An accelerated diagnostic approach to surgical jaundice

A clear distinction between obstructive and hepatocellular jaundice is difficult in many patients. Biochemical and clinical findings may cause confusion and result in long delays in diagnosis and treatment. Ultrasonography is a major advance in the positive identification of patients with dilated intrahepatic ducts, whether or not the gall bladder is dilated. Isotopic imaging also may be useful in identifying obstructive jaundice. If percutaneous transhepatic cholangiography (PTC) is performed soon after, the site and nature of the obstruction will become evident. Another advance is the introduction of a sheathless narrow needle for PTC. This reduces the possibility of complications and has the advantage of being able to puncture a normal, undilated biliary tree in as many as 60% of cases, ruling out an obstructive cause. The use of these newer radiological investigations will appreciably shorten the period between the onset of jaundice and the ascertainment of its cause.