Painless jaundice, weight loss, and a palpable gallbladder. What is the most likely diagnosis and next step?

Study for the Medical Council of Canada Qualifying Examination (MCCQE) I. Engage with flashcards and multiple-choice questions with detailed feedback. Prepare confidently!

Painless jaundice with weight loss and a palpable, non-tender gallbladder points to malignant obstruction of the biliary tree, most commonly a pancreatic head mass. That combination, known for suggesting pancreatic cancer, is the clue here because a mass at the pancreatic head can block the common bile duct, causing jaundice without the painful presentation typical of gallstone disease or pancreatitis. The next step is to obtain cross-sectional abdominal imaging with contrast CT or MRCP to locate a mass, assess the extent of biliary dilation, and evaluate resectability and staging. If imaging raises suspicion for pancreatic cancer, the patient should be referred to oncology and undergo formal staging, including assessment for metastases and tissue diagnosis (often via EUS-guided biopsy) once imaging has clarified the anatomy. This plan aligns with the presentation and avoids misdiagnosis as inflammatory or biliary colic conditions, which usually involve pain and different clinical features.