A 50-year-old male with jaundice, dark urine, and pale stools undergoes abdominal ultrasound demonstrating marked dilation of the common bile duct and intrahepatic ducts with a distended, non-tender gallbladder (Courvoisier's sign). What is the most likely diagnosis?

Answer and explanation

Correct answer: C. Carcinoma of the head of the pancreas

  1. Step 1: Courvoisier's law states that in the presence of painless jaundice, an enlarged, palpably non-tender gallbladder is unlikely to be due to gallstones, because longstanding cholelithiasis causes chronic fibrosis that prevents gallbladder distention.
  2. Step 2: Instead, it strongly suggests malignant obstruction of the common bile duct, most commonly adenocarcinoma of the head of the pancreas or periampullary tumor.
Answer
Carcinoma of the head of the pancreas.
Why not the others: 'Acute calculus cholecystitis' produces an acutely tender, inflamed gallbladder with fever; 'Choledocholithiasis' usually features intermittent colicky biliary pain and a shrunken fibrotic gallbladder; 'Sclerosing cholangitis' produces strictures and beading without a distended thin-walled gallbladder.

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