phuluong2k
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Be cause in gall stones the obstruction is intermittent, not gradual & constant as in cancer
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| chemamr
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although in some cases you can palpate the gallbladder in patients with choledocolithiasis. But classically itīs related with pancreatic cancer (and for USMLE purposes).
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| Renegade
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This revers to Courvoisier Law... Courvoisier himself thought of an explanation for the phenomenon, but it was wrong (I forgot what it was). Apparently most kinds of cancer cause obstrution fast enough for the bladder to distend, while the slow, intermittent obstruction of stones causes bladder fibrosis (not dilated).
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| chemamr
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what i wrote is based in my clinical experience, not in a book. (i forgot to say it).
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| drkpp
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in my med school they taught us that if its a gallstone disease it usually is chronic and most patients wld have suffered from recurrent infections and inflammations leading to fibrosis and shrinkage of gallbladder unlike in the case of pan. ca.
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| ARJ
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I think Renegade, drkpp are right.........................
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| chemamr
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yes drkpp, thatīs correct. In real life there are patients with cholelythiasis or choledocolythiasis with small gallbladder (with fibrosis: by the way, very difficult to remove) but most of them arenīt small, they are inflammed, dilated, even you can palpate them in some cases. But again, thatīs my clinical experience only, not based in a book. But i guess that for USMLE purposes you should think like renegade or phuluong about this question.
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| ARJ
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Thanks Chemamr and all of you guys.................
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