The majority of diagnostic imaging in patients with jaundice will be performed external to the emergency department.

Abdominal UltraSound Scan (USS)

Abdominal USS is a useful initial radiological test to distinguish between hepatocellular and extra-hepatic causes. It is cheap, readily available, lacks radiation and is more sensitive than CT at detecting stones in the gallbladder. The drawback of USS is that it is limited at detecting intraparenchymal disease of the liver or pancreas, and it is operator-dependent.

Computed Tomography (CT)

CT is good at determining intraparenchymal liver and pancreas disease. Neither USS or CT are good at delineating intraductal gallstones.

Magnetic Resonance Cholangio-Pancreatography (MRCP)

MRCP is a non invasive, radiation free diagnostic test. It is useful for evaluating the biliary tree, pancreas and liver. The findings of the MRCP will determine whether a more invasive ‘ERCP’ is required.

Endoscopic Retrograde Cholangio-Pancreatography (ERCP)

ERCP may be required to detect disease in the biliary and pancreatic ducts which may be missed on CT and USS. As well as a diagnostic adjunct, it may be used therapeutically to remove gallstones from the biliary tract or to place stents across narrow ducts. The most common and serious complication of ERCP is pancreatitis.

Liver biopsy

Liver biopsy is used when serum and radiological investigations fail to provide a definitive diagnosis. Liver biopsy is particularly useful in diagnosing autoimmune hepatitis or biliary tract disorders (such as PBC or PSC)