Raynauds pentad

Bile Acid Metabolism During Development. Heidi Eigenrauch Karpen, Saul J. Karpen, in Fetal and Neonatal Physiology (Fifth Edition), 2017. Bile Flow. Bile flow is driven primarily by two factors: bile acid–dependent mechanisms and bile acid–independent mechanisms (see Figures 95-3 and 95-4).The main determinant of bile acid–dependent flow, and the …

Raynauds pentad. Raynauds pentad ; VS tachycardic, hypotensive ; ABCs, Resuscitate ; 2 large bore IV, Foley, Continuous monitor ; 1-2L fluid bolus, repeat until resuscitated ; Diagnosis ? 22 Cholangitis. Infection of the bile ducts due to CBD obstruction 2ndary to stones, strictures ; Charcots triad seen in 70 of pts ; May lead to life-threatening sepsis and septic

Raynaud's phenomenon - ischaemia resulting in atrophy of the finger pulps; oEsophageal dysmotility - if absent, then CRST syndrome; Sclerodactyly - tightening of the skin of the fingers resulting in tapering; Telangiectasia - multiple, large and on the fingers;

The ILC Charitable Foundation Check us out on Facebook for DAILY FREE REVIEW QUESTIONS and updates! (https://www.facebook.com/medschoolmadeeasy) Check out our website for TONS OF FREE REV...Gejala sindrom Raynaud terjadi dalam tiga tahap, yaitu: Tahap 1. Jari tangan atau jari kaki berubah menjadi pucat akibat berkurangnya aliran darah. Tahap 2. Jari tangan atau jari kaki berubah membiru karena kurangnya pasokan oksigen. Pada tahap ini, jari-jari akan terasa dingin dan mati rasa. Tahap 3.Infection within bile ducts usu due to obstrux of CBD. ... Reflux of bile into pancreatic duct and/or obstruction of ampulla by stone ... – A free PowerPoint PPT presentation (displayed as an HTML5 slide show) on PowerShow.com - id: f0959-ZDc1ZJan 18, 2022 · Gejala fenomena Raynaud meliputi: Jari-jari kehilangan warna (menjadi putih kemudian biru dan ungu atau merah) Nyeri, kesemutan dan mati rasa dapat terjadi ketika daerah yang terjangkit menjadi putih. Beberapa orang memiliki pembengkakan, kehangatan, atau berdenyut ketika daerah yang terkena berubah ungu atau merah. Raynaud phenomenon of the nipples presents as breast pain, often associated with pregnancy or lactation. It may follow breast surgery. Typically it presents as extremely painful or throbbing breastfeeding precipitated by exposure to cold, and the usual sequential two or three colour phases of blanching, blueness and/or erythema.Raynaud’s (pronounced ray-nodes) syndrome is a disorder that affects small blood vessels in your fingers and toes. It may also affect blood vessels in your nose, lips or ear lobes. Raynaud’s causes you to have episodic spasms, called vasospastic attacks, in response to cold temperatures or stress. During a Raynaud’s attack, the arterioles ...SUSPECTED CHOLANGITIS A clinical picture compatible with acute suppurative cholangitis (charcot's triad or raynaud's pentad) the most likely diagnosis is choledocholithiasis. Appropriate resuscitation, correction of any coagulopathies if present, and administration of antibiotics ERCP is indicated for diagnosis and treatment If ERCP …

Reynolds' pentad is a collection of signs and symptoms consistent with obstructive ascending cholangitis, a serious infection of the biliary tract.CREST (calcinosis, Raynaud phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia) syndrome is a member of the heterogeneous group of sclerodermas, and its name is an acronym for the cardinal clinical features of the syndrome.[1, 2] In 1910, Thibierge and Weissenbach described the first case report of …Disseminated intravascular coagulation (DIC) can be defined as a widespread hypercoagulable state that can lead to both microvascular and macrovascular clotting and compromised blood flow, ultimately resulting in multiple organ dysfunction syndrome or MODS. As this process begins consuming clotting factors and platelets in a positive feedback loop, hemorrhage can ensue, which may be the ...Reynolds' pentad is a collection of signs and symptoms suggesting the diagnosis of septic (ascending) cholangitis, a serious infection of the biliary system. It is a combination of Charcot's triad (jaundice, fever, abdominal pain) with hypotension (low blood pressure) and an altered mental state. It was named after the surgeon, B.M. Reynolds, who described it …Narcolepsy is a chronic neurological disorder that affects the brain's ability to control sleep-wake cycles. People with narcolepsy may feel rested after waking, but then feel very sleepy throughout much of the day. Many individuals with narcolepsy also experience uneven and interrupted sleep that can involve waking up frequently during the night.Raynaud's disease causes pain in the extremities in response to cold temperatures or stress. Blood vessels narrow and can almost shut down, causing the fingers or toes to turn from white to blue.

Because the diagnosis of cholangitis can be challenging, various diagnostic criteria have been proposed, including Charcot triad (fever with chills, right upper abdominal pain, jaundice),1 Reynolds pentad (hypotension and altered mental status in addition to Charcot triad),2 and Tokyo Guide- lines, which groups signs and symptoms into 3 criteria...Reynolds' pentad is a collection of signs and symptoms consistent with obstructive ascending cholangitis, a serious infection of the biliary tract. It is a combination of …Raynaud’s (pronounced ray-nodes) syndrome is a disorder that affects small blood vessels in your fingers and toes. It may also affect blood vessels in your nose, lips or ear lobes. Raynaud’s causes you to have episodic spasms, called vasospastic attacks, in response to cold temperatures or stress. During a Raynaud’s attack, the arterioles ...Jan 25, 2021 ... Narcolepsy is a life-long central nervous system disorder with a symptom pentad ... Peripheral vasculopathy including Raynaud's phenomenon may ...Check if it's Raynaud's. Raynaud's affects your blood circulation. When you're cold, anxious or stressed, your fingers and toes may change colour. Other symptoms can include: pain. numbness. pins and needles. The skin may turn white or a lighter colour as blood flow is restricted. Sometimes the skin turns blue as blood vessels react.

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Anaemia, Thrombocytopenia, Kidney failure (But see Pentad of TTP below) Hemolytic–uremic syndrome: Horner's Syndrome Triad: ptosis (eyelid), miosis, anhydrosis: Horner's syndrome: Hutchinson's triad: Hutchison's teeth, Interstitial keratitis, Nerve deafness: Congenital syphilis: Kartagener Syndrome Triadshock (Raynauds pentad) Tx NPO, IVF, IV Abx ; Emergent decompression via ERCP or perc transhepatic cholangiogram (PTC) Used to require emergency laparotomy; 14 Gallstone pancreatitis. 35 of acute pancreatitis 2ndary to stones ; Pathophysiology ; Reflux of bile into pancreatic duct and/or obstruction of ampulla by stoneThe 2024 edition of ICD-10-CM I73.0 became effective on October 1, 2023. This is the American ICD-10-CM version of I73.0 - other international versions of ICD-10 I73.0 may differ. transient cerebral ischemic attacks and related syndromes ( G45.-) An idiopathic vascular disorder characterized by bilateral raynaud phenomenon, the abrupt onset of ... Raynaud Disease (โรคเรเนาด์) เป็นโรคที่เกิดความผิดปกติขึ้นกับหลอดเลือดเมื่อเจอความเย็นหรือมีความเครียด ทำให้ผิวหนังบริเวณที่เกิดอาการมีสีซีดลง ...Raynaud phenomenon (RP) is defined as recurrent, reversible episodes of vasospasm involving peripheral small vessels, typically in the fingers and toes. Primary (idiopathic) RP is common (it occurrs in about 5% of the general population) and is usually benign. Secondary RP accounts for 10% to 20% of …Medicines used to treat people with Raynaud's disease may include: Calcium channel blockers. These drugs relax and open small blood vessels in the hands and feet. These drugs also can help heal sores on fingers or toes. Examples include nifedipine (Procardia), amlodipine (Norvasc), felodipine and isradipine. Vasodilators.

Raynaud or Reynaud is a surname. Notable people with the surname include: Alexis Raynaud (born 1994), French sport shooter; Alix Raynaud (born 1974), French executive producer and line producer; André Raynaud (1904-1937), French cyclist; Cecile Reynaud, volleyball player; Émile Reynaud (1844-1918), animator and inventor; Charles Ceccaldi-Raynaud (born 1925), French politicianSep 20, 2023 · Narcolepsy is a chronic neurological disorder that affects the brain's ability to control sleep-wake cycles. People with narcolepsy may feel rested after waking, but then feel very sleepy throughout much of the day. Many individuals with narcolepsy also experience uneven and interrupted sleep that can involve waking up frequently during the night. Study Gallstones flashcards from Craig Warren's University of Glasgow class online, or in Brainscape's iPhone or Android app. Learn faster with spaced repetition.Ehlers–Danlos syndromes (EDS) are a group of 13 genetic connective-tissue disorders in the current classification, with the latest type discovered in 2018. Symptoms often include loose joints, joint pain, stretchy velvety skin, and abnormal scar formation. These may be noticed at birth or in early childhood. Complications may include aortic dissection, joint …Aim: Drug-induced Raynaud's phenomenon (RP) has long been associated with the use of different drugs, including cancer chemotherapy or β-adrenoceptor blockers. However, sources report extremely variable prevalence and the level of evidence for each class is heterogeneous. Moreover, new signals are emerging from case reports and small series.Apr 1, 2021 · In a smaller study of 17 patients with cholangitis only, 4 patients (23.5%) presented with Charcot triad while only 1 patient presented with the complete pentad. 9 A similarly low prevalence was noted in a study that also included patients with biliary strictures and primary sclerosing cholangitis with only 15.6% of younger patients and 18.8% ... leadership team (pentad) consists of the Facility Director, Chief of Staff, Associate Director for Patient Care Services (Nurse Executive), Associate Director, and Assistant Director. Organizational communication and accountability are carried out through a committee reporting structure with the Executive Leadership Board having oversight forThe current investigation, arguably the first in the Western hemisphere, systematically evaluated Charcot triad, Reynolds pentad, and the Tokyo Guidelines criteria in a large, homogeneous group of patients with cholangitis due to ERCP-documented CBD stones, 110 of whom were 80 years of age or older.Reynolds pentad is a combination of clinical signs found in acute cholangitis. It consists of Charcot triad 2-4: fever and/or chills; RUQ pain; jaundice; as well as: delirium or lethargy, and; shock; Usefulness. Sensitivity of Reynolds pentad from a large systematic review of nine studies was found to be 4.82%.

Check if it's Raynaud's. Raynaud's affects your blood circulation. When you're cold, anxious or stressed, your fingers and toes may change colour. Other symptoms can include: pain. numbness. pins and needles. The skin may turn white or a lighter colour as blood flow is restricted. Sometimes the skin turns blue as blood vessels react.

Dec 10, 2022 · Vascular thrombi are formed in the setting of low flow and shear stress and mainly consist of fibrin strands, red blood cells, and a few platelets. In 1856, Rudolf Virchow, a renowned Berlin scientist and physician recognized these factors due to his extensive work on venous thrombosis. These concepts evolved over the years and are relevant to ... Start studying gallbladder. Learn vocabulary, terms, and more with flashcards, games, and other study tools.Case 6 46yo F p/w fever, RUQ pain, jaundice (Charcots triad) If also altered mental status and signs of shock = Raynauds pentad VS tachycardic, hypotensive ABCs, Resuscitate 2 large bore IV, Foley, Continuous monitor 1-2L fluid bolus, repeat until resuscitated. Diagnosis: ? C ONSULTANT GEN. SURGEON LAPROSC OPIST & …• Charcot triad • (right upper quadrant pain, fever, and jaundice) • associated with common bile duct obstruction and cholangitis • Additional symptoms: • alterations in mental status and hypotension, indicate Raynaud pentad, a harbinger of worsening, ascending cholangitis.Jul 26, 2021 · Any condition which causes occlusion of the biliary tree has the potential to cause cholangitis. The most common causes are gallstones , ERCP (iatrogenic), and cholangiocarcinoma. Rarer causes include pancreatitis, primary sclerosing cholangitis, ischaemic cholangiopathy, and parasitic infections. The most common infective organisms implicated ... Raynaud’s is usually triggered by cold temperatures, anxiety or stress. The condition occurs because your blood vessels go into a temporary spasm, which blocks the flow of blood. This causes the affected area to change colour to white, then blue and then red, as the bloodflow returns. You may also experience numbness, pain, and pins and needles.

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... Pentad (AMS, Hypotension); Evaluation. CBC, CMP (D bili, ALP ↑↑↑) Blood Cultures ... Raynauds: CCB (amlodipine, nifedipine), topical nitroglycerin. GERD: PPI.Nov 23, 2022 · Medicines used to treat people with Raynaud's disease may include: Calcium channel blockers. These drugs relax and open small blood vessels in the hands and feet. These drugs also can help heal sores on fingers or toes. Examples include nifedipine (Procardia), amlodipine (Norvasc), felodipine and isradipine. Vasodilators. Cholangitis especially the suppurative type (Charcots triad or Raynauds pentad) is usually secondary to choledocholithiasis. It may also complicate procedures like ERCP. Treatment should include correction of coagulopathy, fluid/electrolyte anomaly, antibiotics and biliary drainage with ERCP where available or trans-hepatic drainage or surgery.Study Clinical Triads, Tetrads, Pentads, Hexads flashcards. Create flashcards for FREE and quiz yourself with an interactive flipper.Aquí nos gustaría mostrarte una descripción, pero el sitio web que estás mirando no lo permite.Mar 25, 2019 · A news post on the SRUK's (Scleroderma & Raynaud's UK) web site provides results of a study on Raynaud's and mental health. We were expecting to see information. no asa, give indomethacin, colchicine, or corticosteroids Chronic gout: probenecid (uricosuric drug), allopurinolRaynaud’s is usually triggered by cold temperatures, anxiety or stress. The condition occurs because your blood vessels go into a temporary spasm, which blocks the flow of blood. This causes the affected area to change colour to white, then blue and then red, as the bloodflow returns. You may also experience numbness, pain, and pins and needles. The 2024 edition of ICD-10-CM I73.0 became effective on October 1, 2023. This is the American ICD-10-CM version of I73.0 - other international versions of ICD-10 I73.0 may differ. transient cerebral ischemic attacks and related syndromes ( G45.-) An idiopathic vascular disorder characterized by bilateral raynaud phenomenon, the abrupt onset of ... ….

Summary. Raynaud's disease is a rare disorder of the blood vessels, usually in the fingers and toes. It causes the blood vessels to narrow when you are cold or feeling stressed. When this happens, blood can't get to the surface of the skin and the affected areas turn white and blue. When the blood flow returns, the skin turns red and …... Pentad (AMS, Hypotension); Evaluation. CBC, CMP (D bili, ALP ↑↑↑) Blood Cultures ... Raynauds: CCB (amlodipine, nifedipine), topical nitroglycerin. GERD: PPI.English translation, New York, 1878. Referring to Désiré-Magloire Bourneville (1840-1909) and Louis-Arthur Sevestre (1843-1907). B. M. Reynolds, E. L Dargan: Acute obstructive cholangitis: a distinct clinical syndrome. Annals of Surgery, Philadelphia, 1959, 150: …Raynaud’s disease is an abnormal sensitivity to cold that causes tingling, discomfort, numbness and color changes in the fingers and/or toes. The blood vessels (arteries) that feed the fingers and toes are very small. If you have Raynaud’s disease, those blood vessels shrink down more and faster than normal.Reynolds' pentad is a collection of signs and symptoms consistent with obstructive ascending cholangitis, a serious infection of the biliary tract. It is a combination of Charcot's triad ( right upper quadrant pain, jaundice, and fever) with shock ( low blood pressure, tachycardia) and an altered mental status. [1]Apr 8, 2021 · The current investigation, arguably the first in the Western hemisphere, systematically evaluated Charcot triad, Reynolds pentad, and the Tokyo Guidelines criteria in a large, homogeneous group of patients with cholangitis due to ERCP-documented CBD stones, 110 of whom were 80 years of age or older. Sep 11, 2023 ... Raynaud phenomenon (RP) is an exaggerated vasoconstrictive response of distal arteries and arterioles (most commonly in the fingers and ...Raynaud Disease (โรคเรเนาด์) เป็นโรคที่เกิดความผิดปกติขึ้นกับหลอดเลือดเมื่อเจอความเย็นหรือมีความเครียด ทำให้ผิวหนังบริเวณที่เกิดอาการมีสีซีดลง ... Raynaud's phenomenon - ischaemia resulting in atrophy of the finger pulps; oEsophageal dysmotility - if absent, then CRST syndrome; Sclerodactyly - tightening of the skin of the fingers resulting in tapering; Telangiectasia - multiple, large and on the fingers Raynauds pentad, Pêntade de Reynolds. A pêntade de Reynolds é uma coleção de sinais e sintomas que sugerem o diagnóstico de colangite ascendente obstrutiva, uma infecção grave do sistema biliar. É uma combinação da tríade de Charcot ( dor no quadrante superior direito, icterícia e febre) com choque ( pressão baixa, taquicardia) e estado mental ... , Study Gallbladder flashcards from Enea Himi's class online, or in Brainscape's iPhone or Android app. Learn faster with spaced repetition., Raynaud's disease causes pain in the extremities in response to cold temperatures or stress. Blood vessels narrow and can almost shut down, causing the fingers or toes to turn from white to blue., 518) o (cryoglobulinemia is a different autoimmune disease: Abs cause Raynauds ... pentad: like HUS plus fever and neurologic signs (confusion, seizure, etc ..., Mar 25, 2019 · A news post on the SRUK's (Scleroderma & Raynaud's UK) web site provides results of a study on Raynaud's and mental health. We were expecting to see information. , Charcot's cholangitis triad is the combination of jaundice; fever, usually with rigors; and right upper quadrant abdominal pain. It occurs as a result of ascending cholangitis (an infection of the bile duct in the liver). When the presentation also includes low blood pressure and mental status changes, it is known as Reynolds' pentad. It is named for Jean-Martin Charcot. , Raynaud’s disease is an abnormal sensitivity to cold that causes tingling, discomfort, numbness and color changes in the fingers and/or toes. The blood vessels (arteries) that feed the fingers and toes are very small. If you have Raynaud’s disease, those blood vessels shrink down more and faster than normal., The Raynaud phenomenon (RP) is a condition in which some of the body's blood vessels (most commonly those in the fingers and toes) constrict in an exaggerated way in response to cold or emotional stress. Normally, the vessels that supply blood to the skin constrict or narrow in response to cold temperatures., Current Health Sciences Journal Vol. 37, No. 2, 2011 Constantin Tirziu, MD. PhD student, University of Medicine and Pharmacy of Craiova 96 For Practitioner Jaundice Obstructive…, Raynauds disease; Systemic sclerosis; Bechet disease. 22. A 55 year old women, with ... pentad, which is associated with significant morbidity and mortality [9]., Thrombotic thrombocytopenic purpura (TTP) is a type of microangiopathic hemolytic anemia that classically has been characterized by the pentad of fever, thrombocytopenia, hemolytic anemia, renal dysfunction, and neurologic dysfunction., PMID: 26468310. PMCID: PMC4569195. 10.1159/000430965. Background: Acute bacterial cholangitis for the most part owing to common bile duct stones is common in gastroenterology practice and represents a potentially life-threatening condition often characterized by fever, abdominal pain, and jaundice (Charcot's triad) as well as confusion and ... , Study Gallbladder flashcards from Enea Himi's class online, or in Brainscape's iPhone or Android app. Learn faster with spaced repetition., • Charcot triad, Raynaud pentad 20 . Physical Examination • Age • Aneamia: hemolysis, cancer, cirrhosis • Gross weight loss: malignancy • Hunched up position: chronic pancreatitis or ca pancrease • Fetor, flapping tremors, personality changes- impending hepatic coma • Skin changes: bruising, purpui=ric spots, spider neavi, palmar erythema, …, What are Charcot's Triad and Raynaud's Pentad? Sign Up; Log In; Messenger; Facebook Lite; Watch; Places; Games; Marketplace; Meta Pay; Meta Store, Raynaud's phenomenon of the penis. Raynaud's phenomenon of the penis. Raynaud's phenomenon of the penis J Urol. 2004 Apr;171(4):1630. doi: 10.1097/01.ju.0000116082.54048.8f. Author R F Kropman 1 Affiliation 1 Department of Urology, Leyenburg Hospital, The Hague, The Netherlands. PMID: 15017241 DOI: 10. ..., Case 6 46yo F p/w fever, RUQ pain, jaundice (Charcots triad) If also altered mental status and signs of shock = Raynauds pentad VS tachycardic, hypotensive ABCs, Resuscitate 2 large bore IV, Foley, Continuous monitor 1-2L fluid bolus, repeat until resuscitated. Diagnosis: ? C ONSULTANT GEN. SURGEON LAPROSC OPIST & …, INTRODUCTION — Raynaud phenomenon (RP) is an exaggerated vascular response to cold temperature or to emotional stress, which is manifested clinically by sharply demarcated color changes of the distal skin of the digits as well as toes, nose, and earlobes. Initial treatment includes patient education and general measures taken by the patient to …, The current investigation, arguably the first in the Western hemisphere, systematically evaluated Charcot triad, Reynolds pentad, and the Tokyo Guidelines criteria in a large, homogeneous group of patients with cholangitis due to ERCP-documented CBD stones, 110 of whom were 80 years of age or older., Gejala fenomena Raynaud meliputi: Jari-jari kehilangan warna (menjadi putih kemudian biru dan ungu atau merah) Nyeri, kesemutan dan mati rasa dapat terjadi ketika daerah yang terjangkit menjadi putih. Beberapa orang memiliki pembengkakan, kehangatan, atau berdenyut ketika daerah yang terkena berubah ungu atau merah., Ehlers–Danlos syndromes (EDS) are a group of 13 genetic connective-tissue disorders in the current classification, with the latest type discovered in 2018. Symptoms often include loose joints, joint pain, stretchy velvety skin, and abnormal scar formation. These may be noticed at birth or in early childhood. Complications may include aortic dissection, joint …, Feb 4, 2015 · Abstract This review describes the principles of approach to, and management of, the patient with Raynaud’s phenomenon (RP). The first step is to establish whether RP is primary or secondary to an underlying cause. If RP is secondary, then this has implications for management: the cause may be treatable, and the RP is likely to be more severe than primary RP. If RP is secondary to systemic ... , The Raynaud phenomenon (RP) is a condition in which some of the body's blood vessels (most commonly those in the fingers and toes) constrict in an exaggerated way in response to cold or emotional stress. Normally, the vessels that supply blood to the skin constrict or narrow in response to cold temperatures., Raynaud’s pentad. The presence of hypotension and confusion alongside the features of Charcot’s triad may be referred to as Raynaud’s pentad. Patients with signs of systemic infection typically have a poorer prognosis., Objective: To determine the prevalence of Charcot triad, Reynolds pentad, and Tokyo Guidelines criteria and clinical outcomes among patients with cholangitis across different …, Charcot triad decreased with older ages. In the group that was age 80 years or older, malaise was the most common symptom; 33.6% (37 of 110) presented with altered sensorium, 9.1% (10 of 110) had no pain, fever, or jaundice, and positive blood culture results were more frequent., Purpose of review. Raynaud’s phenomenon (RP) is a common vasospastic condition that results in digital hypoperfusion in response to cold and/or emotional stress and is associated with significant pain and disability. The aim of our review is to provide a practical approach for clinicians to inform assessment and management of patients with RP., Feb 25, 2023 · The pathogenesis of Raynaud phenomenon has not been completely elucidated 1. It is thought that in patients with Raynaud phenomenon, there is a heightened sympathetic response to triggers such as cold temperatures 5. Under normal circumstances, cold temperatures trigger a sympathetic response 5. Extremities such as fingers and toes have a very ... , Peripheral vascular disease can be either occlusive (e.g. intermittent claudication) in which occlusion of the peripheral arteries is caused by atherosclerosis, or vasospastic (e.g. Raynaud’s phenomenon ). Peripheral arterial occlusive disease is associated with an increased risk of cardiovascular events. This risk is reduced by measures such ..., Nov 25, 2022 · This is when your Raynaud’s is associated with an underlying health condition (see below). Secondary Raynaud’s accounts for 10-20% of Raynaud’s cases. Causes of secondary Raynaud’s. Most cases of secondary Raynaud’s are linked with conditions where your immune system mistakenly attacks healthy tissue in your body. , Raynaud's disease: Definition Raynaud's disease refers to a disorder in which the fingers or toes (digits) suddenly experience decreased blood circulation. It is characterized by repeated episodes of color changes of the skin of digits on cold exposure or emotional stress . Description Raynaud's disease can be classified as one of two types: ..., The Reynolds pentad adds mental status changes and sepsis to the triad. A spectrum of cholangitis exists, ranging from mild symptoms to fulminant overwhelming sepsis. With septic shock , the... , Bile Acid Metabolism During Development. Heidi Eigenrauch Karpen, Saul J. Karpen, in Fetal and Neonatal Physiology (Fifth Edition), 2017. Bile Flow. Bile flow is driven primarily by two factors: bile acid–dependent mechanisms and bile acid–independent mechanisms (see Figures 95-3 and 95-4).The main determinant of bile acid–dependent flow, and the …