A 60-year-old male presents with painless obstructive jaundice, dark urine, pale stools, and 8 kg unintentional weight loss over 2 months. Physical examination reveals a palpable, non-tender gallbladder (Courvoisier's sign). What is the most likely diagnosis?

Answer and explanation

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

  1. Step 1: Courvoisier's law states that in the presence of painless jaundice, a palpable non-tender gallbladder is unlikely to be due to gallstones, because chronic stone disease causes a fibrotic, contracted gallbladder.
  2. Step 2: It strongly suggests malignant obstruction of the common bile duct, most commonly adenocarcinoma of the head of the pancreas or periampullary tumor.
Answer
Adenocarcinoma of the head of the pancreas.
Why not the others: 'Choledocholithiasis with common bile duct impaction' typically causes painful jaundice and a shrunken fibrotic gallbladder; 'Acute acalculous cholecystitis' is a painful acute inflammatory illness seen in critically ill ICU patients; 'Hepatocellular carcinoma complicating cirrhosis' causes liver dysfunction and portal hypertension without isolated distal CBD cutoff.

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