Background and objective: Obstructive jaundice (OJ) and acute cholangitis (AC) are common presentations of biliary obstruction. In Eastern India, data regarding the causes of OJ and AC are scarce. This study aimed to determine the etiological spectrum of OJ and AC in a tertiary center in Eastern India. Materials and methods: The data of consecutive patients admitted to the Department of Gastroenterology from January 2021 to December 2023 with a diagnosis of OJ with or without AC was collected from the hospital’s computerized database. The data were analyzed for different etiologies of OJ and AC. The results were compared with the various etiologies of OJ reported in previous publications from different centers across India. Results: Totally 772 patients were admitted during this period with a diagnosis of OJ with or without AC. There were 368 male and 404 female patients with a male-to-female ratio of 0.91. In 454 (58.8%) and 309 (41.2%) cases, the etiology of OJ was benign biliary obstruction (BBO) and malignant biliary obstruction (MBO), respectively. The etiologies of BBO-associated OJ were choledocholithiasis (51%) and distal biliary stricture (9%). The causes of MBO-associated OJ were gallbladder cancer (GBC) (21%), periampullary malignancy (10.2%), cholangiocarcinoma (CCA) (5.3%), and carcinoma head of the pancreas (3.4%). Acute cholangitis was observed in 203 (26.2%) with OJ; 23% and 10% of cases of BBO-associated OJ and MBO-associated OJ had AC, respectively. BBOs that presented with AC were choledocholithiasis (50.24%) and distal biliary stricture (14.77%). Similarly, MBOs that presented with AC were GBC (16.74%), periampullary malignancy (10.34%), CCA (6.4%), and carcinoma head of the pancreas (0.0098%). Conclusion: Among the etiologies of AC and OJ, BBOs were more common than MBOs. The most common cause of OJ was choledocholithiasis. Gallbladder cancer was the second most common cause of OJ and the most common cause of malignancy-associated OJ. The most common benign and malignant etiologies of AC were choledocholithiasis and GBC, respectively.