A 70 - year old male presents with a C/O fatigue & jaundice. There is no H/O alcohol or liver disease. The liver and spleen are nonpalpable. He has a normocytic, normochromic anemia. The first step in evaluation of this patient is

The first step in evaluating patient with asymptomatic jaundice is to determine whether the increased bilirubin, as evidenced by scleral icterus, is conjugated or unconjugated hyperbilirubinemia. Patients with unconjugated hyperbilirubinemia do not have bilirubin in their urine because unconjugated bilirubin (bound to albumin) is not excreted in the urine; these patients usually have either hemolysis or an enzyme deficiency in the path way for excretion of bilirubin. Conjugated hyperbilirubinemia suggests liver dysfunction and requires fuher assessment