From the Guidelines
For patients presenting with jaundice, an abdominal ultrasound (US) is the recommended initial diagnostic test. This recommendation is based on the American College of Radiology's appropriateness criteria for jaundice, which suggests that abdominal US is the most appropriate initial imaging test for evaluating the liver and biliary system in patients with suspected jaundice 1.
The abdominal US is useful for detecting both cirrhosis and the presence of dilated intrahepatic/extrahepatic bile ducts, with a sensitivity of 65% to 95% for detecting cirrhosis and a positive predictive value of 98% 1. Additionally, US is accurate for the depiction of biliary obstruction, with reported sensitivities ranging from 32% to 100% and specificities ranging from 71% to 97% 1.
Some key points to consider when interpreting the results of an abdominal US for jaundice include:
- The presence of a nodular surface on the liver, which is more sensitive on the undersurface of the liver than the superior surface 1
- The detection of biliary ductal calculi, which may not be visible due to overlaying bowel gas, but can be increased by combining tissue harmonic imaging with other findings such as elevated bilirubin, patient age, and CBD dilatation 1
- The presence of multiple small gallstones in the gallbladder, which creates a 4-fold risk for migration of these stones into the CBD 1
Overall, an abdominal US is a non-invasive and effective initial diagnostic test for evaluating patients with jaundice, and can help guide further testing and management.
From the Research
Diagnostic Tests for Hyperbilirubinemia (Jaundice)
The diagnostic tests for hyperbilirubinemia (jaundice) include:
- Liver chemistry tests, such as bilirubin (conjugated and unconjugated), alkaline phosphatase, alanine aminotransferase, aspartate aminotransferase, and total protein 2
- Fractionated bilirubin to determine whether the hyperbilirubinemia is conjugated or unconjugated 3, 4
- Complete blood cell count 3, 4
- Imaging modalities, such as ultrasonography, computed tomography, and magnetic resonance cholangiopancreatography, to evaluate the hepatobiliary system 2, 3, 5, 4
- Liver biopsy, if the etiology of jaundice is unclear despite laboratory testing and imaging 3, 5, 4
Laboratory Evaluation
The laboratory evaluation for jaundice should include:
- Bilirubin (total and fractionated) 3, 4
- Alanine transaminase and aspartate transaminase 3, 4
- Alkaline phosphatase and gamma-glutamyltransferase 3, 4
- Albumin and prothrombin time/international normalized ratio 3, 4
- Complete blood cell count 3, 4
Imaging Modalities
Imaging modalities, such as:
- Ultrasonography, to evaluate the biliary system and differentiate between extrahepatic obstructive and intrahepatic parenchymal disorders 5, 4
- Computed tomography, to evaluate the hepatobiliary system and detect any obstructions or masses 3, 5, 4
- Magnetic resonance cholangiopancreatography, to evaluate the biliary system and detect any obstructions or masses 3