Gallbladder cancer physical examination: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Gallbladder cancer}} | {{Gallbladder cancer}} | ||
{{CMG}} ; {{AE}} {{VKG}} | |||
== Overview == | == Overview == | ||
Patients with [[gallbladder cancer]] usually appear [[asymptomatic]]. Physical examination of patients with gallbladder cancer is usually remarkable for nonspecific symptoms that are due to [[cholelithiasis]] or [[cholecystitis]]. The preoperative diagnosis rate for gallbladder cancer was only 10 to 15 percent | Patients with [[gallbladder cancer]] usually appear [[asymptomatic]]. Physical examination of patients with [[gallbladder cancer]] is usually remarkable for nonspecific symptoms that are due to [[cholelithiasis]] or [[cholecystitis]]. The preoperative diagnosis rate for [[gallbladder cancer]] was only 10 to 15 percent. | ||
== Physical Examination == | == Physical Examination == | ||
* Physical examination of patients with gallbladder cancer is usually non specific or most oftenly asymptomatic.<ref name="pmid19190960">{{cite journal |vauthors=Fitzgerald JE, White MJ, Lobo DN |title=Courvoisier's gallbladder: law or sign? |journal=World J Surg |volume=33 |issue=4 |pages=886–91 |year=2009 |pmid=19190960 |doi=10.1007/s00268-008-9908-y |url=}}</ref><ref name="pmid28874964">{{cite journal |vauthors=Agrawal S, Vohra S |title=Simultaneous Courvoisier's and double duct signs |journal=World J Gastrointest Endosc |volume=9 |issue=8 |pages=425–427 |year=2017 |pmid=28874964 |pmc=5565509 |doi=10.4253/wjge.v9.i8.425 |url=}}</ref><ref name="pmid22630101">{{cite journal |vauthors=Memon AA, Soomro MI, Soomro QA |title=Courvoisier's law revisited |journal=J Coll Physicians Surg Pak |volume=22 |issue=6 |pages=392–4 |year=2012 |pmid=22630101 |doi=06.2012/JCPSP.392394 |url=}}</ref><ref name="pmid24364089">{{cite journal |vauthors=Gorelik O, Shteinschnaider M, Cohen N, Almoznino-Sarafian D |title=[Visible Courvoisier's sign: a rare presentation of bile duct obstruction] |language=Hebrew |journal=Harefuah |volume=152 |issue=9 |pages=516–7, 565 |year=2013 |pmid=24364089 |doi= |url=}}</ref><ref name="pmid19864733">{{cite journal |vauthors=Munzer D |title=Assessment of Courvoisier's law |journal=Saudi J Gastroenterol |volume=5 |issue=3 |pages=106–12 |year=1999 |pmid=19864733 |doi= |url=}}</ref> | * Physical examination of patients with [[gallbladder cancer]] is usually non specific or most oftenly asymptomatic.<ref name="pmid19190960">{{cite journal |vauthors=Fitzgerald JE, White MJ, Lobo DN |title=Courvoisier's gallbladder: law or sign? |journal=World J Surg |volume=33 |issue=4 |pages=886–91 |year=2009 |pmid=19190960 |doi=10.1007/s00268-008-9908-y |url=}}</ref><ref name="pmid28874964">{{cite journal |vauthors=Agrawal S, Vohra S |title=Simultaneous Courvoisier's and double duct signs |journal=World J Gastrointest Endosc |volume=9 |issue=8 |pages=425–427 |year=2017 |pmid=28874964 |pmc=5565509 |doi=10.4253/wjge.v9.i8.425 |url=}}</ref><ref name="pmid22630101">{{cite journal |vauthors=Memon AA, Soomro MI, Soomro QA |title=Courvoisier's law revisited |journal=J Coll Physicians Surg Pak |volume=22 |issue=6 |pages=392–4 |year=2012 |pmid=22630101 |doi=06.2012/JCPSP.392394 |url=}}</ref><ref name="pmid24364089">{{cite journal |vauthors=Gorelik O, Shteinschnaider M, Cohen N, Almoznino-Sarafian D |title=[Visible Courvoisier's sign: a rare presentation of bile duct obstruction] |language=Hebrew |journal=Harefuah |volume=152 |issue=9 |pages=516–7, 565 |year=2013 |pmid=24364089 |doi= |url=}}</ref><ref name="pmid19864733">{{cite journal |vauthors=Munzer D |title=Assessment of Courvoisier's law |journal=Saudi J Gastroenterol |volume=5 |issue=3 |pages=106–12 |year=1999 |pmid=19864733 |doi= |url=}}</ref> | ||
* Physical examination of patients with gallbladder cancer is usually remarkable for symptoms that are due to [[cholelithiasis]] or [[cholecystitis]]. | * Physical examination of patients with [[gallbladder cancer]] is usually remarkable for symptoms that are due to [[cholelithiasis]] or [[cholecystitis]]. | ||
=== Appearance of the Patient === | === Appearance of the Patient === | ||
* Patients with gallbladder cancer usually appear [[Anorexia|anorexic]]. | * Patients with [[gallbladder cancer]] usually appear [[Anorexia|anorexic]]. | ||
===Vital Signs=== | ===Vital Signs=== | ||
*[[Fever]] | *[[Fever]] | ||
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*Yellowish discoloration of skin in severe [[jaundice]] | *Yellowish discoloration of skin in severe [[jaundice]] | ||
=== Abdominal Examination === | === Abdominal Examination === | ||
* Right upper quadrant abdominal tenderness | * Right upper quadrant abdominal [[Tenderness (medicine)|tenderness]] | ||
* '''[[Courvoisier's sign]]''': also called Courvoisier's Law is a | * '''[[Courvoisier's sign]]''': also called Courvoisier's Law is a sign of [[malignancy]] either [[pancreatic]] or of [[gallbladder]] origin rather than a sigh of [[cholelithiasis]].<ref name="pmid19190960" /> | ||
* '''[[Mirizzi's syndrome|Mirizzi syndrome]]''': when gallbladder cancer invades biliary tree or the region of the [[Hepatoduodenal ligament|hepatoduodenal]] ligament, | * '''[[Mirizzi's syndrome|Mirizzi syndrome]]''': when [[gallbladder cancer]] invades biliary tree or the region of the [[Hepatoduodenal ligament|hepatoduodenal]] ligament, patients present with [[Obstructive jaundice|obstructive]] jaundice.The presence of obstructive [[jaundice]] on is highly suggestive of compression of the [[common hepatic duct]] due to impacted stone in the [[gallbladder]] neck.<ref name="pmid6721287">{{cite journal |vauthors=Witte CL |title=Choledochal obstruction by cystic duct stone. Mirizzi's syndrome |journal=Am Surg |volume=50 |issue=5 |pages=241–3 |year=1984 |pmid=6721287 |doi= |url=}}</ref><ref name="pmid7434217">{{cite journal |vauthors=Starling JR, Matallana RH |title=Benign mechanical obstruction of the common hepatic duct (Mirizzi syndrome) |journal=Surgery |volume=88 |issue=5 |pages=737–40 |year=1980 |pmid=7434217 |doi= |url=}}</ref> | ||
* The presence of palpable mass, [[ascites]] or [[Paraneoplastic syndrome|paraneoplastic]] syndromes like [[acanthosis nigricans]] on physical examination is most likely suggestive of | * The presence of palpable mass, [[ascites]] or [[Paraneoplastic syndrome|paraneoplastic]] syndromes like [[acanthosis nigricans]] on physical examination is most likely suggestive of extra abdominal [[Metastasis|metastases]]. | ||
==References== | ==References== | ||
Latest revision as of 14:38, 9 January 2019
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Vamsikrishna Gunnam M.B.B.S [2]
Overview
Patients with gallbladder cancer usually appear asymptomatic. Physical examination of patients with gallbladder cancer is usually remarkable for nonspecific symptoms that are due to cholelithiasis or cholecystitis. The preoperative diagnosis rate for gallbladder cancer was only 10 to 15 percent.
Physical Examination
- Physical examination of patients with gallbladder cancer is usually non specific or most oftenly asymptomatic.[1][2][3][4][5]
- Physical examination of patients with gallbladder cancer is usually remarkable for symptoms that are due to cholelithiasis or cholecystitis.
Appearance of the Patient
- Patients with gallbladder cancer usually appear anorexic.
Vital Signs
Skin
Abdominal Examination
- Right upper quadrant abdominal tenderness
- Courvoisier's sign: also called Courvoisier's Law is a sign of malignancy either pancreatic or of gallbladder origin rather than a sigh of cholelithiasis.[1]
- Mirizzi syndrome: when gallbladder cancer invades biliary tree or the region of the hepatoduodenal ligament, patients present with obstructive jaundice.The presence of obstructive jaundice on is highly suggestive of compression of the common hepatic duct due to impacted stone in the gallbladder neck.[6][7]
- The presence of palpable mass, ascites or paraneoplastic syndromes like acanthosis nigricans on physical examination is most likely suggestive of extra abdominal metastases.
References
- ↑ 1.0 1.1 Fitzgerald JE, White MJ, Lobo DN (2009). "Courvoisier's gallbladder: law or sign?". World J Surg. 33 (4): 886–91. doi:10.1007/s00268-008-9908-y. PMID 19190960.
- ↑ Agrawal S, Vohra S (2017). "Simultaneous Courvoisier's and double duct signs". World J Gastrointest Endosc. 9 (8): 425–427. doi:10.4253/wjge.v9.i8.425. PMC 5565509. PMID 28874964.
- ↑ Memon AA, Soomro MI, Soomro QA (2012). "Courvoisier's law revisited". J Coll Physicians Surg Pak. 22 (6): 392–4. doi:06.2012/JCPSP.392394 Check
|doi=value (help). PMID 22630101. - ↑ Gorelik O, Shteinschnaider M, Cohen N, Almoznino-Sarafian D (2013). "[Visible Courvoisier's sign: a rare presentation of bile duct obstruction]". Harefuah (in Hebrew). 152 (9): 516–7, 565. PMID 24364089.
- ↑ Munzer D (1999). "Assessment of Courvoisier's law". Saudi J Gastroenterol. 5 (3): 106–12. PMID 19864733.
- ↑ Witte CL (1984). "Choledochal obstruction by cystic duct stone. Mirizzi's syndrome". Am Surg. 50 (5): 241–3. PMID 6721287.
- ↑ Starling JR, Matallana RH (1980). "Benign mechanical obstruction of the common hepatic duct (Mirizzi syndrome)". Surgery. 88 (5): 737–40. PMID 7434217.