Wednesday, October 04, 2006

Finally felt a liver!

In medical school you learn all your examinations on normal people. You learn to palpate the liver on someone without a palpable liver. You palpate systematically up from the suprapubic area to the costal margin on the right side with two hands asking the person to breathe in and out through their mouth. They tell you that when the person inspires the liver will brush up against your fingers and then recede on expiration back upwards (sometimes under the costal margin). This has remained a mystery to me for the past year and a half. I never felt a liver.

Yesterday I felt a liver for the first time. Mr. Yellow was a patient on medical service in for investigations into the source of his jaundice. His liver was HUGE. If you pulled up his shirt and inspected his belly you could actually see the outline of his liver. It took up almost the entire right side of the abdomen and part of the upper left quadrant. I palpated, and felt it, the kiss of a liver on my fingertips. Due to his condition his liver was nodular and I could actually feel the texture as it moved under my hand. Sadly, Mr. Y's CT scan revealed multiple liver mets from an unknown primary CA. I'm impressed that Mr. Y allowed 10 students to come in and palpate his belly and I'm very greatful. Without willing patients on the wards, medical students would only be able to practice on standardized patients and volunteer patients who usually do not have positive findings. They're doing a real service to the medical community by participating in our education.

To anyone who has ever been seen by a medical student: thank you. We all very much appreciate it.


Amy said...

I go to the family practice clinic run by the family medicine group at UBC. We get students who come in to practice taking histories on Fridays. I really like it. They just need to relax. They always seem so nervous. I guess the fact that they get grilled by the doc when she comes in doesn't help the nerves

Morenna said...

Isn't it amazing how huge the liver can get when it is sick? I picked up a chronic alcoholic once who probably weighed 110 pounds, but most of that weight appeared to be her liver. I never did palpate it, but I wanted to just to see what it felt like. She was as yellow as a school bus and her belly was as tight as a drum. Three days later she went into complete liver failure.