A surgeon's evaluation of a patient with jaundice believed to be due to obstruction of the common duct should provide conclusive information relative to four items:
Confirmation that the jaundice is due to obstruction.
Correlation of the clinical manifestations: Is the degree of jaundice minimal or intense? Has it been intermittent or constant? Is it increasing, decreasing or seemingly stationary?
Localization of obstruction.
Determination of the nature of the obstruction: Is it due to calculi, stricture, neoplasm or some other cause?
Confirmation That the Jaundice Is Due to Obstruction.—
Absence of bile from the stool, absence of the bile in duodenal drainage, and the presence of bile in the urine are strong evidence in favor of obstruction. If, in addition, the serum bilirubin and serum alkaline phosphatase are elevated as indicated in Table 2, obstruction is most likely. The laboratory findings outlined in Tables 1 and