Reynolds pentad

 Q; Which of the following is not a part of Reynolds pentad? 

A) Fever 

B) Abdominal pain

C) Jaundice 

D) Tachypnea 

E) Hypotension

Answer: D

The classic presentation of acute cholangitis is Charcot's triad consists of fever, abdominal pain, and jaundice. In its severe form, it becomes a Reynolds pentad with the addition of hypotension and mental status change. These symptoms do not necessarily present all the time or correlate well with the severity of the disease e.g., people on chronic glucocorticoids may have had one or two symptoms. In the contrast, superimposed bacteremia or hepatic abscess may present a patient with more severe symptoms and with multiple system organ failure (MSOF) with shock. 

At the bedside, Reynold pentad may be demonstrated only less than 5 percent of the time (reference # 3).

#hepatology

References:

1. Mosler P. Diagnosis and management of acute cholangitis. Curr Gastroenterol Rep 2011; 13:166.

2. Rumsey S, Winders J, MacCormick AD. Diagnostic accuracy of Charcot's triad: a systematic review. ANZ J Surg. 2017 Apr;87(4):232-238. doi: 10.1111/ans.13907. Epub 2017 Feb 17. PMID: 28213923. 

3. Rosing DK, De Virgilio C, Nguyen AT, El Masry M, Kaji AH, Stabile BE. Cholangitis: analysis of admission prognostic indicators and outcomes. Am Surg. 2007 Oct;73(10):949-54. PMID: 17983054.