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"Normal" LFTs
If possible, I'd like clarification from one of the doctors regarding LFTs.  I often read on this forum that LFTs can return back to "normal" levels in "end-stage liver disease (cirrhosis)".  Does this mean that: a) since cirrhosis is the end stage of liver disease that LFTs normalize as soon as cirrhosis begins; or b) LFTs normalize at the end stage of cirrhosis but remain elevated during the first stages?  I know many others have wanted to know the answer to this question.  

Related to that, can the function tests -- albumin, bilirubin -- reveal normal liver function in those regards, but the liver be compromised in other regards?  In other words, are the liver's functions lost in stages, so that the LFTs can be 100% normal and the liver still be severely damaged (cirrhosis)?   If so, even if this is possible, is it probable?
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You asked:  "... I often read on this forum that LFTs can return back to "normal" levels in "end-stage liver disease (cirrhosis)".  Does this mean that: a) since cirrhosis is the end stage of liver disease that LFTs normalize as soon as cirrhosis begins; or b) LFTs normalize at the end stage of cirrhosis but remain elevated during the first stages? ...."

Enzymes are released when cells die. Primarily ALT (and AST to a lesser degree) is released when liver cells die. The more liver cells dying the more ALT is released and the higher the blood ALT result will be. In end stage liver disease (advanced cirrhosis) there are fewer "live" liver cells left to die (the liver is predominantly scarred at this stage) and therefore the ALT results will often be lower and can, in fact, be normal.

I have heard it said and I have read that ALT, AST and GGT do not really describe liver function. They are biomarkers of liver injury.

Albumin does reflect liver functionality insofar as it is a protein made only by the liver and with cirrhosis albumin levels will be decreased.

Elevated bilirubin can suggest a bile duct problem, a viral hepatitis, other liver disease or cirrhosis.

I would not expect to see the test results of tests normally performed to assess the liver condition to be 100% normal in a patient with a severely damaged liver.
A couple of tests relevant to liver health not mentioned are coagulation tests and alkaline phosphatase. And, of course, there is also physical examination which, in a cirrhotic patient, will generally provide some indication of liver disease.

Mike
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