These ultrasound images demonstrate coarsened liver echotexture concerning for cirrhosis and signs of portal hypertension. 

The portal vein shows a predominantly antegrade, pulsatile, and biphasic-bidirectional flow. Biphasic flows are commonly seen in patients with tricuspid regurgitation, right-heart cardiac failure, and cirrhosis. In this case, the normal appearances of the hepatic veins and the morphological features of cirrhosis make it the most likely cause for the abnormal portal vein flow. 

The portal venous normal waveform should undulate smoothly and must always remain above the baseline.

Case courtesy of Dr Kenny Sim.