Abstract
The initial evaluation of a patient with suspected liver disease includes a directed history of symptoms and risk factors. Physical examination may reveal clues to portal hypertension as well as more obvious findings such as scleral icterus. Initial work-up includes liver chemistries, which help determine the pattern of liver injury and direct the subsequent diagnostic approach, including imaging. Newer techniques such as transient elastography can aid in noninvasive diagnosis, thereby reducing the need for liver biopsy.