Cirrhosis and portal hypertension are common diagnostic findings in the Western world. The aetiology is variable, however alcohol abuse and hepatitis are the commonest causes. Ultrasound is usually the first diagnostic modality to be used. It is easy to find, safe, radiation-free and cheap. Although computed tomography, magnetic resonance and biopsy may be needed for diagnosis and follow up, ultrasound will always be used for initial assessment and in many cases will solve the diagnostic problem. We review the findings on B-mode and Doppler, as well as contrast enhanced ultrasound, according to a protocol which should be followed in order to evaluate a patient with cirrhosis and portal hypertension.