We retrospectively evaluated abdominal ultrasound studies of 273 asymptomatic patients with abnormal liver function tests over an 18-month period to assess the value of abdominal ultrasound as an initial investigation. In-patients, out-patients and general practitioner referrals were included. 143 (53%) examinations were normal. Those with significant abnormality (n=13, 5%) were referred for further investigation/treatment. Those with alterations in hepatic echogenicity (n=117, 42%) underwent clinical and biochemical follow-up, radiological follow-up or biopsy. 20% of patients underwent further radiological investigation. Ultrasound is a non-invasive, cost effective first-line investigation in the evaluation of asymptomatic patients with abnormal liver function tests.