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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