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Jaundice

Pre-hepatic, hepatocellular and cholestatic jaundice, reading the liver test pattern (R ratio, very high aminotransferases, Hy's law), ultrasound first, the liver screen, and the emergencies of cholangitis and acute liver failure.

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3 questions 9 flashcards

At a glance

Jaundice becomes visible at a bilirubin of about 40 to 50 µmol/L, first in the sclerae.
Sort it into pre-hepatic (unconjugated), hepatocellular or cholestatic (intrahepatic or extrahepatic), using the bilirubin fraction and the liver test pattern.
Abdominal ultrasound is the first imaging test: dilated ducts mean extrahepatic obstruction.

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Sources

Therapeutic Guidelines: Gastrointestinal (eTG complete), abnormal liver biochemistryAU/NZTherapeutic Guidelines Limited
Kwo PY, Cohen SM, Lim JK. ACG Clinical Guideline: Evaluation of Abnormal Liver Chemistries. Am J Gastroenterol 2017;112:18-35American College of Gastroenterology, 2017
Newsome PN et al. Guidelines on the management of abnormal liver blood tests. Gut 2018;67:6-19British Society of Gastroenterology, 2018
Kiriyama S et al. Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholangitis. J Hepatobiliary Pancreat Sci 2018;25:17-30Japanese Society of Hepato-Biliary-Pancreatic Surgery, 2018
van der Gaag NA et al. Preoperative biliary drainage for cancer of the head of the pancreas. N Engl J Med 2010;362:129-37New England Journal of Medicine, 2010

Last updated: 14 November 2026

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14 November 2026 Personal emails, About story and Australian-style copy