Question
A patient presented with anorexia, epigastric pain, jaundice, and pruritis for 2 years. Gallbladder palpable. What is the likely diagnosis?
| A. |
Gall bladder carcinoma |
| B. |
Hepatocellular carcinoma (HCC) |
| C. |
Cholelithiasis |
| D. |
Carcinoma head of pancreas |
|
Correct Answer » D Explanation |
 |
– A palpable gallbladder in jaundice suggests malignant biliary obstruction, not gallstones (Courvoisier’s law).
– Mechanism: tumor compresses common bile duct → bile buildup → gallbladder distends & becomes palpable.
– Carcinoma of the pancreatic head typically causes:
• Obstructive jaundice
• Pruritus from bile salt deposition
• Painless or mild epigastric pain
• Palpable gallbladder
• Weight loss/anorexia
– These signs point to a pancreatic head tumor blocking the bile duct.
Incorrect Options:
A. Gallbladder carcinoma – usually with RUQ pain, gallbladder mass, often gallstones; gallbladder often contracted, not distended palpable.
B. Hepatocellular carcinoma – features chronic liver disease, hepatomegaly, ascites, ↑AFP; gallbladder distension not typical.
C. Cholelithiasis – causes biliary colic & acute cholecystitis; repeated inflammation → fibrotic, contracted gallbladder; palpable gallbladder with jaundice rare per Courvoisier’s law.