الفهرس 
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Abstract
The liver, spleen and kidney like other organs of the body, grow with age. It has been estimated that between birth and adulthood, there is an at least ten folds increase in these organs mass. Assessment of these organs size is an important part of clinical examination, so information about the normal size of the liver, spleen and kidney at various ages is necessary for the detection of abnormalities in these organs, a condition that needs further evaluation.
Liver size varies widely according to age. Many diseases can affect their size, ranging from infective processes to malignant disorders. On the contrary, clinically a palpable liver may not be pathological. Pushed down liver due to lung or subdiaphragmatic pathology, and visceroptosis are a few examples of a palpable liver without any clinical significance.
Clinical assessment of the liver is done by palpating the degree of the extension of the liver below the costal margin and the span of dullness on percussion.
The normal liver edge can be felt up to 2 cm below the right costal margin and. The spleen is palpable only when it is two to three times its normal size, although it may be palpable in 10% of healthy children and 15% of neonates.
The accuracy of measuring the spleen and liver by palpation and percussion has been shown to be less accurate particularly in detecting small increase in size of the organ. Kidney sizes cannot be measured by examination and only gross enlargement will be detected by ballottement.
Ultrasonography is an easy, inexpensive, noninvasive and accurate method that is commonly used to assess sizes of these intrabdominal organs. The liver is measured in the mid clavicular line with simultaneous demonstration of the right kidney during breath holding in adolescents. The upper and lower points of the sonographic image are taken as the measuremen. The spleen is measured in the longitudinal coronal view. The maximal distance between the most supero – medial and inferolateral points are taken as the spleen length. The lateral decubitus position is preferred to measure the kidney size.
Literature reports on liver, spleen and kidney size in children are either quite old or deal with a limited number of adolescent, and most were based on Western populations. To our knowledge, there are no data on the liver, spleen and kidney size in Arab, in general, and Egyptian adolescents, in particular. Therefore, in this thesis, we report Z score references of liver, spleen and kidney parameters for healthy Egyptian adolescents from 12 to 18years.
This cross sectional study was conducted on 333 healthy Egyptian adolescents from 12 to 18 years for establishment of Z score reference of liver, spleen and kidney parameters.
This study was part of the Health Profile of Children and Adolescent Project in Egypt, designed primarily for the establishment of growth charts for Egyptian children and adolescents. the original main sample was 333 (45% boys and 55% girls) determined by cross sectional randomized study from different Egyptian geographic districts, with weighted rural-urban representation, all socioeconomic levels were represented, consisting of adolescents aged from 12 to 18 years from January 2022 to September 2022.
Only apparent healthy Egyptian adolescents with good nutritional status with no past or present history of any symptoms or signs of liver, spleen or kidney disease, were eligible for the measurement of liver, spleen and kidney size We excluded any adolescent suffering from any chronic disease (cardiac, hematological, renal, endocrinal and hepatic diseases), fever or documented underlying disease at the time of examination.