Diagnosis in jaundice: a contemporary approach

In jaundiced patients, the most important diagnostic problem is to achieve a correct differentiation between nonobstructive and obstructive causes of jaundice. Several new diagnostic tests are available to the clinician. Noninvasive tests include: US, CT and CS, invasive tests are: PTC and ERC. The latter also have therapeutic potentials to be considered. For a proper selection of diagnostic tests in a particular case, clinical evaluation as to the most probable cause of jaundice is mandatory, because the new tests all have their limited field of application. The accuracies of clinical evaluation, noninvasive and invasive tests are therefore reviewed and a flow chart for the differential diagnosis in jaundice is suggested. The clinical evaluation, which may be assisted by a diagnostic chart presented, should sort out patients with probable obstructive or nonobstructive jaundice in whom direct cholangiography or liver biopsy, respectively, is the most appropriate diagnostic test. In the remaining group of patients with clinically doubtful causes of jaundice, or if liver metastases are the most likely diagnosis, US seems to be the test best suited for further differentiation before direct cholangiography or liver biopsy are used as confirmatory tests.