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May 15, 1981

Cholestatic Jaundice in Adults: Algorithms for Diagnosis

Author Affiliations

From the Departments of Surgery (Dr Fischer) and Medicine (Drs Gelb and Weingarten), Beth Israel Medical Center, New York, and the Mount Sinai School of Medicine of the City University of New York.

JAMA. 1981;245(19):1945-1948. doi:10.1001/jama.1981.03310440045028

IN TWO prior publications in this series, algorithms were presented that primarily dealt with the diagnosis of jaundice in the newborn1 and with medical causes of jaundice in older children and adults.2 In the latter publication, the author concluded that "the most difficult problem in the diagnosis of jaundice is the differentiation of intrahepatic from extrahepatic cholestasis." Our algorithms pursue this problem by branching logic using current diagnostic modalities that have become available during the past few years (Fig 1).

When conjugated hyperbilirubinemia exists with increasing total bilirubin levels of more than 3 mg/dL, visualization of the biliary tree by conventional oral or intravenous cholecystography (IVC) is unlikely and should not be attempted.

The initial step is to determine if there has been recent biliary tract surgery. When a T-tube is still in situ, T-tube cholangiography is the simplest way to opacify the biliary tree and clarify