The trend in mortality induced by liver disease over the past five years has shown an increasing burden, largely driven by conditions such as non-alcoholic fatty liver disease (MASLD), alcoholic liver disease (ALD), cirrhosis, and hepatocellular carcinoma. Accurate diagnosis of liver disease is crucial for effective management and timely intervention. Portal hemodynamics play a central role in the pathophysiology of cirrhosis due to their close association with disease severity. Ultrasound (US) is a commonly utilized imaging technique in the management of chronic liver disease (CLD), due to its simplicity and minimally invasive nature. Doppler ultrasound enables real-time visualization of blood flow under physiological conditions, while contrast-enhanced US with microbubble contrast agents provides detailed evaluation of peripheral blood flow. Additionally, elastography, originally designed for fibrosis assessment, now has a wide range of applications for the liver and spleen. These advancements are driven by the evolution of digital technologies and the widespread dissemination of information. Elastography is a widely used non-invasive technique for staging CLD and has become increasingly popular. Liver and spleen stiffness are important parameters in the assessment of portal hypertension (PHT) and stratify patients with compensated advanced chronic liver disease (cACLD), clinically significant PHT and monitor disease progression or response to therapy. Endoscopic ultrasound (EUS) provides a detailed view of the entire portal vascular system, enabling close observation of the static response, as indicated by the diameter of the component vessels. Given our inability to cure most primary liver diseases (except for hepatitis C), prevention becomes the key intervention. Preventive strategies can help extend the period before the progression of liver disease by preventing or slowing further damage and addressing comorbidities. Multiparametric ultrasound (MPUS) served as an effective tool for screening compensated advanced chronic liver disease (cACLD) and clinically significant portal hypertension (CSPH). Non-invasive tools play a crucial role in risk stratification and assist healthcare providers in identifying patients who are at the highest risk of liver-related complications.