What initial investigations should I perform for a patient presenting with jaundice and suspected cholestasis?

Initial investigations for a patient presenting with jaundice and suspected cholestasis should include:

• Blood tests: Liver function tests (LFTs) to assess bilirubin levels (total and direct), alkaline phosphatase, gamma-glutamyl transferase (GGT), alanine aminotransferase (ALT), and aspartate aminotransferase (AST) to characterise the pattern of liver injury and confirm cholestasis ¹.
• Full blood count and coagulation profile: To evaluate for any associated anaemia, infection, or coagulopathy ¹.
• Serological tests: Viral hepatitis screening (including hepatitis B and C) should be performed to exclude infectious causes of cholestasis ¹,².
• Imaging: Abdominal ultrasound is the first-line imaging modality to assess biliary tree anatomy, detect bile duct dilatation, gallstones, or masses causing obstruction ¹.
• Additional tests: In neonatal or pediatric cases, further specialised tests such as serum alpha-1 antitrypsin, metabolic screening, and genetic tests may be indicated depending on clinical suspicion (Götze et al., 2015).

This integrated approach aligns with UK guidelines emphasising initial blood and imaging investigations to confirm cholestasis and identify obstructive causes, while the literature highlights the importance of tailored additional tests in specific populations such as neonates (Götze et al., 2015) ¹,².