****Liver "Q" for Rid****

[DT4EMS]

Hey Rid,

I know if I have this question........ so do others.

I am in the middle of preparing for the new, new PALS. I have run across something that is new to me:

Palpation of the liver below the costal margin and giving an estimate.

In a cardiac or respiratory emergency, what is the signifigance of palapating the liver?

 

[Ridryder911]

I am by far not a pediatric nurse, but a couple of things come into mind. First of course would be underlying medical conditions such as live size, functioning liver, cardiac failure, and disease processes of the liver.

Some things off the top of my head is checking for patency of liver function such as in size .. which I found this article from one of my books .."The most reproducible method in estimating liver size in neonates is either (1) percussion of the upper and lower borders of (2) percussion of the upper border and palpation of the lower border. The clinical estimate of liver size in a healthy term neonate is 5.65 cm.".....For doing so, remember that neonates are more prone to biliary problems.

Also remember cardiac assessment can be made as well from the liver. Hepatojuglar Reflux (not reflix) can be assessed by palpating the liver for 15-30 seconds and watching jugular distention, indicating possible right side failure.

Most of the medications that we use in the emergency arena are absorbed and distributed through the hepatic system into the circulatory system and diseased liver will decrease the functioning state.

Genetic defects such as Trisomony ( I believe III) will also affect the liver size and are prone to hepatic problems and associated cardiac problems such as enlarged atriums, and increasing problems such as failure. ..

Again, ped.'s are not my bag.. but, interesting thoughts of why they are stressing. I will try to get more info as well.. thanks!

R/r 911

 

[DT4EMS]

Hmmmm......... interesting. There are only 2 cases (in the PALS Course) I found it in. Both are cardiac related. One is the Cardiogenic shock and the other is during symptomatic SVT (narrow complex) but I am not sure if the complex even matters.

The video makes a specific point of showing the outline of the liver during the case discussion phase of the SVT.

I am very curious about this. I am going to try and make a few phone calls too. Please let me know if you get anything on this.

 

[DT4EMS]

Rid see if this makes sense............ (it's news to me)..........

I just called our Medical Director for PALS. He is a pediatric specialist.

First, he thought it was odd the liver was mentioned in the new PALS.

Now, for what he gave me.

The liver enlargement would be secondary to Hepatic congestion. In the SVT situation, the rate is too fast and the blood is backing up in the liver. Hepatomegaly is apparently common in the Cardiogenic Shock state as well.

Again, this was new to me and I am tickled sh*tless I learned something new today!

 

[Ridryder911]

Makes sense too me.. I too learned something new ! Thanks !!

R/r 911