Liver enlargement is reported to have occurred when the liver measures more than 3cm below the costal margin or has a liver span greater than normal for age. Enlargement of the spleen, on the other hand, is reported to have occurred
if the spleen is just palpable. Causes of these conditions are summarized in Table below


  • Full blood count and blood film
  • Liver biopsy when indicated
  • Bone marrow if needed
  • Specific tests will depend on the suspected cause listed in the table

Causes of hepatosplenomegaly

Category of causes The specific causes associated with hepatomegaly The specific causes associated
with splenomegaly
  • Malaria
  • kala azar
  • Schistosomiasis
  • Infectious hepatitis
  • Amoebic hepatitis/abscess
  • Brucellosis
  • Malaria/tropical splenomegaly
  • HIV
  • Kala azar (leishmaniasis)
  • Schistosomiasis
  • Infectious hepatitis
  • Brucellosis
  • Other infections, like SBE, typhoid fever,
  • Infectious mononucleosis
  • Haemolytic anaemia
  • Leukaemia
  • Haemolytic anaemia, e.g., sickle cell
    anaemia in child <3 years autoimmune
    haemolytic anaemia
  • Leukaemia
Nutrition Kwashiorkor Iron deficiency
Congestion Cardiac failure Portal vein thrombosis
  • Liver tumours
  • Displaced rather than enlarged liver
  • Liver cirrhosis (portal hypertension)
  • Juvenile rheumatoid arthritis, SLE


  • Make sure you identify the cause and treat accordingly
  • Admit
    • If patient is severely anaemic – may need transfusion
    • If patient is febrile
    • For invasive diagnostic tests