What signs comprise Reynolds' Pentad in acute cholangitis?

• A. Fever, RUQ pain, jaundice, hypotension, mental status changes
• B. Fever, cough, chest pain, SOB, weight loss
• C. Jaundice, pruritus, dark urine, clay stools
• D. Abdominal distention, ascites, edema, pleural effusion

Answer: (A)

Reynolds' pentad expands the Charcot triad of acute cholangitis to include signs of systemic infection and shock. The five signs are fever, right upper quadrant pain, jaundice, low blood pressure (hypotension), and altered mental status. The first three reflect biliary infection with obstruction, while the added hypotension and mental status changes indicate sepsis progressing toward septic shock, signaling a more severe disease and a need for urgent intervention.

Other clusters of symptoms point to different processes and do not capture this septic picture. Fever with RUQ pain and jaundice is classic for cholangitis, but without the systemic instability, it’s just the Charcot triad; the other options align better with chest infection, isolated cholestasis, or chronic liver disease rather than acute septic cholangitis.