Cirrhosis is irreversible fibrosis and architectural distortion of the liver, most commonly caused by chronic alcohol use, viral hepatitis, or non-alcoholic fatty liver disease. Sonographic features include a coarsened, heterogeneous liver echotexture, nodular liver surface contour, right lobe atrophy with caudate lobe hypertrophy, and signs of portal hypertension such as splenomegaly, ascites, and portosystemic collaterals. Cirrhosis also increases the risk of hepatocellular carcinoma, prompting surveillance ultrasound every six months in affected patients.