A 66-year-old man with symptomatic cholelithiasis presents with fever, jaundice, and right upper quadrant pain. Two hours later he becomes hypotensive with confusion. Which addition to his current findings defines the complete syndrome he has developed?
- A Addition of shock and altered sensorium to Charcot triad ✓
- B Addition of migratory thrombophlebitis and arthralgia
- C Addition of ascites and splenomegaly
- D Addition of painless palpable gallbladder and weight loss
Correct answer: A. Addition of shock and altered sensorium to Charcot triad
Explanation
Charcot triad of fever, jaundice, and right upper quadrant pain indicates acute ascending cholangitis; when suppurative cholangitis supervenes with shock and altered mental status, the five findings constitute Reynolds pentad, requiring urgent biliary decompression. Migratory thrombophlebitis is Trousseau sign of visceral malignancy, and a painless palpable gallbladder with jaundice is Courvoisier law suggesting periampullary carcinoma. Neither relates to cholangitic sepsis.
Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.
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