| Courvoisier's gallbladder: law or sign? | |
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MedLine Citation:
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PMID: 19190960 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Variously described as Courvoisier's law, sign, or even gallbladder, this eponymous "law" has been taught to medical students since the publication of Courvoisier's treatise in 1890. METHODS: We reviewed Courvoisier's original "law," the modern misconceptions surrounding it, and the contemporary evidence supporting and explaining his observations. RESULTS: Courvoisier never stated a "law" in the context of a jaundiced patient with a palpable gallbladder. He described 187 cases of common bile duct obstruction, observing that gallbladder dilatation seldom occurred with stone obstruction of the bile duct. The classic explanation for Courvoisier's finding is based on the underlying pathologic process. With the presence of gallstones come repeated episodes of infection and subsequent fibrosis of the gallbladder. In the event that a gallstone causes the obstruction, the gallbladder is shrunken owing to fibrosis and is unlikely to be distensible and, hence, palpable. With other causes of obstruction, the gallbladder distends as a result of the back-pressure from obstructed bile flow. However, recent experiments show that gallbladders are equally distensible in vitro, irrespective of the pathology, suggesting that chronicity of the obstruction is the key. Chronically elevated intraductal pressures are more likely to develop with malignant obstruction owing to the progressive nature of the disease. Gallstones cause obstruction in an intermittent fashion, which is generally not consistent enough to produce such a chronic rise in pressure. CONCLUSION: We hope that reminding clinicians of Courvoisier's actual observations will reestablish the usefulness of this clinical sign in the way he intended. |
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Authors:
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J Edward F Fitzgerald; Matthew J White; Dileep N Lobo |
Publication Detail:
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Type: Biography; Historical Article; Journal Article |
Journal Detail:
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Title: World journal of surgery Volume: 33 ISSN: 0364-2313 ISO Abbreviation: World J Surg Publication Date: 2009 Apr |
Date Detail:
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Created Date: 2009-03-16 Completed Date: 2009-07-16 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 7704052 Medline TA: World J Surg Country: United States |
Other Details:
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Languages: eng Pagination: 886-91 Citation Subset: IM |
Affiliation:
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Division of Gastrointestinal Surgery, Nottingham Digestive Diseases Centre Biomedical Research Unit, Nottingham University Hospitals, Queen's Medical Centre, Nottingham, NG7 2UH, UK. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Common Bile Duct Diseases
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pathology Dilatation, Pathologic Eponyms* Gallbladder / pathology History, 19th Century Humans Physical Examination / history* Portraits as Topic |
| Personal Name Subject | |
Personal Name Subject:
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Ludwig Georg Courvoisier |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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