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Gastroenterology Biliary Tract Intermediate
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Acute Cholangitis: Charcot Triad & Reynolds Pentad

CHARCOT
&
REYNOLDS
Clinical indicators of acute bacterial ascending cholangitis, differentiating uncomplicated cholangitis from septic biliary emergency.

Ascending cholangitis occurs when biliary outflow obstruction is combined with bacterial superinfection. Charcot triad denotes classic cholangitis, while Reynolds pentad indicates worsening systemic toxicity, suppurative disease, and impending septic shock.

Systematic Breakdown

F

Fever & Chills

Reflects acute systemic bacteremia (often Gram-negative enterics: E. coli, Klebsiella, Enterobacter).

J

Jaundice

Conjugated hyperbilirubinemia from biliary duct obstruction (choledocholithiasis or stricture).

R

RUQ Abdominal Pain

Distension of Glisson capsule and common bile duct irritation [Charcot's Triad complete].

H

Hypotension / Septic Shock

Vasodilation and circulatory collapse caused by endotoxemia [Part of Reynolds' Pentad].

A

Altered Mental Status

Lethargy, confusion, or delirium due to cerebral hypoperfusion and toxic encephalopathy [Reynolds' Pentad complete].

High-Yield Clinical Pearls & Exam Tips
  • Reynolds pentad is a medical-surgical emergency requiring urgent biliary decompression (usually emergent ERCP or PTC) plus broad-spectrum IV antibiotics.
  • Charcot triad is present in ~50-70% of cases, but Reynolds pentad is seen in < 15%, portending high mortality if unrecognized.
Related Pharmaceuticals
Piperacillin-Tazobactam Ceftriaxone Metronidazole
Related Clinical Conditions
Choledocholithiasis Biliary Stricture Sepsis
Authoritative Sources: Tokyo Guidelines (TG18/TG13) for Acute Cholangitis · Schwartz's Principles of Surgery 11e

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