A 58-year-old man presents with painless progressive jaundice, dark urine, pale stools, and a 6 kg weight loss over 2 months. On examination a non-tender, palpable gallbladder is felt in the right upper quadrant. CA 19-9 is markedly elevated. CT abdomen shows a mass in the head of the pancreas with bile duct dilatation but no distant metastases or vascular involvement. Which clinical sign is best described by the palpable gallbladder in this context?
- A Murphy's sign
- B Boas' sign
- C Courvoisier's sign ✓
- D Rovsing's sign
Explanation
Courvoisier's sign (or law) states that in the presence of obstructive jaundice, a palpable non-tender gallbladder is unlikely to be due to gallstones (which cause a fibrotic, non-distensible gallbladder) and suggests malignant obstruction of the bile duct, most commonly carcinoma of the head of the pancreas. Murphy's sign is a pause in inspiration on palpation of the right upper quadrant due to acute cholecystitis. Boas' sign is right subscapular hyperaesthesia in acute cholecystitis. Rovsing's sign is right iliac fossa pain on palpation of the left iliac fossa in appendicitis.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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