Diagnosis of obstructive jaundice

The diagnosis of obstructive jaundice remains difficult yet vital, since operative decompression may relieve extrahepatic blockage, but operation can only harm patients with intrahepatic block or parenchymal cell inflammation or necrosis. Three new diagnostic methods (liver scanning, angiography, and transjugular transhepatic cholangiography) are reviewed, as is bilirubin metabolism, so important in the diagnosis of jaundice. Three clinical problems are discussed: extrahepatic obstruction due to cancer of the pancreas, biliary atresia causing jaundice in the newborn, and the diffuse ductal obstruction known as sclerosing cholangitis.An accurate diagnosis can usually be made with standard diagnostic techniques, such as history, physical examination and biochemical tests, and, when appropriate, gastrointestinal x-ray studies, cholecystography and cholangiography, liver biopsy, observation of the patient's course, and the three new radiological approaches mentioned above. Extrahepatic obstructive jaundice is an indication for surgical treatment, except perhaps in cases of sclerosing cholangitis.