Courvoisier's sign, a palpable non-tender gallbladder in a jaundiced patient, is most suggestive of which condition?

• A. Pancreatic cancer
• B. Cholangitis
• C. Gallbladder carcinoma
• D. Hepatocellular carcinoma

Answer: (A)

Courvoisier's sign reflects painless jaundice with a palpable, non-tender gallbladder due to malignant obstruction of the biliary tree, typically from a tumor blocking the distal common bile duct. When a cancer in the head of the pancreas grows, it presses on and obstructs the lower bile duct, causing bile to back up and the gallbladder to distend without inflammation. The gallbladder becomes enlarged and palpable, but since the obstruction is gradual, it is not inflamed, so there is no tenderness.

This pattern—painless jaundice with a distended, non-tender gallbladder—is most classically associated with pancreatic head cancer, which is the commonest cause of such obstructive physiology. Other causes can present similarly but are less fitting: cholangitis would usually have fever and a tender or inflamed gallbladder; gallbladder carcinoma can cause obstructive signs but is less likely to present with a palpable gallbladder in the context of jaundice; hepatocellular carcinoma tends to cause liver dysfunction with hepatomegaly rather than a distended gallbladder from distal obstruction.