A 64-year-old patient has been hospitalized with complaints of progressive jaundice that developed over 3 weeks without pain syndrome and is accompanied by general weakness and loss of appetite. Objectively: temperature is 36,8°C, heart rate is 78/min, abdomen is soft and painless, peritoneum irritation symptoms are not detected, palpation reveals sharply enlarged tense gallbladder. What disease can be characterized by these symptoms?

Answer options

1. Cancer of pancreas head
2. Chronic cholecystitis
3. Acute cholecystitis
4. Cholecystitis caused by lambliasis
5. Duodenal ulcer

Explanation

Courvoisier’s sign (or law) describes an enlarged, palpable gallbladder inpatient with obstructive jaundice caused by tumors of the biliary tree or by pancreatic head tumors. This kind of biliary obstruction evolves slowly.The gall bladder will be dilated, with a thin wall; it is not tender to the touch. By contrast, acute cholecystitis due to obstruction by stone(s) is a quick process that causes a dilated gall bladder that is tender to the touch (Murphy’s sign).The inflammation of chronic cholelithiasis results in a shrunken, fibrotic gallbladder.Courvoisier's sign can be found in patients withbiliary tumors (cholangiocarcinoma).periampullary carcinoma (adenocarcinoma of Vater papilla or duodenum);pancreatic head cancer.lymph node metastasis in the porta hepatis. Harrison’s Principles of Internal Medicine / KASPER, Dennis L – FAUCI, Anthony S – LONGO, Dan L., et al. – 16th edition. – New York: McGraw-Hill Companies, Inc., 2005. – 2607 p. – P. 537.