PAEA Surgery End Of Rotation (EOR) Practice Exam

Couvoisier's sign is associated with what condition?

1. Acute pancreatitis

2. Pancreatic carcinoma

3. Cholecystitis

4. Pseudocyst rupture

The correct answer is: Pancreatic carcinoma

Couvoisier's sign refers to the presence of a palpable gallbladder in the context of obstructive jaundice caused by a distended gallbladder. This sign is primarily associated with the obstruction of the bile duct, which can occur due to several conditions, but it is most famously linked to pancreatic carcinoma. In pancreatic carcinoma, particularly when the cancer is located in the head of the pancreas, the tumor can obstruct the common bile duct. This obstruction leads to bile accumulation and consequently causes the gallbladder to enlarge, making it palpable on physical examination. In such cases, the gallbladder may appear enlarged but is not tender, distinguishing it from conditions where gallbladder inflammation (like acute cholecystitis) would typically cause tenderness. Therefore, Couvoisier's sign being present suggests a malignant process, especially when most commonly observed with pancreatic cancer, reinforcing the importance of considering this sign in patients suspected of having obstructive jaundice due to underlying malignancy.