What follow-up investigations are recommended for adults with unexplained jaundice after initial assessment?

Follow-up investigations for adults with unexplained jaundice after initial assessment include:

• Referral for urgent imaging, typically an abdominal ultrasound, to assess for obstructive causes or malignancy such as pancreatic cancer, especially in adults aged 40 and over.
• Consideration of a suspected cancer pathway referral if jaundice is unexplained and the patient is aged 40 or over, to exclude pancreatic or other hepatobiliary cancers.
• Blood tests including liver function tests, hepatitis serology (hepatitis B surface antigen, hepatitis C antibody), and other relevant viral markers to exclude infectious causes.
• Additional laboratory tests such as serum alpha-fetoprotein and hepatic ultrasound if chronic liver disease or hepatocellular carcinoma is suspected.
• Referral to a hepatologist or gastroenterologist if hepatitis B surface antigen positive or if decompensated liver disease is present.

These steps ensure timely diagnosis of serious underlying causes such as malignancy or chronic viral hepatitis and guide appropriate specialist referral and management.

References: NICE CG165, NICE NG12