Teaching Points
- Ultrasound is the first imaging modality used in the algorithm for the investigation of cholestatic jaundice.
- Further imaging depends on whether the bile ducts are dilated.
- If the bile ducts are dilated and an ultrasound fails to demonstrate a cause, further imaging depends on a provisional clinical diagnosis. Investigations may the include CT scan of the abdomen, CT cholangiogram, Magnetic Resonance Cholangiopancreatography (MRCP) and Endoscopic US (EUS).
- If the bile ducts are not dilated, hepatocellular causes of jaundice should be excluded prior to further imaging.
- Endoscopic Retrograde Cholangiopancreatography (ERCP) is reserved for therapeutic indications or if there remains ongoing clinical doubt with non-diagnostic imaging studies.
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