Further investigations

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