Which of the following are early signs of retroperitoneal bleeding?

• A. Hypertension, tachycardia
• B. Headache and dizziness
• C. Hypotension, back pain, flank ecchymosis (Grey Turner's sign), hematoma formation, diminished distal pulses
• D. Nausea only

Answer: (C)

Retroperitoneal bleeding tends to present with signs of blood loss and local irritation from blood accumulating in the back/retroperitoneal space. The best clues are hypotension from volume loss, back pain from the bleed irritating retroperitoneal structures, and evidence of bleeding in the area such as flank ecchymosis (Grey Turner's sign) and hematoma formation. Diminished distal pulses show that perfusion to the extremities is compromised because of the drop in circulating blood. Hypertension or nonspecific symptoms like a headache or nausea without signs of poor perfusion don’t point to retroperitoneal bleeding, making the combination of these systemic and local signs the most indicative.