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Gastro Exam

Examining the Flanks

November 26th, 2019


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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