“My wife says I’ve gone yellow — but I feel okay-ish”

PAINLESS jaundice (yellow sclera/skin, dark urine, pale stools, pruritus) with unintentional WEIGHT LOSS and anorexia in an older adult is a red-flag pattern for PANCREATIC (head of pancreas) or biliary/peri-ampullary cancer obstructing the bile duct — classically painless — and must NOT be accepted as "just the booze, cut down and review". NICE NG12: refer adults 40+ with jaundice on a suspected-cancer pathway (for pancreatic cancer), and arrange urgent direct-access CT (or ultrasound if CT unavailable) for suspected pancreatic cancer in those 60+ with weight loss and associated features, plus urgent LFTs/bloods. Exclude acute cholangitis (Charcot’s triad — fever/rigors, pain, jaundice ± confusion) which needs emergency admission, and safety-net for it. The examinable hidden agenda is alcohol-guilt-driven avoidance: he blames the drinking and would rather attribute it to something he can "fix" than face hospital tests, while his wife’s collateral concern is the reliable signal. Heed her, surface and address the fear and self-blame without colluding, handle alcohol proportionately without reducing the diagnosis to it or delaying the work-up, and ensure urgent imaging/referral happens.