further investigations
Last reviewed 01/2018
Investigations worth considering in the further unravelling of jaundice include, depending on site:
Pre-hepatic jaundice:
- direct Coomb's test - positive in haemolytic anaemia
- blood film - abnormal red cells suggest haemolysis
- reduced haptoglobins in haemolysis
- bone marrow examination
Hepatic jaundice:
- viral markers - for hepatitis A, B, C, E; cytomegalovirus
- Monospot test for Epstein-Barr virus
- immunological test - antimitochondrial, anti-smooth muscle, and antinuclear antibodies for chronic active hepatitis or primary biliary cirrhosis
- serum ferritin - increased in alcoholic liver disease, haemochromatosis
- alpha feto protein - raised in hepatocellular carcinoma
- caeruloplasmin - reduced in Wilson's disease
- needle liver biopsy - reserved for the patient who presents diagnostic difficulty
Extra-hepatic jaundice - also, see cholestasis:
- percutaneous transhepatic cholangiography
- endoscopic retrograde cholangio-pancreatography
- needle liver biopsy
- CT scan abdomen - especially for lesions of head of pancreas