A 70-year-old woman presents with painless jaundice, pruritus, and a 10 kg weight loss over 3 months. On examination, a non-tender, palpable gallbladder is noted. Serum bilirubin is 12 mg/dL (predominantly conjugated), ALP 680 U/L. Abdominal ultrasound shows dilated intrahepatic and extrahepatic bile ducts with a mass at the head of pancreas. What eponymous sign explains the palpable non-tender gallbladder in this setting?
- A Murphy's sign
- B Courvoisier's sign ✓
- C Charcot's triad
- D Boas' sign
Explanation
Courvoisier's law states that in obstructive jaundice due to a periampullary or pancreatic head carcinoma, the gallbladder is palpable and non-tender because it distends progressively as the obstruction is gradual and the gallbladder wall is normal (not chronically inflamed). In contrast, jaundice from choledocholithiasis (gallstone) is usually associated with a chronically diseased, fibrosed gallbladder that cannot distend. Murphy's sign is inspiratory arrest on deep palpation in the right hypochondrium, characteristic of acute cholecystitis. Charcot's triad (fever, jaundice, RUQ pain) denotes ascending cholangitis. Boas' sign is referred pain to the right shoulder tip in acute cholecystitis.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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