Noninfectious jaundice. Figuring out what's going on
Even after the clinician has excluded surgical, infectious, and toxic causes, jaundice remains a diagnostic challenge. A complete history is extremely important and usually points toward the correct diagnosis. It should include a history of family illness, travel, drug ingestion, alcohol intake, and systemic illnesses. Physical examination and laboratory testing add more information. Ultrasonography helps differentiate obstructive from nonobstructive causes of jaundice. If the common bile duct (or other ducts) is dilated, visualization with endoscopic or percutaneous imaging techniques is indicated. If obstruction is found, appropriate therapy with surgical, percutaneous, or endoscopic procedures can be chosen. Some investigators recommend doing endoscopic retrograde cholangiopancreatography even if ducts are not dilated on ultrasonography; then, if no obstruction is noted, further laboratory evaluation or liver biopsy is indicated.