In the Charcot's triad of ascending cholangitis, the three classic features are fever with rigors, jaundice, and right upper quadrant pain. Reynolds' pentad adds two more features. Which two features distinguish Reynolds' pentad from Charcot's triad?
- A Nausea and vomiting
- B Elevated alkaline phosphatase and direct hyperbilirubinemia
- C Hypotension and altered mental status ✓
- D Peritoneal signs and hyperamylasemia
Correct answer: C. Hypotension and altered mental status
Explanation
Reynolds' pentad = Charcot's triad (fever/rigors, jaundice, RUQ pain) + hypotension + altered mental status (confusion/obtundation). These additional features indicate septicaemia and septic shock from acute suppurative cholangitis, which demands emergency biliary decompression. Reynolds' pentad carries a high mortality if not treated promptly with IV antibiotics and urgent ERCP or percutaneous drainage.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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