Why can significant hepatocellular loss occur before clinical signs appear?

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The liver has a large functional reserve and strong regenerative capacity, so it can lose a substantial amount of hepatocytes and still maintain essential functions. The remaining hepatocytes can upregulate activity to continue detoxification, metabolism, and synthesis (such as albumin and clotting factors) until a critical threshold is reached. Only when enough functional mass is lost or overwhelmed do clinical signs and symptoms appear, which is why significant hepatocellular loss can occur before anything noticeable.

The other ideas don’t fit as well: regeneration isn’t instantaneous, enzymes in the blood reflect cell injury rather than how much function remains, and symptoms do not typically appear early.