mjl1717
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When you see a + Courvoisier sign, extrememly elevated alkaline phosphatase, total bilirubin and ALT (all 3 ) bilirubin in the urine, negative urobilinogen, epigastric pain after eating and jaundice, what ds should be high on the list?
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| asmi
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pancreatic cancer (head of pancreas)
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| shawn333
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since it is not painless , so it is not the pancreatic carcinoma .It is gall stone . it is not cholisistitis becasue the murphy sign is not present ,
rida am i right ?
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| mjl1717
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muy bien!  I didnt even mention that he had 20lb weight loss, clay colored stools, and a smoker. [Asmi is correct and that was fast]
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| asmi
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Thanks mjl  .
What is muy bien ?
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| Renegade
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"shawn333" wrote:
since it is not painless
Head of pancreas adenocarcinoma might give epigastric pain... Courvoisier gallblader is, by definition, painless.
BTW, I'd answer periampular carcinoma... duodenum/bile duct carcinomas may also be responsible for those problems. Pancreatic is the most frequent, though.
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| mjl1717
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very good
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| mani
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shawn333 look at the exact wording of courvoiser's law and then see what u said.
" in a jaundiced pt a palpable gall bladder cant be due to stone"
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| hiwa
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we cant apply courv. law it is only used when the jaundice is painless, otherwise the answer is pancreatic ca,
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| mani
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hiwa, i m sure the doesnt include painful or painless. see, it says "it is NOT DUE TO STONE" but it doesnt specify the cause, rather it excludes stones as cause
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| hiwa
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It says if jaundice painless, palpate GB if palpable---> it is not GS
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| Renegade
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Courvoisier's bladder is never painful
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