Doctors often say things are just a little off because in end stage cirrhosis liver enzymes are only a little elevated. This is because the liver cells are mostly dead and have no enzymes to show up in the blood. Other signs, as Gillian shows, such as disordered bleeding and a low albumin are the giveaways. The latter test, albumin, is part of the panel that contains liver enzymes so an alert doctor should see it. But not all are alert.