Toxic injury to liver sinusoids causes sloughing of endothelial cells which embolise to hepatic venules and cause eventual fibrosis of the venules. This results in hepatic congestion (similar to Budd-Chiari syndrome) and post-sinusoidal portal hypertension.

 

Ultrasound

 

Imaging modality of choice: may show 

 

• hepatomegaly 

  • portal vein abnormalities:

  • portal vein dilatation

  • portal venous pulsatility

• hepatofugal portal venous flow

• elevated hepatic artery resistive index (> 0.8)

• loss of triphasic hepatic venous flow

• gallbladder wall thickening (> 6-8 mm) 

• periportal edema

• ascites