Pancreatic Cancer: The Daily PANCE Blueprint

The answer is C. Pancreatic cancer

Pancreatic cancer, particularly in the head of the pancreas, presents with painless jaundice, weight loss, and epigastric pain due to obstruction of the common bile duct. A painless, palpable gallbladder (Courvoisier’s sign) is a key finding, suggestive of malignant obstruction rather than gallstone disease. Diagnosis is made with CT abdomen, which typically shows a hypodense pancreatic mass with possible bile duct dilation. CA 19-9 may be elevated. Management depends on staging: surgical resection (Whipple procedure) is the only curative option but is often not feasible due to late-stage presentation. Advanced cases may require palliative stenting for biliary obstruction.

• A. Acute cholecystitis – Presents with RUQ pain, fever, and a positive Murphy’s sign (pain on palpation of the RUQ with inspiration). It is not associated with painless jaundice or weight loss and does not cause a painless, distended gallbladder.
• B. Primary sclerosing cholangitis – A chronic inflammatory disease of the bile ducts associated with ulcerative colitis. It leads to progressive jaundice but does not typically present with a palpable gallbladder or pancreatic mass.
• D. Choledocholithiasis – Gallstones in the common bile duct can cause obstructive jaundice, but they usually present with RUQ pain and intermittent symptoms rather than a painless, palpable gallbladder.
• E. Hepatocellular carcinoma – Typically presents with abdominal pain, weight loss, and signs of liver disease (ascites, hepatomegaly, varices). It does not usually cause biliary obstruction leading to a palpable gallbladder.