Investigating jaundice (Investigation of jaundice (hyperbilirubinaemia))

What does investigating jaundice involve?

Jaundice is a yellowing of the skin and the whites of the eyes caused by a build-up of bilirubin, a yellow waste product normally cleared by the liver. You may also notice dark urine, paler stools and itchy skin. Because jaundice can be a sign of something serious, it usually needs prompt assessment rather than watchful waiting.

Investigating jaundice means working out where the problem is: too much bilirubin being made (for example when red blood cells break down quickly), a problem within the liver itself (such as hepatitis or a medicine reaction), or a blockage in the bile ducts (such as a gallstone or, less often, a tumour). The pattern of blood tests and the scans point to which of these it is.

The investigation has two jobs at once: to find the cause, and to judge how urgent it is. A blocked bile duct with fever, or jaundice with confusion, needs same-day hospital care. Other causes can be worked up more steadily.

This guide explains the usual steps. It is not a diagnosis, and new jaundice should always be assessed by a doctor.

Types, options & approaches

There may be different ways to do this. The right approach depends on the clinical question and your circumstances.

Where the problem sits

This is a simplified map. People can have overlapping causes, and your doctor decides the order of tests based on your results and symptoms.

Preparing for your test

• Treat new jaundice as urgent: contact a doctor promptly rather than waiting for a routine appointment. For urgent but non-life-threatening advice, use NHS 111 in England, Scotland or Wales; in Northern Ireland, contact your GP out-of-hours service or your HSC Trust's Phone First service.
• Bring a full list of medicines, supplements and herbal remedies, as several can cause jaundice.
• Be ready to give an honest alcohol history and mention any recreational drug use.
• Note recent foreign travel, tattoos, new sexual partners or possible hepatitis exposure.
• Mention any tummy pain, fever, weight loss, itching, or pale stools and dark urine.
• If a scan such as an ultrasound or MRCP is planned, ask whether you need to fast beforehand.
• If you might be pregnant, say so, as this affects which tests and scans are used.

What happens

Assessment usually starts with questions about your symptoms, alcohol, medicines and travel, an examination, and blood tests taken from a vein. These help separate a blood-cell cause, a liver cause and a blockage.

Most people then have an ultrasound scan of the liver and bile ducts. If this suggests a blockage, you may go on to an MRCP (a detailed MRI of the ducts) or an ERCP, where a telescope is used to find and often treat the blockage under sedation.

Depending on the likely cause, a CT scan, a wider liver screen or a liver biopsy may follow. Because some causes are urgent, this can happen quickly, sometimes in hospital, rather than over several outpatient visits.

Is this test right for me?

A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.

Before you decide

Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.

Comfort, sedation or contrast choices

If local anaesthetic, sedation, contrast or pain relief is used, ask what is planned, why, and what it means afterwards.

The blood tests and ultrasound are low-risk; the more important risks come from invasive procedures such as ERCP and from delay. ERCP in particular can cause pancreatitis and other complications, so it is generally used when treatment, not just imaging, is needed. Ask why each test is being done and whether a lower-risk scan (such as MRCP) would answer the question first.

Published figures to discuss

The basic work-up (blood tests, ultrasound, MRCP) is low-risk. The defensible numeric risks relate to ERCP, which is sometimes part of investigating an obstructive cause. Rates vary with the indication, the operator and the patient, and the figures below are broad ranges from published series and patient information rather than guarantees.

These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.

What happens afterwards

There is no recovery from a blood test, and an ultrasound or MRI needs no recovery time. After an invasive procedure such as ERCP you will be observed for some hours; what matters most afterwards is understanding the cause and the treatment plan.

• Yellowing that takes days to weeks to fade once the cause is treated
• Continued dark urine and pale stools until a blockage is relieved
• Itching that improves gradually as bilirubin falls
• Mild tiredness while the underlying cause settles
• Some waiting between tests as the cause is pinned down

Aftercare

• Make sure you understand the suspected cause and what the plan is, including any procedure.
• Keep all scan, specialist and procedure appointments, as jaundice can have serious causes.
• Avoid alcohol while being investigated, and review medicines and supplements with a clinician.
• Follow fasting and sedation instructions carefully if a procedure such as ERCP is planned.
• After sedation, do not drive, sign legal documents or be alone for the rest of the day.
• Seek urgent help for severe tummy pain, fever, confusion, vomiting blood or worsening jaundice.
• Confirm who is responsible for chasing each result and how you will be told.

• Up-to-date list of medicines, supplements and herbal remedies
• Note of recent travel, alcohol and any exposure risks
• Clarity on fasting before any planned scan or procedure
• Someone to take you home if sedation is used
• The plan written down: next test, who does it, and when
• Agreed way to receive results and an urgent contact route
• A clear list of red-flag symptoms that mean seeking same-day help

⚠ Get urgent help if…

• Jaundice with fever or shivering (rigors) — seek same-day medical help
• Severe pain in the upper right or central tummy, especially radiating to the back
• Confusion, drowsiness or unusual sleepiness — call 999 or go to A&E
• Vomiting blood or passing black, tarry stools — call 999 or go to A&E
• Rapidly deepening yellowing of the skin or eyes
• Easy bruising or bleeding, or swelling of the tummy or legs
• After ERCP: severe tummy pain, fever or repeated vomiting

Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.

General guidance — it doesn't replace the specific advice your specialist gives you.

Results & realistic expectations

A 'good' result is a clear cause and a plan to treat it. For some people that means relieving a blocked bile duct; for others, treating hepatitis, stopping a medicine, or managing a blood condition. The yellowing itself usually fades over days to weeks once the cause is addressed.

Results must be read together. Blood tests suggest where the problem lies, the ultrasound and any MRCP show whether there is a blockage, and further tests confirm the specific cause. A normal scan does not always mean a harmless cause, so investigation continues until the picture makes sense.

Once the cause is treated, jaundice usually settles, but how long this takes and whether it can recur depends entirely on the cause — a one-off gallstone differs greatly from a long-term liver condition. Your clinician will explain whether you need ongoing monitoring, repeat scans or specialist follow-up, and what symptoms should prompt you to return.

Related tests, treatments or support

Investigating jaundice overlaps with investigating abnormal liver blood tests, and the same liver-screen tests are often used. Imaging may be combined: an ultrasound first, then MRCP or CT, with ERCP reserved for when a blockage needs treating. A liver biopsy is sometimes added when the cause within the liver remains unclear.

Follow-up & long-term care

Follow-up depends on the cause and may involve a liver specialist (hepatologist), gastroenterologist, surgeon or haematologist. After any procedure, you should be told what was found, what was done, and what happens next. Make sure you know who is coordinating your care and how to get help urgently if symptoms worsen.

• Specialist follow-up if a long-term liver or blood condition is found
• Repeat liver blood tests to confirm the jaundice is settling
• Surgical review (for example gallbladder removal) if gallstones caused a blockage
• Ongoing monitoring or scans where a more serious cause is being managed

Repeat, follow-on and what comes next

• Investigation is often staged: an initial scan may lead to a more detailed one before any treatment.
• An ERCP may need to be repeated, for example to change or remove a stent.
• If the first round of tests is inconclusive, further imaging or a biopsy may be needed.
• Some causes need ongoing specialist follow-up rather than a single fix.

Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.

What good aftercare looks like

• Clear written information on the suspected cause and the treatment plan.
• A named contact and an urgent route to help if symptoms worsen.
• Specific warning-sign advice after any procedure such as ERCP.
• Confirmation of who is coordinating care across the specialists involved.
• Arranged follow-up tests to confirm the jaundice is settling and the cause is controlled.

What affects the cost

Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:

• Which blood tests are needed, including a full liver screen and clotting tests
• The type and number of scans (ultrasound, MRCP, CT) and who reports them
• Whether an invasive procedure such as ERCP is needed, including sedation and facility costs
• Whether a liver biopsy is required for unclear liver causes
• Specialist consultations with a hepatologist, gastroenterologist or surgeon
• How urgently testing is arranged and whether a hospital stay is involved

• Which blood tests and scans are included, and who reports them
• Whether sedation and facility fees are covered if a procedure such as ERCP is needed
• The specialist consultation fee and any follow-up appointments
• What happens, and what it costs, if results are unclear and more tests are required
• How and when you receive written results
• An urgent contact route in case symptoms worsen during the work-up
• What happens if you need to transfer urgently into NHS care

On the NHS? New jaundice is usually assessed urgently on the NHS; it should not wait for a routine private appointment, particularly if you are unwell or have red-flag symptoms.

You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.

Consent traps and marketing red flags

These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.

Choosing a specialist safely

• Check the specialist is on the GMC Specialist Register for this area.
• Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
• You're entitled to time to consider and to have your questions answered before you agree — the specialist who looks after you should explain it, not a salesperson.
• Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
• You're entitled to your total cost in writing — including any follow-up — before you decide.

How Vuemedics verifies every consultant →

Take this to your consultation. A good specialist will welcome every one of these.

• Which broad type of jaundice do my tests suggest — a blood, liver or blockage cause?
• What is the next test, and could a lower-risk scan answer the question first?
• If an ERCP is suggested, is it for treatment as well as diagnosis, and what are its risks?
• What does my ultrasound show about my bile ducts and liver?
• What treatment is likely, and how quickly does it need to happen?
• Who is coordinating my care, and how do I get urgent help if I get worse?
• Will I need follow-up scans or specialist review after this is treated?
• Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
• Will you be the specialist who carries out my test, and who looks after me afterwards?
• What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
• What does a realistic result look like — and what can this test not achieve?
• What are my options, including waiting, doing nothing for now, or choosing a different approach?
• Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
• What is the total cost in writing, including any follow-ups, and how much time do I have to decide?

Find a verified specialist for investigating jaundice

Every consultant is GMC-checked and independently reviewed. Search by postcode and distance, or switch to a map. Ordered by rating, relevance and recency — never by who pays.

How we made this page

Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →

Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.

Sources & standards: NHS — Jaundice in adults British Liver Trust — Tests, diagnosis and screening BSG/BASL — Guidelines on the management of abnormal liver blood tests British Liver Trust — Full liver screen blood tests Patient.info — Jaundice (professional reference) nidirect — Urgent and emergency care services nidirect — GP out-of-hours service

Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.

Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.