A 62-year-old man presents with painless progressive jaundice, dark urine, pale stools, and weight loss. On examination he is deeply icteric and a smooth, non-tender, globular swelling is palpable in the right hypochondrium that moves with respiration. Which statement best explains this finding?

• A A palpable non-tender gallbladder in obstructive jaundice indicates chronic cholelithiasis
• B This finding occurs only when the obstruction is above the cystic duct
• C A palpable non-tender gallbladder in obstructive jaundice is unlikely to be caused by gallstones ✓
• D This finding rules out malignancy as the cause of jaundice

Explanation

This is Courvoisier's law: a palpable, non-tender gallbladder with jaundice is unlikely to be due to gallstones. Stones causing obstructive jaundice arise in a chronically inflamed, fibrotic gallbladder that cannot distend, whereas malignant obstruction at the lower end of the bile duct allows progressive painless distension of a healthy gallbladder. The usual cause is periampullary or head of pancreas carcinoma. Obstruction must be distal to the cystic duct for the gallbladder to fill, which eliminates option B.

Reference: Bailey and Love's Short Practice of Surgery, 28th ed.

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Written and medically reviewed by the StethoPrep medical team.