so they aren’t directly affected by hepatocellular injury or cholestasis. Insulin and glucagon are pancreatic hormones, not products of liver function, so they’re also not primary measures in this context. In advanced liver disease, coagulation factors (like fibrinogen) and platelets can be influenced, but the most characteristic and direct changes in hepatocellular injury or cholestasis are bilirubin handling and albumin synthesis.