Francisco J Cervantes MD FAAP With the gentle collaboration of numerous Radiologists in Laredo

1. Francisco J Cervantes MD FAAP With the gentle collaboration of numerous Radiologists in Laredo Liver Size by U/S in Children Laredo Medical Center Laredo TX May 7, 2013 WWW.LaredoPediatrics.com

2. BMI scale for Adult Population

7. The importance of liver size in pediatrics Briefly, we request a liver ultrasound ( U/S ) in an overweight child, if he or she already has elevation of the liver enzymes above the normal values ( which means Mean +/- 2 SD that represents , the 95% sample of a normal population , a range might be larger) as Alkaline Phosphatase ( see Graphs for boys and girls ), SGOT (AST) above 50 and 46, SGPT (ALT) 47 and 41, GGT 32 and 28 respectively for boys and girls, and Total Bilirubin (TB) at 0.8 or any higher values ( More details information can be found at our web site www.laredopediatrics.com, click at “our clinical studies”. Briefly, elevations of Alk. Phos. And /or SGOT might indicate presence of a fatty liver. Elevations of SGPT and GGT might indicate the beginning of steatohepatitis ( Non Alcoholic Steato Hepatitis ) or some another type of hepatitis. Elevations of GGT and bilirubin might indicate Gallbladder (GB) disease. The Liver U/S might show some other alterations besides the presence of a fatty liver such as HEN ( Hyperechoic nodes, FFS (Focal Fat Sparing or starry sky appearance (SSA) around blood vessels; lithiasis, sludge, thickened wall, contracted , dilated or septated GB, splenomegaly, hypoeechoic or prominent pancreas, pleural fluid and ascites and more recently, Hepatomegal (H). When you request a liver U/S, also ask specifically for liver (Sagital measure) size. This new clinical tool has allowed us to see a different relationship between liver involvement and overweight in children. As you might see in the table of “Difference between the 4 subgroups of normal BMI”, children (10 or <, 25, 50 and 75 percentiles) at the Glucose, Insulin, HDL and TGL, there is already significant differences between the larger and the smaller subgroups. Same happens to the liver size and at the liver enzymes ( Those numbers will be presented at the 29th annual update in Medicine conference in Oct/2013). Liver size increases with the BMI. We knew that liver size (abdominal circumference) was a good measure of either under, normal or overnutrition in the fetus and baby to be born in Neonatology, and now is obvious that liver increases with overweight, either by excessive fat accumulation or another metabolic substrate, such as glycogen, etc. It’s hard to try to palpate a liver edge in an overweight child or time consuming trying to percute the liver area. Liver size by U/S is precise and correlates with BMI (last graph). Only 14 of 23 Children with liver size larger than +SD were read by Hepatomegaly. Some of the early radiologic reports were mentioned as Hepatomegaly without measures, and viceversa, some other the liver was not that big. We do not know what to do when they report us large spleen (Beginning of cirrhosis?) There are values for liver transverse measurement but the standard mesasure is a sagital. Laredo Medical Center , May 7, 2013