Gallbladder
Courvoisier's law states that a palpable, non-tender gallbladder with jaundice is unlikely to be due to gallstones, and points to a malignant obstruction such as carcinoma of the head of the pancreas.
What our notes say
- Courvoisier's law states that a palpable, non-tender gallbladder with jaundice is unlikely to be due to gallstones, and points to a malignant obstruction such as carcinoma of the head of the pancreas. (Surgery Question Bank: 12 Clinical MCQs)
- | Gallbladder | Larger, empties slowly; cholestasis is almost physiological | Gallstones and intrahepatic cholestasis of pregnancy | (Physiological changes in pregnancy)
- The gallbladder is opened to reveal ten multifaceted 0.5 to 1 cm diameter dark, greenish-black gallstones. (Gastrointestinal and liver — Past Paper Questions & Answers)
- Gallbladder hypotonia and more lithogenic bile raise the risk of gallstones and cholestasis. (Reproductive Health 1 End of Trimester CAT: November 2018)
- CT or MRI show the same features plus a widened fissure and gallbladder fossa. (Internal Medicine CAT 1 (MBIM 6112), 2019/2020: gastroenterology and hepatology,)
- Acute and chronic cholecystitis; empyema and mucocele of the gallbladder. (Internal Medicine CAT 1 (MBIM 6112), 2019/2020: gastroenterology and hepatology,)
Study material on Gallbladder
- Internal Medicine CAT 1 (MBIM 6112), 2019/2020: gastroenterology and hepatology, 30 MCQs and 4 short answers
- CNS & Abdominal Exam: Clinical Techniques, History & Neurology
- Gastrointestinal and liver
- LECTURE 7: GI tract Hormones
- Pancreatic Disorders: A Comprehensive Review
- Liver Histology & Physiology
- Liver Histology & Physiology
- Surgery Question Bank: 12 Clinical MCQs
- GASTROINTESTINAL PATHOLOGY (Part 2)
- MCQ: GASTROINTESTINAL PATHOLOGY — 60 MCQs (Redistributed Answers)
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Practice questions on Gallbladder
A major part of gallbladder contractions are due to:
- A. Secretin.
- B. Gastrin.
- C. Vagal stimulation and Cholecystokinin (CCK).
- D. Somatostatin.
Answer: C. Gallbladder contraction is primarily stimulated by Cholecystokinin (CCK), released in response to fats and proteins in the duodenum. Vagal (parasympathetic) stimulation also contributes to gallbladder contraction. Secretin primarily stimulates bicarbonate secretion. Gastrin stimulates gastric acid. Somatostatin is inhibitory.
Which of the following hormones stimulates the gallbladder to release bile?
- Enterokinase
- Secretin
- Cholecystokinin
- Gastrin ✅ Answer: C. Cholecystokinin
Answer: A. Cholecystokinin is the physiologically correct answer per standard MBChB-level teaching on this topic. ---
A 65-year-old male with a history of smoking develops painless jaundice, weight loss, and a palpable non-tender gallbladder (Courvoisier's sign). What is the most likely diagnosis?
- Gallstones
- Choledocholithiasis
- Pancreatic cancer
- Hepatitis
Answer: C. Painless jaundice, weight loss, and a palpable gallbladder (Courvoisier's sign) in an elderly male smoker are highly suggestive of pancreatic cancer obstructing the common bile duct. The painless nature is key. While gallstones can cause jaundice, it's usually associated with pain (biliary colic), and Courvoisier's sign is less common. Hepatitis typically presents with constitutional symptoms and less likely a palpab
A 45-year-old male presents with right upper quadrant pain, fever, and jaundice, along with a palpable, distended gallbladder. Lab results show elevated alkaline phosphatase and direct bilirubin. What is the most likely diagnosis?
- Cholecystitis
- Choledocholithiasis with cholangitis
- Hepatitis
- Pancreatitis
Answer: B. The combination of right upper quadrant pain, fever, jaundice, elevated alkaline phosphatase, direct bilirubin, and a palpable distended gallbladder is characteristic of choledocholithiasis (stones in the common bile duct) complicated by cholangitis (infection of the bile ducts). ---
A 65-year-old presents with painless jaundice, a palpable non-tender gallbladder, and weight loss. Where is the tumor MOST likely located?
- Tail of pancreas
- Body of pancreas
- Head of pancreas
- Ampulla of Vater only
Answer: C. Courvoisier sign + painless jaundice = classic head of pancreas cancer obstructing the common bile duct. 60–70% of PDAC arise here. ---
Long-term carriage and chronic shedding in the gallbladder are most likely after infection with:
- Salmonella Typhi
- Shigella sonnei
- Vibrio cholerae
- Campylobacter jejuni
Answer: A. S. Typhi can establish chronic carriage in the gallbladder, leading to continued shedding in feces.