[Differential diagnosis of jaundice]

Jaundice is a symptom with a multitude of possible causes. These can be divided up into primary diseases of bilirubin metabolism, secondary hyperbilirubinemia in patients with liver disease, and diseases with bile duct occlusion. The major objective of the examination must be to exclude those causes that represent an acute danger to the patient, in particular cholangitis or cholecystitis. Symptoms that should cause alarm bells to ring include abdominal pain, fever and chills. When obtaining the patient's anamnesis, particular attention must be paid to lithiasis and previous operations. Laboratory findings of elevated alkaline phosphatase and gamma-GT indicate the presence of cholestasis. If an extrahepatic obstruction is suspected, ultrasonography of the upper abdomen is required.