Reynolds pentad

Charcot triad is the classic picture of acute cholangitis and comprises jaundice, abdominal pain, rigors, and pyrexia. Hypotension and confusion are often a feature of acute suppurative cholangitis in which the bile duct is filled with purulent bile under pressure (Reynold pentad).

Patients can also present with Reynolds pentad, which is the Charcot triad (fever, pain and jaundice) plus shock and delirium (and/or lethargy) 1-3. Pathology. Gram-negative enteric bacteria, most commonly Escherichia coli, are the primary pathogens 3. Acute cholangitis is seen in the setting of biliary tree obstruction 1,2:La pentada de Reynolds es el nombre que reciben los 5 signos y síntomas diferentes que pueden emplearse como herramienta de diagnóstico para detectar la colangitis aguda. Incluye los síntomas comprendidos en la triada de Charcot, a los que se le suman el shock físico y un estado mental alterado. La colangitis es una enfermedad caracterizada ...Nov 10, 2018 · Reynold’s pentad describes the presence of all three components of Charcot’s triad, and also mental status changes and hypotension, suggesting life-threatening cholangitis. Although both Charcot’s triad and Reynolds’ pentad are highly specific for ascending cholangitis, neither is sufficiently sensitive for screening for the diagnosis. • Reynolds pentad : + septic shock, gangguan kesadaran. Page 63. DIAGNOSIS. Pemeriksaan fisik. Pemeriksaan laboratorium. USG : batu kandung empedu. Dilatasi CBD.Ascending Cholangitis: Pathogenesis and clinical findings Authors: Brandon Hisey, Neel Mistry Reviewers: Alec Campbell, Vina Fan, Ben Campbell, Kelly Burak*, Eldon Shaffer* * MD at time of publication Reflux of biliary contents into the vascular system (cholangiovenous reflux) Bacteria ascends into biliary tract from duodenum via Sphincter of Oddi Gallstone in the common bile duct Stricture of ...History. In 1877, Charcot described cholangitis as a triad of findings of right upper quadrant (RUQ) pain, fever, and jaundice. The Reynolds pentad adds mental status changes and sepsis to the... In more severe cases, they also have altered mental status and hypotension, which is referred to as Reynolds' pentad. Additionally, other general symptoms of nausea, vomiting, ileus, and abdominal distension may also be present. These individuals will require aggressive fluid resuscitation and intravenous antibiotics as part of the initial ...อนึ่ง ในกรณี ท่อน้ำดีอักเสบรุนแรง จะประกอบด้วยอาการหลัก 5 อาการร่วมกัน เรียกว่า 'Reynolds' pentad' คือ อาการของ Charcot's triad (3อาการดังกล่าว ...

The specificity of Reynold's pentad was not studied. Conclusion: Charcot's triad has limited clinical utility as a diagnostic algorithm for AC. It is an effective rule-in test but a poor rule-out test and should be applied and taught accordingly. A more sensitive diagnostic tool is required to achieve superior outcomes for AC patients.Reynolds numbers; Reynolds pentad; Reynolds Plantation Builders Association; Reynolds Porter Chamberlain; Reynolds Private Managed Network; Reynolds Stress; Reynolds Stress Model; Reynolds stress tensor; Reynolds stresses; Reynolds syndrome; Reynolds v. Sims; Reynolds World Investment Enterprises, LLC; Reynolds Wrap; Reynolds' number; Reynolds ...총담관결석증 및 여러 가지 원인으로 담관 (biliary tract)에 폐색이 생기면서 담즙의 배출에 장애가 생기고, 이로 인해 박테리아가 증식하면서 담관에 염증이 생기는 질병을 담관염이라고 한다. 주로 총담관결석증 으로 인해 발생하나, 다른 원인으로는 앙성종양 ...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 alterado. Às vezes, os ...This clinical combination has been traditionally known as Charcot's triad. AC is primarily an infectious disease characterized by the proliferation of bacteria within bile and with the secondary blockage of biliary tracts. 8 The Reynolds' pentad is defined as the occurrence of confusion and shock along with Charcot's triad. 36

برای نمایش الگو به حالت باز از { {علائم و نشانه‌ها |state=expanded}} استفاده کنید. اگر می‌خواهید این الگو فقط زمانی که الگوی هم‌نوع آن در صفحه باشد شکل تاشده به‌خود بگیرد از { {علائم و نشانه‌ها |state ...There is a triad of symptoms called Charcot triad that characterizes this type of cholangitis. The triad is jaundice (due to elevated bilirubin), fever, and right upper quadrant pain. If the patient shows signs of shock and altered mental status, the collection of signs is then called Reynolds pentad.Reynolds Pentad: Consists of Charcots Triad plus altered mental status and hypotension suggestive of septic cholangitis. Courvoisiers Sign: The combination of painless jaundice and a palpable gall bladder is suggestive of a biliary obstruction resulting from a malignancy other than a stone.Rupture of the cyst into the lumen of the gallbladder can present with Charcot's triad and subsequently Reynolds Pentad. These patients are misdiagnosed as calculus disease of the gallbladder on clinical examination, but ultrasound can help establish the definitive diagnosis.

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Acute cholangitis is the result of bacterial infection superimposed on partial or complete obstruction of the biliary system. It occurs in 6% to 9% of patients admitted with cholelithiasis. In the past, about 80% of cases were related to choledocholithiasis. However, due to the increase in endoscopic and radiological intervention and prolonged survival in patients with malignant disease, more ...Reynolds risk score answers are found in the Taber's Medical Dictionary powered by Unbound Medicine. Available for iPhone, iPad, Android, and Web.Chilaiditi syndrome is a rare condition when pain occurs due to transposition of a loop of large intestine (usually transverse colon) in between the diaphragm and the liver, visible on plain abdominal X-ray or chest X-ray. [1] Normally this causes no symptoms, and this is called Chilaiditi's sign. The sign can be permanently present, or ...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 with shock and an altered mental status. Sometimes the two additional signs are listed simply as low blood pressure and confusion.read more , and fever or chills (Reynolds' pentad) predict about a 50% mortality rate and high morbidity. Pearls & Pitfalls Suspect acute cholangitis (a surgical emergency) in patients with abdominal pain, jaundice, and fever or chills.

Abdominal pain, also known as a stomach ache, Is a symptom associated with both non-serious and serious medical issues. Since the abdomen contains most of the body's vital organs, it can be an indicator of a wide variety of diseases. Given that, approaching the examination of a person and planning of a differential diagnosis is extremely important. ...Bilangan Reynolds diperoleh dengan persamaan R e = V R / R e = (1000 kg / m 3 x 10 m / s x 0,000002m) / 0,001 kg / (m s) R e = 20. Bilangan Reynolds adalah 20. Alirannya turbulen. Kegunaan. Bilangan Reynolds memegang peranan penting dalam mekanika fluida dan perpindahan panas karena merupakan salah satu parameter utama …fever’ as by Dr. Jean-Martin Charcot). In 1959, Reynolds expanded the description of acute cholangitis by adding lethargy/mental con - fusion and shock indicative of ongoing biliary sepsis, thus dubbed the Reynolds’ pentad [11]. However, an unequivocal diagnosis of acute cholangitis calls for confirmation of the underlying biliaryPMID: 17983054. Acute cholangitis is a life-threatening complication of biliary obstruction that is exacerbated by delays in diagnosis and treatment. Since the introduction of endoscopic retrograde cholangiography and endoscopic therapeutic modalities, few investigations have addressed admission prognostic indicators of adverse outcomes.Reynold's Pentad is a collection of both signs and symptoms that a Medical Practitioner or paramedic can identify in order to determine a diagnosis of ...The Reynolds Bexley Gym in Dartford Kent, offers high quality fitness facilities and affordable membership. Call us now on 01322 522209.Courvoisier's law. Courvoisier's principle (known as Courvoisier's sign or Courvoisier–Terrier's sign, or Courvoisier syndrome) states that a painless palpably enlarged gallbladder accompanied with mild jaundice is unlikely to be caused by gallstones. Usually, the term is used to describe the physical examination finding of the right-upper ...RG. Abbrev. for Remedial Gymnast. Want to thank TFD for its existence? Tell a friend about us, add a link to this page, or visit the webmaster's page for free fun content .Reynolds PENTAD. fever, jaundice, RUQ pain, AMS, hypotension (acute cholangitis) Becks Triad. muffled heart sounds, distended neck veins, hypotension (cardiac tamponade)

10.TREATMENT • ABC • CODE SPESIS • Early Fluids • IV Abx within 1 hour- gold standard as per Surviving Sepsis Guidelines • Cover for Gram Neg- most important • Start Broad • amoxy/ampicillin 2 g (child: 50 mg/kg up to 2 g) IV, 6-hourly PLUS gentamicin 4 to 6 mg/kg (child <10 years: 7.5 mg/kg; >10 years: 6 mg/kg) IV, daily for up to 3 days (adjust dose for renal function) • 3rd ...

Purpose. Differentiating upper right quadrant pain. In medicine, Murphy's sign (also known as Sweeney's sign) is a maneuver during a physical examination as part of the abdominal examination. [1] It is useful for differentiating pain in the right upper quadrant. Typically, it is positive in cholecystitis, but negative in choledocholithiasis ...RG. Abbrev. for Remedial Gymnast. Want to thank TFD for its existence? Tell a friend about us, add a link to this page, or visit the webmaster's page for free fun content .Encopresis is voluntary or involuntary passage of feces outside of toilet-trained contexts (fecal soiling) in children who are four years or older and after an organic cause has been excluded. [1] Children with encopresis often leak stool into their undergarments. This term is usually applied to children, and where the symptom is present in ...(9) Common bile duct lithiasis was responsible in 80% of cases presenting with Reynolds' pentad and in 66% of postoperative mortality. (10) The presence of renal impairment, occurring as frequently as any of the pentad of features that characterize the syndrome, has important implications for the prognosis and long term management of these ...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. شکم حاد (به انگلیسی: acute abdomen) در اشاره به درد ناگهانی و شدید دارد. در بسیاری موارد چنین عارضه‌ای نیاز به سریع و فوری دارد. در برخی موارد نیز لازم می‌شود. [۱] آپاندیسیت حاد شایع‌ترین علت شکم حاد ...Reynolds risk score answers are found in the Taber's Medical Dictionary powered by Unbound Medicine. Available for iPhone, iPad, Android, and Web. Abdominal distension occurs when substances, such as air (gas) or fluid, accumulate in the abdomen causing its expansion. It is typically a symptom of an underlying disease or dysfunction in the body, rather than an illness in its own right. People with this condition often describe it as "feeling bloated".Affected people often experience a sensation of fullness, abdominal pressure, and ...

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Joseph Banks, painted by Joshua Reynolds, circa 1771-1773. Wikimedia. It seems a perfectly reasonable assumption that this advice had a decisive influence on both the decision to send an ...(9) Common bile duct lithiasis was responsible in 80% of cases presenting with Reynolds' pentad and in 66% of postoperative mortality. (10) The presence of renal impairment, occurring as frequently as any of the pentad of features that characterize the syndrome, has important implications for the prognosis and long term management of these ... تهوع. برای دیگر کاربردها، تهوع (ابهام‌زدایی) را ببینید. تَهَوُّع نوعی حالت است که قبل از بالا آوردن غذا از لوله گوارش به بیرون دهان احساس می‌شود. نوعی احساس است همراه با حرکت معکوس اندام‌های ...Reynolds pentad. Reynolds pentad is a collection of signs and symptoms suggesting the diagnosis obstructive ascending cholangitis, a serious infection of the biliary system. Charcot's triad + altered mental status and hypotension. Boas' sign. right subscapular pain from cholelithiasis. About us. About Quizlet;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 with shock and an altered mental status. Sometimes the two additional signs are listed simply as low blood pressure and confusion.Charcot triad and Reynolds pentad have high specificity but low sensitivity for diagnosing cholangitis. 5 The sensitivity of Charcot triad may be as low as 7% 6 and that of Reynolds pentad less than 5%. 7 The Tokyo Guidelines have not been validated in elderly patients or in a US population. We therefore sought to determine in a US cohort which ...PMID: 17983054. Acute cholangitis is a life-threatening complication of biliary obstruction that is exacerbated by delays in diagnosis and treatment. Since the introduction of endoscopic retrograde cholangiography and endoscopic therapeutic modalities, few investigations have addressed admission prognostic indicators of adverse outcomes.History. In 1877, Charcot described cholangitis as a triad of findings of right upper quadrant (RUQ) pain, fever, and jaundice. The Reynolds pentad adds mental status changes and sepsis to the... Ascending cholangitis, also known as acute cholangitis or simply cholangitis, is inflammation of the bile duct, usually caused by bacteria ascending from its junction with the duodenum (first part of the small intestine).It tends to occur if the bile duct is already partially obstructed by gallstones.. Cholangitis can be life-threatening, and is regarded as a … ….

Chilaiditi syndrome is a rare condition when pain occurs due to transposition of a loop of large intestine (usually transverse colon) in between the diaphragm and the liver, visible on plain abdominal X-ray or chest X-ray. [1] Normally this causes no symptoms, and this is called Chilaiditi's sign. The sign can be permanently present, or ...อนึ่ง ในกรณี ท่อน้ำดีอักเสบรุนแรง จะประกอบด้วยอาการหลัก 5 อาการร่วมกัน เรียกว่า ‘Reynolds’ pentad’ คือ อาการของ Charcot’s triad (3อาการดังกล่าว ...雷诺兹五联征（英语：Reynolds' pentad），是由急性梗阻性化脓性胆管炎引起的沙尔科三联征（腹痛、寒战高热、黄疸）、休克和中枢神经系统抑制的症状。Objective: To determine the prevalence of Charcot triad, Reynolds pentad, and Tokyo Guidelines criteria and clinical outcomes among patients with cholangitis across different age groups.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 ...Reynolds' pentad (B. M. Reynolds) Related people. Jean-Martin Charcot; Charcot's triad (fever, jaundice, and upper abdominal pain) plus hypotension and altered mental status changes (CNS depression). ... B. M. Reynolds, E. L Dargan: Acute obstructive cholangitis: a distinct clinical syndrome. Annals of Surgery, Philadelphia, 1959, 150: 299-303.2. Petechiae (often in the axilla/thorax)3. Dyspnea. Triad of bilateral hip, thigh, and buttock claudication, Symmetric atrophy of the bilateral lower extremities due to chronic ischemia. Hypoglycaemia during attacks. Resolution of symptoms upon correction of blood glucose. Symptoms brought about by low glucose states.Reynolds, the creator of the first ballpoint pen in the US in 1945, remains one of the most popular and renowned pen brands globally. Its products, such as the 045, Brite, Aeroslim and Jetter series, are sought-after for their superior quality and unique designs. The Reynolds ball pens are known for their reliability, smoothness, and comfort during use, …Common bile duct lithiasis was responsible in 80% of cases presenting with Reynolds' pentad and in 66% of postoperative mortality. In 75% of patients with tumors, the clinical picture showed a rapid development following PTC. 79% of patients responded positively to antibiotic therapy with subsequent elective surgery, while in 21% of patients ...The most sensitive finding (77%) for cholecystitis is nausea, and the most specific (87%) is Murphy’s sign. The combination of right upper quadrant pain, fever, and jaundice is Charcot’s triad. Add hypotension and altered mental status, and you get Reynolds’ pentad. Reynolds pentad, Charcot triad is the classic picture of acute cholangitis and comprises jaundice, abdominal pain, rigors, and pyrexia. Hypotension and confusion are often a feature of acute suppurative cholangitis in which the bile duct is filled with purulent bile under pressure (Reynold pentad)., Charcot triad describes cholangitis as clinical findings of fever, right upper abdominal pain, and jaundice. The Reynolds pentad adds altered mental status and sepsis to the triad. Many patients with acute cholangitis do not present with classic symptoms and signs. Charcot triad has a high specificity (95.9%), while sensitivity is low (26.4%)., ukraynalı askerlerin rusları keklik gibi avlaması 157. arda güler'in oyun stili ile benzediği futbolcu 158. 31 mart 2024 istanbul yerel seçimi 386. filistin'in uygur politikasında çin'i desteklemesi 248. sadece cahillerin kullandığı kelimeler 152. çocukluğa dönmek için yenen abur cubur 136. evde yemek yapma kültürünün bitmesi ..., Abdominal pain,Fever,Jaundice,Shock, andDepression of central nervous system function (usually indicative of acutesuppurative cholangitis) Reynolds Pentad Pentalogy of Fallot Fallot's tetralogy with, in addition, a patent foramen ovale or Atrial septal defect., Appendicitis, Tubo-ovarian pathology. Alder's sign, also known as Klein's sign, [1] is a medical sign used to differentiate between appendicitis and tubo-ovarian pathology. [2], In 1959, Reynolds expanded the description of acute cholangitis by adding lethargy/mental confusion and shock indicative of ongoing biliary sepsis, thus dubbed the Reynolds' pentad . However, an unequivocal diagnosis of acute cholangitis calls for confirmation of the underlying biliary source of the systemic infection, e.g. by aspiration of ..., The findings from this study documenting the limited utility of Charcot triad and Reynolds pentad confirm previous observations.5, 7 The atypical presentation of cholangitis in patients 80 years ..., Objective To determine the prevalence of Charcot triad, Reynolds pentad, and Tokyo Guidelines criteria and clinical outcomes among patients with cholangitis across different age groups. Patients ..., Dysphagia is difficulty in swallowing. Although classified under "symptoms and signs" in ICD-10, in some contexts it is classified as a condition in its own right.It may be a sensation that suggests difficulty in the passage of solids or liquids from the mouth to the stomach, a lack of pharyngeal sensation or various other inadequacies of the swallowing mechanism., ... Reynolds' pentad and denotes more severe disease. Today's top picks on the Haymarket Medical Network. Hepzato Kit Approved for Unresectable Hepatic-Dominant ..., Acute cholangitis is bacterial infection of the extra-hepatic biliary system. As it is caused by gallstones blocking the common bile duct in most of the cases, its prevalence is greater in ethnicities with high prevalence of gallstones. Biliary obstruction of any cause is the main predisposing factor. Diagnosis is established by the presence of ..., What is Reynolds pentad? ERCP (endoscopic retrograde cholangiopancreatography) What provides the most direct and accurate means of determining the cause, location, and extent of obstruction for cholangitis?, R10.4. ICD-9-CM. 789.6. نشانه بلومبرگ (Blumberg's sign) که به آن تندرنس بازگشتی (rebound tenderness) یا نشانه شچتکین-بلومبرگ (Shchetkin–Blumberg's sign) نیز گفته می‌شود، یک نشانه بالینی است که در آن به جای زمان اعمال فشار به شکم ..., 100% (1) View full document, However, in the systematic review above, the sensitivity of Reynolds’ pentad across nine of the studies was 4.82% . Dr. Charcot was born in 1825 and received his medical doctorate from the University of Paris in 1853, before working at the Salpêtrière [ 7 , 10 ]., Abstract The structure and evolution characteristics of intraseasonal (20–100 day) variations of sea surface temperature (SST) and associated atmospheric and oceanic circulations over the Kuroshio Extension (KE) region during boreal summer are investigated, using satellite-based daily SST, observed precipitation data, and reanalysis data. The …, Differential diagnosis. acute appendicitis. Markle's sign, or jar tenderness, is a clinical sign in which pain in the right lower quadrant of the abdomen is elicited by the heel-drop test (dropping to the heels, from standing on the toes, with a jarring landing). It is found in patients with localised peritonitis due to acute appendicitis. [1], تریاد شارکوت. سه گانه (تریاد) شارکوت یا شارکو (به انگلیسی: Charcot's triad) عنوانی است که به دو مجموعه از ویژگی های بالینی اشاره دارد: یکی برای کلانژیت حاد (به انگلیسی: acute cholangitis)، و مجموعه دوم که کمتر ..., Reynolds' pentad, which includes the additional symptoms of hypotension and altered mental status, occurs in only 10-30% of patients. Laboratory findings that distinguish cholangitis from acute calculous cholecystitis are hyperbilirubinemia and elevated alkaline phosphatase., 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 ..., Pentad is a Greek word that means “a group of five.”. It can be used in a lot of contexts, from describing a five-note chord to naming a literary theory. In terms of weather, it is used in ..., The addition of these findings to Char cot's triad is known as Reynolds' Pentad and is seen in about 5-7% of cases [10, 11]. According to the Tokyo Guidelines, the diagnosis of cholangitis may be classified as suspected or definite based on criteria and can be classified as severe, moderate, or mild . Diagnostic criteria include: ..., The addition of altered mental status and hypotension (Reynolds pentad) signifies acute suppurative cholangitis and is an endoscopic emergency. According to the Tokyo guidelines (revised in 2018), ..., In 1959, Reynolds and Dargon described a more severe form of the illness that included the additional components of septic shock and mental confusion, which is referred to as the Reynolds pentad. Next: Pathophysiology. Historically, choledocholithiasis was the most common cause of biliary tract obstruction resulting in cholangitis. ..., Charcot triad and Reynolds pentad have high specificity but low sensitivity for diag-nosing cholangitis.5 The sensitivity of Charcot triad may be as low as 7%6 and that of Rey-nolds pentad less than 5%.7 The Tokyo Guidelines have not been validated in elderly patients or in a US population. We therefore sought to determine in a US cohort which of, Ascending cholangitis, also known as acute cholangitis or simply cholangitis, is inflammation of the bile duct, usually caused by bacteria ascending from its junction with the duodenum (first part of the small intestine).It tends to occur if the bile duct is already partially obstructed by gallstones.. Cholangitis can be life-threatening, and is regarded as a medical emergency., Charcot’s triad is the manifestation of biliary obstruction with upper abdominal pain, fever and jaundice. The condition may progress rapidly to Reynold’s pentad, which consists of Charcot’s triad with confusion and hypotension. Acute cholangitis is a serious complication of biliary disease where the bile duct is obstructed by either ..., For example, the full complement of symptoms and signs described as Charcot's triad and as Reynolds' pentad are infrequent and as such do not really assist the clinician with planning management ..., Reynolds pentad is a collection of signs and symptoms suggesting the diagnosis obstructive ascending cholangitis, a serious infection of the biliary system. It is a combination of Charcot's triad (jaundice, fever, and right upper quadrant pain) with shock and an altered mental status.[1], RUQ pain, fever, jaundice *Reynolds pentad (+ Hypotension, AMS) What type of gallstone is seen more commonly in bacterial and parasitic infections, as well as more prevalent in south Eastern Asia? Brown stone. Child with yellowing of skin occurring during times of stress, small rise in indirect bilirubin on labs, otherwise normal findings. Dx?, Evaluation of Charcot Triad, Reynolds Pentad, and Tokyo Guidelines for Diagnosis of Cholangitis Secondary to Choledocholithiasis Across Patient Age Groups. Mayo Clinic Proceedings: Innovations, Quality & Outcomes 2021-04 | Journal article DOI: 10.1016/j.mayocpiqo.2021.01.008 Contributors ..., Cholangitis is inflammation of the biliary system that causes fever, jaundice, and abdominal pain (Charcot triad). 8 Charcot triad becomes Reynolds pentad when hypotension and altered mental state are also present. 8 These symptoms develop due to bile stasis and bacterial infection in the biliary tract., David Blakesley: [Kenneth] Burke himself used the pentad on many kinds of discourse, especially poetry and philosophy.He also later added a sixth term, attitude, making the pentad into a hexad.Pentad or hexad, the point is that 'well-rounded statements' about human motivation will make some reference (explicitly or not) to act, scene, agent, agency, purpose, and attitude...