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, in a newborn infant upto 3.5 cm below the costal margin in the midclavicular line. 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.
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 children, in particular. Therefore, in this thesis, we report Z score references of liver, spleen and kidney parameters for healthy Egyptian children from birth to 5 years.
This cross sectional study was conducted on 355 healthy Egyptian children from birth to 5 years for establishment of Z score reference of liver, spleen and kidney parameters.
Only apparent healthy Egyptian infants and children 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 child suffering from any chronic disease (cardiac, hematological, renal, endocrinal and hepatic diseases), fever or documented underlying disease at the time of examination.
All anthropometric measurements was done (weight for age, height for age, and calculate BMI for age for both sexes). All measured were collected by the same physician. All children were examined by identical measuring equipment.
The participants were examined in the supine position, the physician used a standardized technique in examination of liver (percussion and palpation of the upper and lower borders respectively).