Further diagnostic exams other than biochemical liver tests to assess hepatic diseases include principally ultrasound, computed axial tomography (CT scan), nuclear magnetic resonance (NMR), laparoscopy and liver biopsy.

Ultrasound, CTscan, NMR
Ultrasound shows the liver characteristics; it is very useful to demonstrate dilated bile ducts, dilated portal vein, enlarged liver and spleen, presence of initial ascites and to detect benign and malignant hepatical focal lesions.
A CT scan is an even more sensitive test than ultrasound. It is the best procedure for space-occupying lesions.
NMR has similar indications to those for CT scan, but the methodology is completely harmless. New softwares recently permit precise diagnosis to detect stones in bile ducts (RNM-colangiography) and to evaluate patency of portal vein and hepatic artery (often avoiding more invasive technique, such as arteriography).

Laparoscopy
Laparoscopy is the name given to the direct examination of the intra-abdominal organs by an optical system that penetrates through the abdominal wall. This methodology is  less frequently performed nowadays, since it is partially substituted by ultrasound, Ct-scan etc.The following figures depict laparoscopic vision of a normal and cirrhotic liver.

Liver Biopsy
Liver biopsy is a safe and important tool for the hepatologist. Liver biopsy has traditionally been the gold standard for assessing the extent of injury and determining prognosis in chronic viral hepatitis.
Liver biopsies are generally performed as outpatient procedures with a 5-6 hour post-biopsy observation period unless patients are considered at high risk (high-risk patients are observed overnight). Prior to biopsy, the physician will check the PT (clotting time) to minimize the risk of excessive bleeding. Patients are placed on their back, and the needle entry site is determined by ultrasound. With the patient holding his/her breath, a 1.4 mm (large diameter) needle is quickly thrust into and out of the liver, obtaining a core of liver tissue by aspiration. 
The following are potential complications of liver biopsy: 
Pain occurs at the biopsy site or in the right shoulder in about 1 out of 4 to 5 patients. This is usually temporary and not severe. 
There is always mild bleeding at the biopsy site and within the liver, forming a hematoma (collection of blood) that usually resolves by itself. However, in fewer than 1% of patients, more severe bleeding may occur within the liver itself, into the biliary tree (hemobilia), or into the abdominal cavity. This complication requires hospitalization and observation, and may necessitate blood transfusions. 
Puncture of other organs, such as the lung, gallbladder, gut, and kidney is rare (one in about 10,000). 
A very thin "slice" of the liver biopsy specimen is examined under a microscope. Histologic examination is useful to identify specific disease patterns, guide patient management, and follow the response to therapy. 
When examining liver tissue, the pathologist looks for various changes in cellular appearance that are signs of ongoing inflammation, necrosis, and/or fibrosis. 
Cirrhosis is easily diagnosed (loss of normal hepatic lobular architecture, with fibrous bands separating and surrounding nodules of regenerating cells)
A modern classification scores the extension of inflammation and necrosis (grading) and the extension of fibrosis (staging ).
In some instances, it may be appropriate to perform biopsy before initiating antiviral therapy. Consideration should be given to omitting biopsy whenever this is associated with excessive risk to the patient such as in hemophilia and severely decompensated cirrhosis. Also, some experts question the need for biopsy in individuals with persistently normal ALT levels unless they are part of a research protocol. 

Some examples of liver biopsies are reported in the following figures.