Cholestatic Jaundice in Adults: Title and subTitle BreakAlgorithms for Diagnosis FREE

Murry G. Fischer, MD; Alvin M. Gelb, MD; Leonard A. Weingarten, MD

[+] Author Affiliations

Reprint requests to Beth Israel Medical Center, 10 Nathan D. Perlman PI, New York, NY 10003 (Dr Fischer).

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

Text Size: A A A

Published online

Article

References

ABSTRACT

ABSTRACT | REFERENCES

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

REFERENCES

ABSTRACT | REFERENCES

Thaler MM: Jaundice in the newborn: Algorithmic diagnosis of conjugated and unconjugated hyperbilirubinemia . JAMA 1977;;237:58-62.

Ostrow JD: Jaundice in older children and adults: Algorithms for diagnosis . JAMA 1975;; 234:522-526.

Goldstein LI, Sample WF, Kadell BM, et al: Gray-scale ultrasonography and thin-needle cholangiography: Evaluation in the jaundiced patient . JAMA 1977;;238:1041-1044.

Ram MD, Watanatittan S: Cephalothin levels in human bile . Arch Surg 1974;;108:187-189.

Keighley MRB, Drysdale RB, Quoraishi AH, et al: Antibiotic treatment of biliary sepsis . Surg Clin North Am 1975;;55:1379-1390.

Osnes M, Serck-Hanssen A, Myren J: Engoscopic retrograde brush cytology of the biliary and pancreatic ducts . Scand J Gastroenterol 1975;;10:829-831.

Blackstone MO, Cockerham L, Kirsner JB, et al: Intraductal aspiration for cytodiagnosis in pancreatic malignancy . Gastrointest Endosc 1977;;23:145-147.

Roberts-Thomson IC, Hobbs JB: Cytodiagnosis of pancreatic and biliary cancer by endoscopic duct aspiration . Med J Aust 1979;;1:370-372.

Tsuchiya R, Henmi T, Kondo N, et al: Endoscopic aspiration biopsy of the pancreas . Gastroenterology 1977;;73:1050-1052.

Redeker AG, Karvountzis GG, Richman RH, et al: Percutaneous transhepatic cholangiography: An improved technique . JAMA 1975;; 231:386-387.

Ferrucci JT, Wittenberg J, Sarno RA, et al: Fine needle transhepatic cholangiography—a new approach to obstructive jaundice . AJR 1976;; 127:403-407.

Juler GL, Conroy RM, Fuelleman RW: Bile leakage following percutaneous transhepatic cholangiography with the Chiba needle . Arch Surg 1977;;112:954-958.

Kreek MJ, Balint J: Special report: Risks of the skinny needle procedure . Read before the Annual Meeting of the AASLD, Chicago, Nov 7, 1978.

Kaude JV, Weidenmier CH, Agee OF: Decompression of bile ducts with the percutaneous transhepatic technique . Radiology 1969;; 93:69-71.

Fischer MG, Wolff WI, Geffen A, et al: Combined use of percutaneous transhepatic cholangiography and endoscopic ampullary cholangiography in the diagnosis of 'difficult' jaundice cases . Am J Gastroenterol 1975;;63:369-380.

Davis JL, Milligan FD, Cameron JL: Septic complications following endoscopic retrograde cholangiopancreatography . Surg Gynecol Obstet 1975;;140:365-367.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal