The following in not a feature of common bile duct stones: (AIIMS Nov 2011)
|B||Distended gall bladder|
|D||Clay colored stools|
a. Courvoisier's law (or Courvoisier syndrome, or Courvoisier's sign or Courvoisier-Terrier's sign) states that in the presence of an enlarged gallbladder which is nontender and accompanied with mild jaundice, the cause is unlikely to be gallstones.
b. This shrunken gallbladder is less likely to be palpable on exam. In contrast, the gallbladder is more often enlarged (and more easily palpated) in pathologies that cause obstruction of the biliary tree over a shorter period of time such as pancreatic malignancy leading to passive distention from backpressure.
c. Note that a palpable tender gallbladder may be seen in acute acalculouscholecystitis, which commonly follows trauma or ischemia and causes acute inflammation of the gallbladder in the absence of gallstones.
d. Exceptions to Courvoisier's law implies that a stone IS responsible for jaundice and a non-tender, palpable gall bladder.
e. Typically gall bladder stones form slowly which allow time for the gall bladder to become tender.
f. The exceptions to the law are stones that dislodge and acutely jam the duct distally to the hepatic/cystic duct junction:
i. Gallstone falling and blocking the Ampula of Vater
ii. Gallstone falling and cystic/hepatic duct junction
g. Cholangiocarcinoma, Klatskin tumors, ascariasis, or oriental hepatitis are not exceptions to the law because they all fall under it.
h. The law simply says that jaundice and non-tender, palpable gall bladders are caused by other things than chronic bile stone formation.
i. The law does not say that these symptoms automatically mean pancreatic cancer.