Differential diagnosis of jaundice: Biliary obstruction vs Liver disease

Parameter Biliary obstruction Liver disease
History Abdominal pain

Fever, rigors

Prior biliary surgery

Older age

Anorexia, malaise, myalgias (viral prodrome)

Known viral exposure

History of blood product receipt or injection drug use

Exposure to known hepatotoxin

Family history of liver disease

Physical examination Fever

Abdominal tenderness

Palpable abdominal mass

Abdominal surgical scar

Spider telangiectasias

Stigmata of portal hypertension(e.g., prominent abdominal veins, splenomegaly, ascites)


Laboratory studies Predominant elevation of serum alkaline phosphatase relative to aminotransferases

Prothrombin time (INR) normal or normalizes with Vitamin K administration


Elevated serum amylase or lipase level

Predominant elevation of serum aminotransferase levels relative to alkaline phosphatase

Prolonged prothrombin time that does not normalizes with Vitamin K administration


Serologies indicative of specific liver disease

Sleisenger and Fordtran’s Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. 10th Ed. Elsevier Saunders, 2016

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