How can I differentiate between obstructive and hepatocellular causes of jaundice based on laboratory results?

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 14 August 2025Updated: 14 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

To differentiate between obstructive and hepatocellular causes of jaundice based on laboratory results, focus on the pattern of liver function tests (LFTs), specifically bilirubin in conjunction with alkaline phosphatase (ALP) and alanine transaminase (ALT) .

  • Obstructive or Cholestatic Jaundice: This picture is indicated by raised bilirubin in conjunction with a raised alkaline phosphatase (ALP) . People presenting with this pattern on LFTs should be referred to an upper gastrointestinal surgeon, gastroenterologist, or liver clinic, with the urgency determined by clinical judgement .
  • Hepatocellular or Hepatitic Jaundice: This picture is indicated by raised bilirubin in conjunction with a raised alanine transaminase (ALT) . People with a hepatitic picture on LFTs should be referred urgently to a liver clinic or gastroenterologist .

It is important to note that all people with unexplained jaundice should be referred immediately for urgent investigation and treatment, as it often indicates a serious underlying illness .

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