Approach to the Patient with Cholestatic Jaundice
- 23 June 1983
- journal article
- Published by Massachusetts Medical Society in New England Journal of Medicine
- Vol. 308 (25), 1515-1519
- https://doi.org/10.1056/nejm198306233082507
Abstract
On the basis of clinical evaluation, the physician should decide whether extrahepatic biliary obstruction is highly unlikely, possible, or very likely. If it is highly unlikely, no further workup for obstruction is indicated unless the clinical picture is altered on follow-up examination. Further evaluation of the biliary tree is warranted in other patients. Ultrasonography is currently the noninvasive imaging technique of first choice. Computed tomography is indicated if ultrasonography has yielded technically inadequate results or in special circumstances when it is anticipated that decisions regarding further diagnostic evaluation or treatment will be importantly influenced by the results. Negative findings obtained in a technically adequate examination may represent a logical stopping point in the workup of patients in whom obstruction is considered merely a possibility to be excluded, but they should not dissuade the clinician from further diagnostic evaluation if obstruction is considered very likely. Indeed, in selected circumstances, such as cases in which choledocholithiasis is suspected after cholecystectomy, direct cholangiography is appropriate as an initial test. If evidence of obstruction is obtained by noninvasive imaging, direct cholangiography will be required in many patients before treatment, and the choice between percutaneous or retrograde cholangiography should be made on an individual basis. The challenge to the clinician is to minimize the risk, expense, and time involved in obtaining sufficient information for a definitive diagnosis and treatment.Keywords
This publication has 57 references indexed in Scilit:
- Biliary Obstruction in a Canine ModelInvestigative Radiology, 1981
- Obstruction without dilation. Importance in evaluating jaundiceJAMA, 1981
- Fine-needle transhepatic cholangiography: reflections after 450 casesAmerican Journal of Roentgenology, 1981
- The Predictive Value of Prostatic Acid Phosphatase as a Screening Test for Prostatic CancerNew England Journal of Medicine, 1980
- Real-Time UltrasonographyNew England Journal of Medicine, 1980
- The initial investigation of jaundice in a district general hospital: a study of ultrasonography and hepatobiliary scintigraphyThe British Journal of Radiology, 1980
- Rapid and accurate diagnosis of acute cholecystitis with 99mTc-HIDA cholescintigraphyAmerican Journal of Roentgenology, 1979
- The role of grey scale ultrasonography in the investigation of jaundiceBritish Journal of Surgery, 1979
- Nonsurgical, percutaneous transhepatic cholangiography?Diagnostic significance in medical problems of the liverDigestive Diseases and Sciences, 1974
- CLINICAL VERSUS ACTUARIAL PREDICTION IN THE DIFFERENTIAL DIAGNOSIS OF JAUNDICEThe American Journal of the Medical Sciences, 1960