Abstract

The initial stages of liver damage can be difficult to detect using standard clinical and imaging diagnostic tests. Prior to the development of advanced fibrosis or liver failure, the diseased liver may abnormally metabolise nutrients and drugs. Such changes can be measured by differences in low molecular weight metabolites in body fluids using a range of state-or-the-art analytical chemistry methods, including proton nuclear magnetic resonance spectroscopy and mass spectrometry. Gut microbial cometabolites, for example hippurate and trimethylamine-N-oxide, may also be detected in urine and blood. In this chapter we illustrate results of urinary, plasma and serum metabolic profiling, using proton nuclear magnetic resonance spectroscopy, for characterising specific aspects of liver disease and monitoring treatment of liver cirrhosis.