[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Clinical exam](https://durgical.com/en/clinical-exam/) › [Abdomen](https://durgical.com/en/clinical-exam/#a-abdomen) › Courvoisier sign [Clinical exam](https://durgical.com/en/clinical-exam/) · [Abdomen](https://durgical.com/en/clinical-exam/#a-abdomen) # 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](https://durgical.com/en/anatomy/gallbladder/) · [Pancreas](https://durgical.com/en/anatomy/pancreas/) · [Common bile duct](https://durgical.com/en/anatomy/bile-duct/) · [Cystic duct](https://durgical.com/en/anatomy/cystic-duct/) · [Liver](https://durgical.com/en/anatomy/liver/) ## Key points - Jaundice plus a palpable, large, painless gallbladder: non-stone distal bile duct obstruction, above all cancer of the head of the pancreas. - Chronic stones leave a fibrotic, shrunken gallbladder that does not distend. - Classic exception: one stone in the cystic duct (mucocele) together with another in the common bile duct. - A tender palpable gallbladder suggests cholecystitis, not Courvoisier. - It is not the same as pancreatic cancer: that is the most common cause, but distal cholangiocarcinoma and ampullary tumors also cause it. ## 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. ## Memory aid Old stones shrink the bag; a slow tumor inflates it without pain. ## 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. [Add to my cards (3)](https://durgical.app/estudiar/?add=/en/clinical-exam/courvoisier-sign/) ## See it in 3D The structures of Durgical's 3D anatomy where it is found. - [Gallbladder](https://durgical.com/en/anatomy/gallbladder/) - [Pancreas](https://durgical.com/en/anatomy/pancreas/) - [Common bile duct](https://durgical.com/en/anatomy/bile-duct/) - [Cystic duct](https://durgical.com/en/anatomy/cystic-duct/) - [Liver](https://durgical.com/en/anatomy/liver/) ## Related - [Murphy sign](https://durgical.com/en/clinical-exam/murphy-sign/) - [Palpation of the liver and spleen](https://durgical.com/en/clinical-exam/palpation-of-the-liver-and-spleen/) - [Abdominal palpation: light and deep, guarding and masses](https://durgical.com/en/clinical-exam/abdominal-palpation-light-and-deep-guarding-and-masses/) - [Jaundice: prehepatic, hepatic and posthepatic](https://durgical.com/en/clinical-exam/jaundice-prehepatic-hepatic-and-posthepatic/) ## Related conditions - [Pancreatic cancer](https://durgical.com/en/conditions/pancreatic-cancer/) - [Cholangiocarcinoma (bile duct cancer)](https://durgical.com/en/conditions/cholangiocarcinoma/) - [Gallstones (cholelithiasis)](https://durgical.com/en/conditions/gallstones/) [← All of the clinical exam](https://durgical.com/en/clinical-exam/) 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](https://en.wikipedia.org/wiki/Courvoisier%27s_law) (Wikipedia, 2026); [Pancreatic Cancer - Oncology - Merck Manual Professional Edition](https://www.merckmanuals.com/professional/gastrointestinal-disorders/tumors-of-the-gastrointestinal-tract/pancreatic-cancer) (Merck & Co., Inc., 2025). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/clinical-exam/courvoisier-sign/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/clinical-exam/courvoisier-sign/