Patient was a 68-year-old male who complained of weight loss, boring pain in right
hypochondrium, skin itching, discharge of acholic faeces and deep-brown urine.
Inspection showed icteric scleras and greenish-yellow colour of the skin. Palpation
of abdomen revealed enlarged soft-elastic tender gallbladder in its point.
What type of jaundice did the patient have?
What is the most probable cause of this jaundice?
Name the symptom revealed by palpation of gallbladder.
List additional methods and their possible results that confirm the type of
jaundice recognized by you.
Type of jaundice: Obstructive (cholestatic) jaundice
Most probable cause:pancreatic carcinoma
Symptom revealed by palpation of gallbladder: Courvoisier’s sign – enlarged, non-tender gallbladder
Ultrasound: dilated bile ducts, mass in pancreas
CT/MRI: confirms mass and obstruction
MRCP/ERCP: visualizes bile duct blockage
Liver function tests: increased conjugated bilirubin, ALP, GGT
Tumor marker: raised CA 19-9
The patient is likely experiencing obstructive jaundice. The most probable cause is a blockage in the common bile duct, potentially due to gallstones or a tumor. The palpable, tender, enlarged gallbladder is known as Murphy’s sign. Additional tests like an abdominal ultrasound, blood tests, and possibly ERCP can confirm the obstruction.