Investigating jaundice (summary)

This is a basic article for medical students and other non-radiologists

Investigation of jaundice is heavily reliant on radiology, from the simplest of investigations (the ultrasound) through to much more complicated MRI-based test and intervention.

It is important to determine whether jaundice is pre-hepatic, intra-hepatic or post-hepatic. Many of the tests that are performed by radiology are focused on assessment of post-hepatic causes.

Reference article

This is a summary article; we do not have a more in-depth reference article.

Summary

• questions
  • when did it start, has it happened before
  • is there associated pain
  • is the cause most likely pre-hepatic, intra-hepatic or post-hepatic
• investigations
  • US
    • almost always the first investigation of choice
      • is there biliary duct dilatation
      • are there gallstones (or sludge)
      • assessment of liver, gallbladder and biliary tree, spleen and pancreas
  • MR
    • ultimately led by blood tests and ultrasound result
    • MRCP (MR cholangiopancreatogram)
      • assessment of gallbladder and biliary tree
    • MR liver
      • assessment of liver lesions
  • ERCP (endoscopic retrograde cholangiopancreatogram)
    • contrast study of the biliary ducts under fluoroscopy
    • able to intervene, e.g. biopsy or sphincterotomy
  • CT
    • can be useful for assessment of neoplastic obstruction
      • head of pancreas carcinoma
  • PTC (percutaneous transhepatic cholangiogram)
    • specialist test in large centers
    • mainly used for drainage of an obstructed system
• making the request
  • know the question that is being asked by the clinical team
  • include relevant history and blood results
  • if it's a specialist test talk to the radiologist
• common pathology
  • gallstone disease
  • acute cholecystitis
  • obstructive jaundice
  • malignant biliary tract obstruction