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May 1978

Modern Diagnosis of JaundiceEmbarras de Richesses

Arch Surg. 1978;113(5):555-556. doi:10.1001/archsurg.1978.01370170017001

Time was when only two factors were necessary for jaundice before laparotomy: yellow skin and clinical suspicion of mechanical biliary obstruction. The simplicity of those days is gone. The surgeon is now overwhelmed by new diagnostic techniques for use in the jaundiced patient. Each is touted by an enthusiastic practitioner who, armed with his shiny expensive new tools, like a detail man extols their accuracy and benignity. The current buzz word that apparently excuses all errors of inaccuracy, omission, and commission is the "noninvasive character" of each new technique. This is apparently a sufficiently broad pardon to cover all types of clinical sins, leaving most of us a little breathless and confused.

The question is, which of the many procedures should be performed and in what order prior to operation? The options include history, physical examination, liver function tests, upper gastrointestinal barium roentgenograms, and oral or intravenous cholecystography. This was

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