A 78 year old male presents with jaundice associated with increased itching and a palpable gall bladder. Possible diagnosis is –
**Core Concept**
The patient's presentation of jaundice, increased itching, and a palpable gall bladder suggests a diagnosis related to gallbladder disease, specifically a condition that causes obstruction of the bile ducts.
**Why the Correct Answer is Right**
The correct diagnosis is likely Choledocholithiasis, which is the presence of gallstones in the common bile duct. This condition causes obstruction of the bile ducts, leading to jaundice and pruritus (itching). The palpable gallbladder suggests that the gallbladder is distended due to the obstruction, leading to a "Courvoisier's sign," a classic clinical finding in this condition. The increased itching is due to the buildup of bile salts in the skin.
**Why Each Wrong Option is Incorrect**
* **Option A:** This option is likely a distractor representing a diagnosis of primary biliary cirrhosis, a chronic liver disease characterized by progressive destruction of intrahepatic bile ducts. While this condition can cause jaundice and itching, it is not typically associated with a palpable gallbladder.
* **Option B:** This option might represent a diagnosis of primary sclerosing cholangitis, a chronic liver disease characterized by inflammation and scarring of the bile ducts. While this condition can cause jaundice and itching, it is not typically associated with a palpable gallbladder.
* **Option C:** This option might represent a diagnosis of pancreatic cancer, which can cause obstructive jaundice due to invasion of the bile ducts. However, a palpable gallbladder is not a typical finding in pancreatic cancer.
**Clinical Pearl / High-Yield Fact**
In patients presenting with jaundice and a palpable gallbladder, consider the diagnosis of Choledocholithiasis, and remember that a palpable gallbladder in the setting of jaundice is a classic sign of bile duct obstruction, known as Courvoisier's sign.
**Correct Answer: C. Choledocholithiasis**