initial investigations

Last reviewed 06/2021


  • full blood count - may be anaemic due to malignancy
  • raised white count may indicate cholangitis or underlying malignancy
  • leucopaenia may occur in viral hepatitis
  • reticulocytosis indicates pre-hepatic jaundice
  • prothrombin time - prolonged in chronic liver disease; will return to normal in cholestasis following parenteral vitamin K, 10 mg


  • serum transaminases - increased in hepatic jaundice and to a lesser degree, in extrahepatic jaundice
  • serum alkaline phosphatase - raised in extra-hepatic jaundice; hepatic origin confirmed by concomitant rise in gamma glutamyl transferase
  • serum bilirubin - confirms jaundice; used to monitor progress
  • serum albumin and globulin - little change in acute jaundice; albumin decreased and globulin increased in chronic hepatic jaundice



  • pale stools in cholestasis
  • occult blood - suggests carcinoma

Abdominal ultrasound - assesses bile duct dilatation, liver size, liver metastases, portal blood flow, ascites, lymphadenopathy

Chest x-ray - to show primary or secondary tumours, and any irregularity or elevation of the right diaphragm due to enlarged or nodular liver