Key messages

• Traditionally, biochemical tests of liver function give relatively little information about how well the liver is performing, as they are essentially indicators of hepatic dysfunction.

• Unconjugated hyperbilirubinemia occurs when the production of bilirubin exceeds the ability of the liver to remove and conjugate it.

• Conjugated hyperbilirubinemia occurs when there is leakage of bilirubin into the blood system, at or distal to the hepatocytes, when its normal route of excretion is blocked.

• The main value of the aminotransferases is in detecting hepatocellular damage and in monitoring the patient's progress. Alanine aminotransferase has greater hepatic specificity than aspartate aminotransferase.

• Serum levels of alkaline phosphatase enzymes rise in many types of liver disease, particularly where there is intra- or extrahepatic obstruction to the flow of bile and in the presence of intrahepatic space-occupying lesions such as tumors.

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