ABSTRACT
In developed countries, jaundice in patients with terminal illness is most commonly encountered in advanced malignancy. Jaundice caused by extensive tumor infiltration of the liver by primary liver cancer or intrahepatic metastases is a sign of very extensive dysfunction and it is usually accompanied by other features of liver failure. Clinical evaluation often yields substantial information in the assessment of the cancer patient who presents with jaundice. Imaging studies help one to identify the presence or absence of intrahepatic metastases, the presence of intrahepatic or extrahepatic cholestasis, and the site of obstruction if present. Patients with biliary obstruction at the bifurcation of the hepatic ducts present a difficult challenge, and there is much controversy as to the importance of establishing drainage of both liver lobes in malignant hilar obstruction. Pruritus may occur with any type of liver disease but is primarily associated with acute or chronic cholestasis.
