Fatty liver disease usually causes few or no symptoms, and with its most common kind you may have no symptoms even if it goes on to cause cirrhosis. So feeling well is no sign of how far it has gone, and a line about fat in your liver is worth following up yourself, even on a scan booked for your gallbladder.
Why a report on a gallstone scan mentions your liver
An abdominal ultrasound is used to look at the organs in the abdomen, including the liver, gallbladder, pancreas and kidneys, and looking for stones in the gallbladder is one of the reasons for having one, so a scan booked to find gallstones pictures your liver too. Routine imaging tests can show fat in your liver.
Steatotic liver disease, formerly called fatty liver disease, happens when too much fat builds up in your liver; some fat in liver cells is typical, and too much can be a problem. Its two main types are alcohol-associated liver disease, which is caused by heavy alcohol use, and metabolic dysfunction-associated steatotic liver disease, or MASLD, which is not. MASLD used to be called nonalcoholic fatty liver disease, or NAFLD, and it is the most common long-term liver disease.
Experts estimate that about 24% of U.S. adults have MASLD, and research suggests it is present in up to 75% of people who are overweight and in more than 90% of people who have severe obesity. When it does cause symptoms, you may feel tired or have discomfort in the upper right side of your abdomen.
What the line in your report establishes about your liver
The line in your report establishes that there is fat in your liver, but not which of the two forms of MASLD you have, simple fatty liver or the inflamed form called MASH: routine imaging tests cannot show inflammation or fibrosis, so your doctor cannot use them to tell the two apart. A line nobody has commented on leaves that question open. Nodules are a different matter: if you have cirrhosis, routine imaging may show nodules, or lumps, in the liver, so if your report mentions nodules or lumps, raise that line with your own doctor too.
In simple fatty liver, there is fat in your liver but little or no inflammation or liver damage. It typically does not progress to cause liver damage or complications, though it can cause pain from an enlarged liver. In MASH, which used to be called NASH, the liver is inflamed and damaged as well as fatty, and that inflammation and damage can cause fibrosis, or scarring. MASH may lead to cirrhosis, in which the liver is scarred and permanently damaged.
Even with simple fatty liver, the risk of other health problems is higher. People with MASLD have a higher risk of certain health problems, including cardiovascular disease, which is the most common cause of death in people with MASLD, and type 2 diabetes, metabolic syndrome, high blood pressure and abnormal levels of cholesterol and triglycerides in the blood. Ask your own doctor when your blood pressure, blood sugar and cholesterol were last checked.
Where the fat in your liver can come from besides your weight
If medical tests suggest a buildup of fat in your liver, your doctor may ask questions or order tests for causes other than MASLD, the kind linked with weight. With a history of heavy alcohol use and fat in your liver, your doctor may decide you have alcohol-associated liver disease instead of MASLD. Someone with risks for MASLD who also drinks excessively could have both at the same time, and no tests can easily tell how much each plays a role. That is why your doctor will ask about your alcohol intake, to find out whether the fat is a sign of alcohol-associated liver disease or MASLD.
If alcohol turns out to be the cause, stopping drinking is the most important part of treating it, and if you need help, you may benefit from counseling, a recovery program, or medicines that reduce cravings or make you feel sick if you drink.
Other causes of excess fat in the liver include:
- disorders called lipodystrophies, which make the body use or store fat improperly
- rapid weight loss or malnutrition
- some medicines, including corticosteroids, HIV treatment, the main female sex hormones taken as medicine, certain medicines used to treat cancer, and others
- exposure to some toxins
- rare genetic diseases, such as Wilson disease and hypobetalipoproteinemia
If you take one of those medicines, do not stop it on your own. If a doctor treating you thinks a certain medicine is the cause, they may tell you to stop it or switch to another.
Doctors recommend weight loss to treat MASLD, and recommend that it be gradual, because rapid weight loss and malnutrition can make liver disease worse; physical activity alone, even without weight loss, is also beneficial. If you are losing weight on a plan or a weight medicine now, ask the clinician who manages it whether the speed suits a liver with fat in it. Losing weight very quickly may also raise your chances of forming gallstones (see Pain under the right ribs while weight comes off fast can be the gallbladder).
Several conditions besides weight make MASLD more likely. Type 2 diabetes, high triglycerides, abnormal cholesterol and metabolic syndrome are among them, and it is also more common in people who have prediabetes, high blood pressure or certain infections, such as hepatitis C. The A1C test can be used to diagnose type 2 diabetes and prediabetes (see An A1C result nobody explained, and when to test again). Certain genes may also make MASLD more likely, and experts are still studying which.
Who follows up the finding, and what happens after it
You start it: call the office of the clinician who ordered the gallbladder scan, ask whether they saw the line about your liver, and ask what you should do about the results. If they say your own doctor should take it on, book an appointment with your own doctor and say that a scan has found fat in your liver. Whenever a test is ordered, ask how you will get the results.
At that appointment, doctors use your medical history, a physical exam and tests to diagnose MASLD. Expect questions about the conditions and the alcohol use described above, and about how active you are and how much sugar you eat and drink. In the exam, a doctor usually checks your weight and height to calculate your body mass index, and looks for signs such as an enlarged liver, darkened skin patches over your knuckles, elbows and knees, and an enlarged spleen.
Doctors use blood tests, imaging tests and sometimes a liver biopsy to diagnose MASLD and to tell simple fatty liver from MASH:
| Test | What it can show | What to know about it |
|---|---|---|
| Your gallbladder ultrasound | Fat in your liver, and in cirrhosis it may show nodules | It cannot tell simple fatty liver from MASH |
| Blood tests for the liver enzymes ALT and AST | Raised levels may make your doctor suspect MASLD | Other health conditions may raise these enzymes too, and your doctor may order more blood tests to check for them |
| Scores such as FIB-4 or APRI | They can help identify or rule out advanced fibrosis, or scarring | Your doctor may calculate them from the results of routine blood tests |
| Elastography, a newer kind of imaging | It measures how stiff your liver is, and increased stiffness may be a sign of fibrosis | Doctors may order it in some cases; two of the commonly used types are kinds of ultrasound and one is a kind of MRI |
| Liver biopsy, small pieces of liver tissue examined under a microscope | It is the only test that can prove MASH and show clearly how severe the disease is, and it can show fibrosis at earlier stages than elastography can | Doctors don't recommend it for everyone with suspected MASLD; your doctor may recommend it if you are more likely to have MASH with advanced fibrosis, if other tests show signs of advanced liver disease or cirrhosis, or in some cases to rule out other liver diseases |
Some of the blood work may already exist. Many liver function tests are included in a common blood test called a comprehensive metabolic panel, or CMP, which providers often order as part of a routine checkup, so ask your own doctor whether you have a recent result. On their own, liver function tests usually cannot diagnose a specific disease, so an abnormal result usually means more tests to find the exact cause, and it does not always mean a problem with your liver: high levels of ALP, one of the enzymes mainly made in your liver, can be a sign of bone disease or liver disease, for example. Ask the clinician who ordered the test to explain what your results say about your health.
For a new liver test, the clinician who orders it will tell you how to prepare, and you will probably need to fast, with nothing to eat or drink, for 10 to 12 hours. Tell that clinician about everything you take, because certain medicines can affect the results.
If it turns out that you have long-term liver disease, you are more likely to get infections, and your doctor may recommend vaccinations for hepatitis A and B, the flu and pneumococcal disease, so ask about them. No medicine has been approved for simple fatty liver. For some adults with MASH and moderate to advanced scarring of the liver, the FDA approved a first medicine in 2024, to be used along with diet and exercise, and a second in 2025, so once you know which form you have, ask your own doctor whether either applies to you. Some herbal remedies can damage your liver, so check with your own doctor before taking dietary supplements, such as vitamins, or any complementary or alternative medicine.
Using NicoCares as well? Send the line from your report to the NicoCares care team through Spruce, the messaging app its patients use, and add each test result as it comes back, because rapid weight loss is one of the causes of fat in a liver and the clinical decision about your treatment belongs to the licensed physician who prescribes for you. Book any tests, and any scan, with whichever doctor takes the finding on, the clinician who ordered your scan or your own doctor.
Which symptoms need your own doctor, and which need a hospital
Symptoms of liver disease or damage need your own doctor, and you may need liver function tests if any of them appear:
- nausea and vomiting
- lack of appetite
- fatigue
- weakness
- jaundice, which turns your skin and eyes yellow
- swelling or pain in your abdomen
- swelling in your ankles and legs
- dark urine or light-colored stool
- frequent itching
With any of these symptoms, call your own doctor's office, name the symptom and say that a scan has found fat in your liver. Call that office even if NicoCares is part of your care, because your NicoCares care team answers in Spruce and NicoCares names no turnaround time for those answers.
Vomiting blood and black or bloody stools are different, because cirrhosis can cause enlarged veins in the esophagus or stomach that burst and bleed inside the body. If you vomit blood or have black or bloody stools, go to a hospital emergency room right away. This applies even if your report did not mention cirrhosis, because you may have no symptoms even with cirrhosis.
