A rational diagnostic procedure has to be not only scientifically should but also economically reasonable. One has always to ask to what purpose the diagnosis shall serve. The diagnosis is mainly necessary for the treatment of a patient. This includes aiming at a causal
therapy, informing the patient about cause and meaning of his symptoms, and also considering prognosis and, if necessary, prophylaxis. In
liver disease the following investigations are obligatory: history, signs and symptoms and a minimal set of tests (
SGPT,
SGOT, gamma-GT, serum
bilirubin,
urobilinogen in the urine). The next level of diagnostic measures evolves out of several questions: in case of
acute disease: etiology (
infections; toxic?); evidence of chronic
liver disease; differentiation between intra- and
extrahepatic cholestasis; evidence of a circumscript lesion of the liver; associated reaction of the liver in connection with other extrahepatic diseases. Serum
bilirubin is of relatively little importance except for disturbances of the
bilirubin metabolism. The same is true for serum
iron except for the diagnosis of
hemochromatosis. Blood coagulation tests are of great value for the diagnosis and evaluation of acute and chronic
liver disease as are immunologic and serologic investigations (
HBsAg,
HBcAg, Anti-
HBeAg, Anti-HVA,
ANF, SMA).