Elevated ammonia levels are seen in advanced liver dysfunction.

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

Answer: (B)

Ammonia detoxification occurs primarily in the liver through the urea cycle. In advanced liver dysfunction, this detoxification is impaired, so ammonia accumulates in the blood. Gut bacteria continuously produce ammonia from amino acids, and portal-systemic shunting or severe hepatic impairment allows more ammonia to bypass the liver, further raising blood levels. Elevated ammonia is a hallmark of advanced liver disease and underlies hepatic encephalopathy, with cognitive changes ranging from subtle confusion to coma. Decreased or normal ammonia levels would not reflect the liver’s reduced capacity to clear it, and a statement that it’s not associated with liver disease is incorrect.