Saturday, November 15, 2014

Exception to Courvoisier's law mnemonic


Courvoisier's law states that in a patient with jaundice, if there is a palpable gallbladder, it is not due to stones.

Obviously, exception to the rule will be conditions with a stone and palpable gallbladder!

The mnemonic is, "DHE exception".
D: Double impacted stone - one in CBD and one in cystic duct, with mucocele of gallbladder.
H: Large stone in Hartmann's pouch.
E: Empyema gallbladder.

The rule ain't useful if the patient doesn't have a gallbladder (absence, previous cholecystectomy) or if the gallbladder is intrahepatic.

That's all!
'DHEm' rebellious conditions breaking rules xD

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