A 60-year-old male smoker presents with a 2-month history of painless, progressive jaundice, pale clay-colored stools, and dark urine. On palpation, a non-tender, distended gallbladder is felt in the right hypochondrium (Courvoisier sign). What is the most likely diagnosis?

Answer and explanation

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

  1. Step 1: Courvoisier's law states that the presence of an enlarged, non-tender, palpable gallbladder in the setting of obstructive jaundice is unlikely to be gallstones and suggests malignant obstruction of the common bile duct.
  2. Step 2: Adenocarcinoma of the pancreatic head is the classic and most frequent cause.
Answer
Adenocarcinoma of the head of the pancreas.
Why not the others: 'Chronic cholecystitis with cholelithiasis' causes fibrotic scarring that prevents gallbladder distension; 'Hepatocellular carcinoma' presents with painful hepatomegaly in a cirrhotic liver without Courvoisier gallbladder; 'Acute viral hepatitis A' causes tender hepatomegaly with transaminitis rather than malignant ductal obstruction.

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