Friend 45 yr old ultrasound swollen spleen pancreas and liver blood work fine liver area hurts what are the possibilities of cause ?

Mult Possibilities: I hate my summary, but the 3 organs swollen do not really fit. The enlarged liver could be from the fatty liver, which contrary to a lot of information can hurt & cause tenderness. A "swollen" liver depending on the cause and how advanced can cause can enlarged spleen. The large Pancreas does not quite fit, but fluid in the belly can cause this. Then there is the Lupus which changes everything.

Possibly from liver: If there is splenomegaly, one cause would be congested blood backing up from the liver venous circulation. The GI or hepatologist need to be involved to find the cause, benign or from other causes need to ruled out. Blood work may not show causes but a team with radiologist, internist, gastroenterologist need to look at your friend in the whole to evaluate causes and recommend course of action