The initial investigation of jaundice in a district general hospital: a study of ultrasonography and hepatobiliary scintigraphy

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Abstract
Jaundiced patients (25) were investigated by ultrasonography (performed by a medical physicist) and hepatobiliary scintigraphy using 99Tcm-HIDA [N-(2,6-dimethylphenylcarbamoylmethyl)-iminodiacetic acid]. Hepatobiliary scintigraphy was completely unable to distinguish medical from surgical jaundice. However, with mild jaundice, bilirubin < 100 .mu.mol/l, the presence or absence of gall-bladder activity fairly accurately predicted the presence or absence of gall-bladder disease. Ultrasonography had 3 technical failures. Of the remaining 22 patients, medical jaundice was correctly predicted in 9 of 10 patients and surgical jaundice in 8 of 12 patients. Erroneous results were only obtained from patients with mild jaundice, the accuracy being 100% in the 15 patients with serum bilirubin > 60 .mu.mol/l. Ultrasonography is recommended as the investigation of 1st choice in jaundice, perhaps complemented by hepatobiliary scintigraphy when the jaundice is mild.