1. PTC 2. ERCP -3. Ultrasound4. Liver biopsy-Intravenous contrast may not filter trough the liver due to obstruction but more importantly, IVcontrast can cause renal damage with obstructive jaundice, this is further complicated by hepato renal syndrome. Percutaneous transhepatic cholangiography (ptc) is localised injection of contrast into the biliary system and will localise an obstructing lesion. ERCPis diagnostic as well as therapeutic allowing removal of stones, sphinterotomy and stent insertion for drainage of bile. Ultrasound will show the presence of stones, size of cbd and any extra or intrahepatic duct dilation the latter requiring more urgent therapy due to risk of infection and sepsis. Liver biopsy can be used to diagnose the cause and will confirm diagnosis of cirrhosis. But it must be done after correction of clotting in obstructive jaundice!
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