Examining the Flanks
Overview
- During the gastrointestinal examination the flanks are often ignored in favour of the abdomen, however there is valuable information to be gained from inspecting and palpating the flanks routinely.
Grey-Turner’s Sign
Look For
- Bruising of the flanks.
Significance
- A sign of retroperitoneal haemorrhage, along with Cullen's sign (bruising around the umbilicus).
Causes of Grey-Turner’s Sign
- Pancreas - acute pancreatitis, trauma
- Gynae - ruptured ectopic pregnancy, ovarian enlargement
- GI - perforated duodenal ulcer
- Liver - hepatocellular carcinoma, lymphoma, amoebic abscess
- Spleen - splenic rupture
- Vascular - ruptured AAA / internal iliac aneurysm
- Iatrogenic
Flank Tenderness
Feel For
- Tenderness over the lower back, lateral to the spine on either side.
Causes of Flank Tenderness
- Infection - pyelonephritis, perinephric abscess
- Malignancy - renal cell carcinoma, transitional cell carcinoma
- Renal infarction
- Trauma
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