A patient with acute cholangitis deteriorates, developing hypotension and confusion in addition to fever, jaundice, and right upper quadrant pain. This full constellation, described as Reynolds pentad, indicates:

• A Gallstone pancreatitis with systemic inflammation
• B Emphysematous cholecystitis with gangrene
• C Mirizzi syndrome with secondary sepsis
• D Acute suppurative cholangitis requiring urgent biliary decompression ✓

Explanation

Reynolds pentad adds shock and altered mental status to Charcot's triad and signals acute suppurative cholangitis, an emergency demanding urgent biliary decompression by ERCP, percutaneous transhepatic drainage, or surgery. The tempting distractor is emphysematous cholecystitis, but that entity produces gas in the gallbladder wall in diabetics and does not cause obstructive jaundice, which is central to Charcot's triad.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.