Organomegaly = abnormal enlargement of internal organs. Most often involves the liver (hepatomegaly), spleen (splenomegaly), and kidneys (nephromegaly). It is a clinical sign of systemic disease rather than a diagnosis itself. Causes include infection, malignancy, vascular disease, storage disorders, and metabolic conditions.

🟤 Liver (Hepatomegaly)

Cause	Investigations	Management
Fatty Liver (NAFLD) 🥓	LFTs ↑ ALT/AST, US: bright liver, biopsy if severe	Lifestyle modification (weight loss, exercise), control diabetes/lipids, monitor
Cirrhosis 🍷	LFTs (↑ bilirubin, ALP), US/CT (nodular), biopsy	Treat cause (alcohol abstinence, antivirals), manage ascites/varices/HE, transplant if advanced
Hepatocellular carcinoma / Metastases 🎯	LFTs + AFP, CT/MRI, biopsy	Resection, transplant, chemo/radiotherapy, targeted/palliative therapy
Hepatitis (Viral/Autoimmune) 🦠	LFTs ↑ ALT/AST, viral serology, autoimmune markers, biopsy	Antivirals (HBV/HCV), immunosuppressants, monitor for cirrhosis/HCC

🔴 Spleen (Splenomegaly)

Cause	Investigations	Management
Infectious Mononucleosis (EBV) 🤒	FBC (lymphocytosis), Monospot, EBV serology, US	Supportive (hydration, rest, analgesia), avoid contact sports (rupture risk)
Haematological Malignancy (Leukaemia, Lymphoma) 🧬	FBC (cytopenias), marrow/lymph node biopsy, CT/PET staging	Chemo, immunotherapy, radiotherapy, transplant, supportive transfusions
Portal Hypertension (Cirrhosis) 🩸	LFTs, Doppler US, endoscopy for varices	Treat liver disease, beta-blockers, variceal banding, TIPS if severe
Infections (Malaria, Leishmaniasis) 🦟	Blood smear (malaria), serology/PCR, FBC	Antimalarials (ACT), amphotericin B/antimonials, supportive care

🟢 Kidney (Nephromegaly)

Cause	Investigations	Management
Polycystic Kidney Disease 🥚	US/CT (multiple cysts), creatinine, genetic testing	BP control (ACEi/ARB), monitor function, dialysis/transplant if ESRD
Hydronephrosis (Obstruction) 🚰	US (dilated renal pelvis/ureters), CT/MRI, creatinine	Relieve obstruction (stent/nephrostomy), treat cause (stone/tumour), surgery if severe
Renal Tumours (Wilms, RCC) 🎗️	US/CT/MRI, renal function, biopsy/resection	Nephrectomy, chemo/radiotherapy in selected cases, targeted therapy in RCC

💡 Clinical Pearls

🩺 Examination: Always palpate systematically – liver edge, splenic notch, ballotable kidney.
⚠️ Painful organomegaly → infection or congestion; Painless → malignancy, infiltration, storage disease.
🔎 Ultrasound is first-line for confirming and characterising organ size.
📊 Always link organomegaly to systemic signs: jaundice (liver), cytopenias (spleen), hypertension/haematuria (kidneys).

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Organomegaly

🟤 Liver (Hepatomegaly)

🔴 Spleen (Splenomegaly)

🟢 Kidney (Nephromegaly)

💡 Clinical Pearls

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