SAEM Clinical Image Series: A Page Turner

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Chief complaint: Abdominal pain

History of Present Illness: A 36-year-old male with a history of alcohol abuse, hypertension, hyperlipidemia, and myocardial infarction with a subsequent stent on ticagrelor and aspirin presents with abdominal pain.

He reports 3 days of epigastric and periumbilical pain and multiple episodes of non-bloody, non-bilious emesis. He denies fever, diarrhea, blood in his stool, and urinary symptoms. He endorses bruising to his bilateral flanks and multiple falls recently while drinking.

Physical Exam

Vitals: Temp 36.5 °C, HR 142, Resp 22, SpO2 97% , BP 103/65

General: Alert and oriented. Uncomfortable.

Cardiac: Tachycardic, regular rhythm. Tachypneic.

Pulmonary: Normal breath sounds.

Abdominal: Soft abdomen. Epigastric and umbilical abdominal tenderness. No rebound or guarding. Bilateral flank and forearm ecchymoses.

Laboratory Data

CBC: WBC 12.3, Hgb 15, Hct 43.9, Plt 239

CHEM: Na 136, K 3.4, Cl 101, CO2 26, BUN 9, Cr 0.62, glucose 128, albumin 3.7, total bilirubin 1.9, AST 49, ALT 29, alkaline phosphatase 71, lipase 588

Troponin: <0.03

Coags: INR 1.08, PT 12.3, PTT 31.4

Lactic acid: 1.5

Urinalysis: Unremarkable

Case Question: What is the name of this classic sign?

Grey Turner’s sign

Described as flank ecchymosis or discoloration classically associated with hemorrhagic pancreatitis

Case Question: What is this sign suggestive of?

It is nonspecific and may be present in different diseases resulting in retroperitoneal or intra-abdominal hemorrhage.

Case Discussion

Peri-pancreatic bleeding results from fat necrosis and inflammation induced by pancreatitis. Blood enters a defect in the transversalis fascia eventually reaching the subcutaneous tissue of the flanks.

In acute pancreatitis, a Grey Turner’s sign suggests high mortality and may be seen with Cullen’s sign (periumbilical bruising).

Copyright

Images and cases from the Society of Academic Emergency Medicine (SAEM) Clinical Images Exhibit at the 2019 SAEM Annual Meeting | Copyrighted by SAEM 2019 – all rights reserved. View other other cases from this series on ALiEM.

Author information

Kimberly Fender, MD

Resident Physician
Department of Emergency Medicine
University of North Carolina

The post SAEM Clinical Image Series: A Page Turner appeared first on ALiEM.

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