Jaundice distinction based on laboratory findings is to differentiate unconjugated (nonobstructive) hyperbilirubinemia (ie, hepatitis/sepsis, alcoholic (obstructive) hyperbilirubinemia (CBD obstruction, commonly by stones or tumor). There is a paucity of rigorous evidence directly comparing the following primary imaging methods used in evaluating the jaundiced patient: abdominal ultrasound (US), CT, MR cholangiopancreatography (MRCP), endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic US [13]. Special Imaging Considerations Radiography Radiographs rarely provide any information on the site or the cause of obstruction and have a limited role in the evaluation of the jaundiced patient. Occasionally, radiographs may be useful as they are expeditiously obtained, and can quickly assess for the presence of calcified gallstones in the gallbladder or CBD [14], find calcific deposits in the pancreas (in the setting of chronic pancreatitis), and evaluate for the presence of an indwelling biliary or pancreatic stent. Discussion of Procedures by Variant Variant 1: Jaundice. No known predisposing conditions. Initial imaging. The most common causes of all types of jaundice are: (1) hepatitis/sepsis, (2) alcoholic liver disease, (3) blockage of the CBD by a stone or tumor, and (4) toxic reaction to a drug or medicinal herb [7]. Of these common etiologies, imaging is most useful in the setting of suspected underlying cirrhosis or CBD obstruction, as it can demonstrate either the morphologic redistribution of the liver in cirrhosis and/or depict findings of portal hypertension, and, in CBD obstruction, depict dilation of the bile ducts and potentially identify the reason for the obstruction. Imaging can also be a useful tool to help exclude active biliary obstruction and the presence of cirrhosis in a patient presenting with an unclear cause of jaundice.
Jaundice. Jaundice distinction based on laboratory findings is to differentiate unconjugated (nonobstructive) hyperbilirubinemia (ie, hepatitis/sepsis, alcoholic (obstructive) hyperbilirubinemia (CBD obstruction, commonly by stones or tumor). There is a paucity of rigorous evidence directly comparing the following primary imaging methods used in evaluating the jaundiced patient: abdominal ultrasound (US), CT, MR cholangiopancreatography (MRCP), endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic US [13]. Special Imaging Considerations Radiography Radiographs rarely provide any information on the site or the cause of obstruction and have a limited role in the evaluation of the jaundiced patient. Occasionally, radiographs may be useful as they are expeditiously obtained, and can quickly assess for the presence of calcified gallstones in the gallbladder or CBD [14], find calcific deposits in the pancreas (in the setting of chronic pancreatitis), and evaluate for the presence of an indwelling biliary or pancreatic stent. Discussion of Procedures by Variant Variant 1: Jaundice. No known predisposing conditions. Initial imaging. The most common causes of all types of jaundice are: (1) hepatitis/sepsis, (2) alcoholic liver disease, (3) blockage of the CBD by a stone or tumor, and (4) toxic reaction to a drug or medicinal herb [7]. Of these common etiologies, imaging is most useful in the setting of suspected underlying cirrhosis or CBD obstruction, as it can demonstrate either the morphologic redistribution of the liver in cirrhosis and/or depict findings of portal hypertension, and, in CBD obstruction, depict dilation of the bile ducts and potentially identify the reason for the obstruction. Imaging can also be a useful tool to help exclude active biliary obstruction and the presence of cirrhosis in a patient presenting with an unclear cause of jaundice.