Although the differential diagnosis between jaundice due to ob struction of the ductal system and other causes is for the most part well established, the surgeon occasionally confronts a patient in which this diagnosis is exceedingly difficult.
Frank Glenn, MD, professor of surgery at Cornell University College of Medicine and surgeon-in-chief, New York City Hospital, outlined for physicians at a symposium on jaundice at the Annual AMA Convention the procedures followed at New York City Hospital to make an evaluation in difficult cases.
The clinical manifestations of the patient's illness sometimes are difficult to determine. The degree of jaundice is, of course, evident. However, it may be difficult, Glenn said, to establish whether it has been intermittent or constant, decreasing or seemingly stationary. Also, jaundice of long-standing and marked intensity may render the cause more obscure.
"Then, too, when the clinical evidence is in favor of obstructive jaundice, whether or