[Rational diagnosis of the cholestasis syndrome]

Aim of a rational diagnostic approach is keeping the risks and challenges of the patient at a minimum, shortening the time interval till the diagnosis is established and putting the charges to a low level. Anamnesia, clinical examination and laboratory results allow the experienced clinician in about 90% a correct diagnosis if an extrahepatic cholestasis is the case in question. On the other hand the result is only 75-80% if there is an intrahepatic cholestasis. Non dilated bile ducts do not exclude an extrahepatic cholestasis and additional diagnostic measures like ERCP or/and PTC are recommended in case the suspicion of a extra hepatic pattern exists. The diagnostic approach may be shorten at all if anamnesia and clinical statement are suspect of an extrahepatic cholestasis. Then after getting the laboratory results the ERCP or PTC may add.