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

ABSTRACT

Twenty-five jaundiced patients presenting to a district general hospital were investigated by both ultrasonography (performed by a medical physicist) and hepatobiliary scintigraphy using 99Tcm-HIDA. Hepatobiliary scintigraphy was completely unable to distinguish medical from surgical jaundice. However, with mild jaundice--bilirubin < 100 mumol/l--the presence or absence of gall-bladder activity fairly accurately predicted the presence or absence of gall-bladder disease. Ultrasonography had three technical failures. Of the remaining 22 patients, medical jaundice was correctly predicted in nine of ten patients and surgical jaundice in eight 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 mumol/l. In a district general hospital ultrasonography is recommended as the investigation of first choice in jaundice, perhaps complemented by hepatobiliary scintigraphy when the jaundice is mild.