A 62-year-old woman presents with fever, jaundice, and right upper abdominal pain. She is confused and hypotensive (BP 82/50 mmHg). Ultrasound shows a common bile duct stone with biliary dilatation. Which clinical pentad completes the full diagnostic picture in this patient?

• A Fever, jaundice, right upper quadrant pain, ascites, and asterixis
• B Fever, jaundice, right upper quadrant pain, hepatomegaly, and spider angiomas
• C Fever, jaundice, right upper quadrant pain, pruritus, and pale stools
• D Fever, jaundice, right upper quadrant pain, hypotension, and altered mental status ✓

Explanation

This is Reynolds' pentad, indicating acute obstructive suppurative (biliary) cholangitis. It comprises Charcot's triad (fever, jaundice, RUQ pain) plus hypotension and altered mental status. Charcot's triad alone is seen in uncomplicated cholangitis. Ascites and asterixis suggest hepatic decompensation. Pruritus and pale stools occur in any obstructive jaundice. Spider angiomas are signs of chronic liver disease, not acute cholangitis.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

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Written and medically reviewed by the StethoPrep medical team.