Obstructive jaundice is a sign of intra- or posthepatic blockage of bile flow. This diagnosis has to be differentiated from various other diagnoses such as disorders of bilirubin metabolism or hepatocellular causes of jaundice. An accurate evaluation of the past medical history and clinical examination of the patient can already establish obstruction as the cause of jaundice in most cases. For prevention of a cholangitis further imaging procedures should focus on rapidly establishing the cause and the location of obstruction. Further therapeutic procedures are dependent on the type of obstruction and the condition of the patient. Most importantly there should be a decompression of the biliary tree with ES or PTBD.