رجل عمره ٧٠ سنة معروف بحصوات المرارة، عنده حرارة ٣٩٫٢ مع رجفة، واصفرار في العين والجلد، وألم في أعلى يمين البطن. صار مشوشاً. الضغط ٨٦/٥٠، النبض ١٢٤. ما الحالة المتوقعة ومدى خطورتها؟

A 70-year-old man with known gallstones has a temperature of 39.2 °C with rigors, jaundice and RUQ pain, and has become confused. BP 86/50, HR 124. What is the likely condition and its urgency?

1. Viral hepatitis to be followed up in clinic in two weeks
2. Hereditary Gilbert syndrome, a harmless condition
3. Ascending cholangitis, an emergency needing urgent drainage
4. Simple biliary colic that settles with analgesia in hours

Answer: C) Ascending cholangitis, an emergency needing urgent drainage. Charcot’s triad (fever, jaundice, RUQ pain) plus confusion and hypotension (Reynolds’ pentad) indicates severe cholangitis with sepsis needing fluids, antibiotics and urgent endoscopic drainage.