Courvoisier sign !
- Sign
In someone with jaundice, a large gallbladder that can be felt and does not hurt points to a tumor blocking the bile duct, not to stones.
Updated 2026-11-01
See it in 3D: Gallbladder · Pancreas · Common bile duct · Cystic duct · Liver
What it is
Courvoisier sign (or law) states that in a jaundiced patient, a palpable, enlarged, painless gallbladder is unlikely to be caused by stones. Slow, progressive blockage of the distal bile duct, typical of cancer of the head of the pancreas or distal cholangiocarcinoma, distends a healthy gallbladder. Stones, in contrast, inflame the gallbladder over time and make it fibrotic and small, so it does not dilate.
The anatomy it tests
- The distal common bile duct passes through the head of the pancreas before entering the duodenum; a tumor there compresses it slowly.
- Retained bile raises pressure behind the blockage, dilates the cystic duct and distends a gallbladder whose wall is healthy and elastic.
- In chronic gallstone disease, repeated inflammation scars the gallbladder wall, which loses its elasticity and does not dilate.
How to elicit it
- Inspect the sclerae and skin for jaundice; ask about itching, dark urine, pale stools and weight loss.
- Patient supine with knees flexed; examiner on the right.
- Palpate the right hypochondrium gently, from below up to the costal margin, where the lateral border of the rectus crosses the margin (gallbladder point).
- Feel for a smooth, rounded, pear-shaped mass that moves down on inspiration, below the liver edge.
- Check whether the mass is tender; the sign requires that it is not.
- Tell it apart from the liver edge or a prominent liver lobe; record the finding and request imaging.
What a positive result means
- Positive: a palpable, distended, painless gallbladder in a jaundiced patient.
- Suggests malignant obstruction of the distal bile duct: cancer of the head of the pancreas, distal cholangiocarcinoma, ampullary or duodenal tumor.
- A negative sign does not rule out cancer: many distended gallbladders cannot be felt, especially in obesity.
- It does not apply if the gallbladder is tender (cholecystitis) or if there is no jaundice (for example Mirizzi syndrome or an isolated mucocele).
Usefulness and limits
- In words: reasonable specificity for malignant obstruction, low sensitivity because a large gallbladder is often not palpable.
- Ultrasound shows the distended gallbladder and the dilated bile ducts; CT or MRI define the cause.
Test yourself
Think of the answer, then tap the question to see it.
What does Courvoisier sign state?
In a jaundiced patient, a palpable, enlarged, painless gallbladder is probably not due to stones but to a distal, often malignant, obstruction.
Why do gallstones rarely produce a large, palpable gallbladder?
Chronic inflammation scars and shrinks the gallbladder wall, so it loses the ability to distend.
What is the most common cause of a positive Courvoisier sign?
Cancer of the head of the pancreas, which slowly compresses the distal common bile duct.
See it in 3D
The structures of Durgical's 3D anatomy where it is found.
Related
- Murphy sign
- Palpation of the liver and spleen
- Abdominal palpation: light and deep, guarding and masses
- Jaundice: prehepatic, hepatic and posthepatic
Related conditions
Educational content on the clinical exam; it is learned and practised under supervision. It does not replace assessment by a health professional and is not for self-diagnosis.
Sources: Courvoisier's law (Wikipedia, 2026); Pancreatic Cancer - Oncology - Merck Manual Professional Edition (Merck & Co., Inc., 2025).
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Representative model, for educational purposes only.