In cirrhosis, is the liver always small?

That's a really good question.

All things being equal, cirrhosis tends to create a shrunken, scarred liver; hepatomegaly is not a usualy feaure.

However, there are a few causes of liver cirrhosis where the liver is actually enlarged. Knowing them can be few helpful in establishing the aetiology of the cirrhosis. They are:

• Alcoholic cirrhosis
• Haemochromatosis
• Primary biliary cirrhosis
• Hepatoma superimposition

In all but the last case, the liver is enlarged due to it being stuffed with, respectively, fat (remember: alcohol causes a fatty liver), iron and bile. Always consider a hepatoma too, since cirrhosis is a high risk condition for the development of this cancer. It can be excluded a combination of ultrasound and alpha fetoprotein measurements.