The liver is a complex organ with multiple functions and no single test can be used to assess its function. Such complexity is exemplified by the absence of any long-term means of artificial support short of organ transplantation, in contrast to the options available when loss of other vital organs occur. A variety of investigations are available to evaluate liver function but several have become obsolete due to their cost, complexity and substitution by modern imaging techniques and are not discussed here. This chapter focuses on the principal aspects of liver function and reviews common liver biochemical tests. From this chapter, readers should gain an excellent knowledge of the cardinal functions of the liver, be comfortable with the interpretation of abnormal liver biochemistries and also be cognizant of the limitations of these investigations. A thorough history and physical examination is always the first step in the evaluation of abnormalities in liver function and should guide physicians towards a prompt and cost-effective evaluation and diagnosis.
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