The causes of cholestasis range from intrinsic hepatocellular disease to extrahepatic mechanical obstruction of the bile tree. Gallstones are the most common cause of obstructive cholestasis, but it is not seldomly associated with malignant disease. A systematic approach to diagnosing cholestatic liver disease, including thorough patient history, clinical examination, lab-panels and proper use of imaging and treatment alternatives, starting from least invasive and most cost-effective, ensures efficient patient outcomes and minimises the risk of complications as summarised in this review.