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Practice paper
Published in Andrew Schofield, Paul Schofield, The Complete SAQ Study Guide, 2019
Andrew Schofield, Paul Schofield
Grey Turner’s sign is bruising along the flanks and is seen in haemorrhagic pancreatitis. It represents retroperitoneal and intraabdominal bleeding where altered blood tracks subcutaneously. Similar bruising around the umbilicus is known as Cullen’s sign. (2)
Dermatological manifestations of serious gastrointestinal disorders
Published in Biju Vasudevan, Rajesh Verma, Dermatological Emergencies, 2019
Purpura, bruising, and jaundice may occur in patients with acute pancreatitis, but none of these are specific for pancreatitis. The tracking of hemorrhagic fluid in interfascial defect produces purpura or bruise. Classically Grey Turner sign manifests as bruise in the left flank due to left-sided acute pancreatitis. However, there are many sites of retroperitoneal hemorrhage, such as splenic rupture, ectopic pregnancy, metastatic tumor, or aortic aneurysm, that may mimic acute pancreatitis. Patients of pancreatitis may also have dermatological signs related to their etiological conditions, e.g., alcohol abuse, hepatic cirrhosis, or xanthomas due to hypertriglyceridemia [36].
Medical and Surgical Treatment of Intra-abdominal Infections
Published in Thomas T. Yoshikawa, Shobita Rajagopalan, Antibiotic Therapy for Geriatric Patients, 2005
John G. Carson, Ryan W. Patterson, Samuel Eric Wilson
Patients with pancreatitis who have more than four of Ranson's criteria, an unexpectedly prolonged course, hemodynamic instability, fever, and failure of medical therapy should have a contrast-enhanced CT scan. We routinely obtain a CT scan on all hospitalized pancreatitis patients for its prognostic value. On physical examination, epigastric abdominal pain and tenderness with a mass on palpation are sought. Grey-Turner sign (discoloration of flanks) or Cullen sign (periumbilical discoloration) are characteristic of retroperitoneal bleeding but rarely noted. Other findings include vital signs consistent with sepsis, abdominal guarding, rebound tenderness, vomiting, jaundice, fever, and leukocytosis. Serum amylase is elevated but<1000IU/L. A serum albumin <2.5g/dL and elevated alkaline phosphatase are characteristic of pancreatic abscess. Contrast-enhanced CT scans are examined for nonenhancing areas, which indicates loss of vascularity, necrosis, or, in the case of abscess, a fluid collection. Percutaneous needle aspiration of these areas may detect bacteria with Gram stain and culture.
Clinical spectrum, risk factors, management and outcome of patients with retroperitoneal hematoma: a retrospective analysis of 3-year experience
Published in Expert Review of Hematology, 2020
Kamal Kant Sahu, Ajay Kumar Mishra, Amos Lal, Susan V. George, Ahmad Daniyal Siddiqui
Clinical signs especially dermatological findings are easy to recognize and often extremely helpful in detecting concealed pathologies [20–31]. In our series, four patients also complained of abdominal wall discoloration as a presenting feature. It is worth mentioning classical dermatological signs not limited to but seen in RPH: Grey Turner’s sign (ecchymosis/discoloration of the flanks), Cullen’s sign (periumbilical ecchymosis), Fox’s sign (upper thigh along the inguinal ligament), Bryant’s sign (blue discoloration of the scrotum), Stabler’s sign (bruising of the pubis and groin). Also, the presence of Carnett’s sign (worsening of abdominal pain on straight leg raising or lifting the shoulders) or Fothergill sign (persistence of abdominal wall swelling on a straight leg raising) indicate the presence of concomitant rectus sheath hematoma.
Pregnancy and subsequent uterine rupture in a 72-year-old gravida: medical tourism versus procreative freedom
Published in Journal of Obstetrics and Gynaecology, 2018
Physical re-examination of the patient demonstrated significant umbilical bruising (Cullen’s sign, Harris and Naina 2008) and flank ecchymosis (Grey Turner’s sign, Figure 1(B)). She was resuscitated with crystalloid and packed red blood cells (pRBCs), while awaiting an exploratory laparotomy. In the operating theatre she was given additional pRBCs, fresh frozen plasma, platelets, and cryoprecipitate as she developed disseminated intravascular coagulation (DIC). Following the vertical skin incision, approximately three litres of haemoperitoneum was noted upon entrance of the abdomen that was evacuated, while the uterus was identified. The gravid, previously unscarred, uterus was spontaneously ruptured at the fundus (Figure 1(C)). The intact amniotic sac, the placenta and the foetus were delivered. The neonatal intensive care unit (ICU) team confirmed foetal demise at delivery.
Vascular injury at laparoscopy: a guide to management
Published in Journal of Obstetrics and Gynaecology, 2018
Victoria Asfour, Edward Smythe, Rizwan Attia
Major abdominal vessel laceration can occur at entry due to the anatomical proximity of the aorta and inferior vena cava to the umbilicus. The risk of injury is highest in the thinnest patient due to the close proximity of the vessels to the overlying skin. Multi-gravid and elderly patients may have divarification of the recti that may lead to uncontrolled rapid entry with the trocars. Inserting the instruments at a 45° angle in a flat supine position can reduce this risk. In obese patients, the length of instrument needed to achieve entry is longer, making a 90° entry a safe technique. Sometimes the injury is not immediately obvious at entry. If there is a small puncture in the retro-peritoneum, the gaseous pressure may tamponade any bleeding during the operation. A slow leak can occur post-operatively leading to a haematoma, lower limb ischaemia or present later with anaemia. In severe cases, retroperitoneal haematoma may lead to extensive bruising of the flank 24–48 hours later (Grey–Turner sign).