Right upper quadrant ultrasound is often the first step in the evaluation of hepatobiliary disease. An in-depth knowledge of the ultrasound findings of common and important diseases, as well as the limitations of and new advances in ultrasound technology, is key to helping patients and referring providers reach diagnostic and management decisions. The utility of contrast-enhanced ultrasound is expanding, shear wave elastography is emerging as a sophisticated quantitative measure of fibrosis, and the new US LI-RADS reporting standard is changing surveillance practices for patients with cirrhosis. This article will provide a review of hepatobiliary ultrasound interpretation with an emphasis on diagnostic accuracy and new techniques.