Ultrasound as initial investigation for liver failure
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The liver is enlarged and demonstrates a nodular surface. The liver echotexture is markedly coarse and nodular. No focal liver lesions found. The hepatic vein surface is slightly wavy. The hepatic and portal veins are patent and demonstrate normal direction of flow. The hepatic arteries are prominent, which most likely contributes to arterialised traces seen in the hepatic and portal veins (likely transmitted). No flow seen in ligamentum teres. The spleen measures 15.4 cm in craniocaudal length. The splenic vein is patent demonstrates normal direction of flow. Ascites is demonstrated.
Conclusion: Hepatosplenomegaly, cirrhosis and ascites. The hepatic and portal veins are patent.