(Arun's Gastro Aphorism☺
It's unlikely that you have finished Gastro rotation and never heard of this!)
🟠What's in a name?
❌a.k.a Curvoisier's Law (well hey, there ain't any laws in medicine!)
✔Curvoisiers gallbladder ( A Verghese, Lancet 1986)
✔Curvoisiers Sign
✔✔Curvoisier-Terrier Sign ( personal preference!)
🟠 What exactly is it?
"In a patient with painless jaundice, a palpable gallbladder is unlikely due to stones"
Most likely malignancy
🟢History Buffs assemble here!
🔶Ludwig George Curvoisier(1843-1918)
✔ Sx from Basel, 🇨🇭
✔Trained under Czerny& Billroth
✔1st choledocholithotomy
✔Post Gastroenterostomy
✔Best works in non-medical !!
🔶Louis Felix Terrier(1837-1908)
✔Sx from 🇫🇷
🟠Original description
n=187; 87 stones, 100 others
70/87(80℅) - GB atrophic
92/100(92%) - GB distended.
Concluded that malignancy was more likely if GB distended
🟠Scientific backing?
✔Malig➡higher ductal pre, jaundice duration vs stones
But both groups has similar GB pliability
(RS Chung, Dis dis Sci 1983)
🛑Why stones don't cause high ductal pre?? 💡💡💡
❌No one really knows for sure!
Probably due to
? Incomplete obstrn
? More dramatic clinical presentation⏩seek medical attention earlier??
(RS Chung, Dig dis Sci 1983)
🚫Exceptions to the "law"!
🔴Double impaction of stones( in CD & CBD)
🔴Pancr stone obstr Amp of Vater
🔴Oriental cholangiohepatitis
🔴 C/c and AIP
🔴Choledochal cyst
🔴Hilar CCA
🔴Periportal LNE
🔴Mirizzis synd
🔴Periamp Ca post CCx
🔴AIDS Cholangio
Exceptions can be thought of as
⛔ Malignancy without GB distension
➕Benign conditions with GB distension
🟠Is it still relevant?
✔Times of original description and advanced imaging in present day⏩ incomparable
✔Objective measurements of GB vol appears to validate Curvoisier sign!! (n=394)
I was pleasantly surprised by the overwhelming response to a tweetorial posted yday.
So here's one for those who want more. Do let me know if you like similar tweetorials in Clin Med/Hepat/GE.
This time, Spider Naevi!
🟡 What's a spider nevus?
Aka Nevus araneus/ spider angiomata
It has 5 components: cutaneous arterial net, central arteriole, subepidermal ampulla, ⭐ shaped afferents & capillaries (J Am Acd Dermatol 1997)
0.1- 1cm, sometimes huge
Warmer than surrounding
🆔 Ludwig Traube(1818-1876) 🇩🇪
✔Under Josef Skoda & Carl Rokitansky
✔ 👫 of Virchow, Frerichs& Osler
Primary ❤- Resp, kidney & ❤
✔described in Lt pleural eff(esp TB)
✖Name it/ associate with splenomeg
(Arch Int Med 1992) (2/n)
1st described in HE by Adams RD & Foley JM
(Trans Am Neurol Assoc 1949)
(1/n)
🟣Historical snippet
✔1st observed at Boston City Hospital.
✔Foley described it to a Jesuit scholar, Father Cardigan over a 🥂
✔Called it "An-iso-sterixis"
✔Tongue twister> abbreviated to asterixis
✔Adams on Harrisons editorial bd⏩popular