Investigating jaundice (summary)

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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
Medical student radiology curriculum