Fatty Liver Symptoms: What Can a Liver Ultrasound Show?

Fatty liver can be easy to miss.

Many people have no obvious symptoms and only discover changes in their liver after a blood test or scan carried out for another reason. Others may notice persistent tiredness or discomfort underneath the ribs on the right-hand side.

Fatty liver means that excess fat has accumulated within the liver. When liver fat occurs alongside metabolic risk factors, healthcare professionals may use the term metabolic dysfunction-associated steatotic liver disease (MASLD). You may also still see the older term non-alcoholic fatty liver disease (NAFLD) used in some NHS and clinical information.

A liver ultrasound can assess the size, shape and appearance of the liver and may identify changes consistent with fatty liver. However, a standard ultrasound cannot tell you how well the liver is functioning and does not reliably measure liver fibrosis or scarring.

This guide explains the possible symptoms and causes of fatty liver, what a liver ultrasound can show, how liver blood tests differ and when further assessment may be needed.

VitalScan offers a dedicated Liver Ultrasound service in Milton Keynes for people who need structural imaging of the liver.

Fatty liver occurs when excess fat accumulates within liver cells.

A small amount of liver fat may not cause symptoms or significant problems. However, persistent fat accumulation can sometimes be associated with inflammation and, in a smaller proportion of people, progressive liver damage.

The term steatotic liver disease (SLD) is now used as a broad description for conditions involving excess liver fat.

MASLD refers more specifically to steatotic liver disease associated with metabolic risk factors such as diabetes, excess weight, high blood pressure or abnormal cholesterol levels.

Fat accumulation can also occur for other reasons, including alcohol use, certain medicines and some medical conditions. This is why finding fat in the liver does not always explain its underlying cause.

Fatty liver can exist at different stages.

These may include:

• Steatosis: excess fat is present in the liver without significant inflammation.
• MASH: metabolic dysfunction-associated steatohepatitis, where liver fat is accompanied by inflammation and liver-cell injury.
• Fibrosis: repeated or ongoing injury leads to the development of scar tissue.
• Cirrhosis: advanced scarring changes the normal structure of the liver.

Not everyone with fatty liver progresses through these stages.

For many people, fatty liver remains at an early stage. The purpose of assessment is therefore not simply to identify liver fat, but to consider whether there are signs or risk factors that suggest further investigation may be needed.

One of the difficulties with fatty liver disease is that it often causes no obvious symptoms.

Many people only become aware of it after:

• Routine blood tests
• An abdominal ultrasound
• Imaging performed for another reason
• A general health assessment

When symptoms do occur, they can include:

• Persistent tiredness
• Feeling generally unwell
• Discomfort in the upper-right abdomen
• A dull ache beneath the right-hand ribs

These symptoms are not specific to fatty liver.

Tiredness and upper abdominal discomfort can occur for many reasons, which means symptoms alone cannot confirm whether fat has accumulated in the liver.

When discomfort is associated with fatty liver, it is usually described in the upper-right side of the abdomen, underneath the ribs where the liver is located.

It may feel more like a dull ache, pressure or discomfort than severe pain.

However, pain in this area can also arise from the gallbladder, stomach, bowel, muscles and other abdominal structures.

If you have severe, sudden or rapidly worsening abdominal pain, it should not automatically be assumed to be caused by fatty liver.

Yes.

Fatty liver is commonly discovered in people who otherwise feel well.

Someone may have liver fat without experiencing pain, tiredness or any other noticeable symptoms.

This is one reason why fatty liver is sometimes identified unexpectedly during an ultrasound or after abnormal liver-related blood results.

Feeling well does not necessarily mean that liver fat is absent, just as having symptoms does not automatically mean fatty liver is the cause.

Metabolic health is one of the main factors associated with fatty liver.

The likelihood may be higher in people with:

• Excess weight, particularly around the waist
• Type 2 diabetes
• High blood pressure
• High cholesterol or triglycerides
• Metabolic syndrome
• Low levels of physical activity
• Increasing age

However, body weight alone does not determine whether someone can develop fatty liver.

Yes.

Although excess weight increases the likelihood of metabolic fatty liver disease, people who are not overweight can still develop liver fat.

Other contributing factors may include:

• Type 2 diabetes
• Abnormal cholesterol or triglyceride levels
• Genetics
• Certain medicines
• Other metabolic conditions
• Some underlying medical conditions

Alcohol can also contribute to liver fat and liver injury.

Because several different factors can affect the liver, the cause should be considered alongside medical history, medicines, alcohol intake and other health information rather than based on weight alone.

There is no single test that answers every question about liver health.

Assessment may involve a combination of:

• Medical history
• Alcohol history
• Medication review
• Liver blood tests
• Liver ultrasound
• Blood pressure and metabolic assessment
• Diabetes or blood glucose testing
• Cholesterol testing
• Fibrosis assessment
• Further imaging when clinically appropriate

Blood tests and imaging provide different types of information.

A blood test cannot directly show liver fat, while an ultrasound cannot directly measure how effectively the liver is performing all of its functions.

A liver ultrasound scan can identify changes in the appearance of the liver that may be consistent with fatty infiltration.

Ultrasound uses high-frequency sound waves to create images of internal structures and does not use ionising radiation.

During a liver ultrasound, the sonographer can assess features such as:

• Liver size
• Liver shape and contour
• Liver texture
• Changes consistent with fatty liver
• Visible cysts or focal abnormalities
• Bile ducts
• Relevant blood vessels
• Nearby upper-abdominal structures where appropriate

VitalScan’s Liver Ultrasound provides structural imaging of the liver and surrounding areas where clinically relevant.

Not completely.

Conventional ultrasound can identify changes associated with fatty liver, particularly when fat accumulation is more established.

However, mild or early steatosis may not always be visible on a standard ultrasound.

A normal ultrasound therefore does not necessarily exclude every degree of liver fat or every type of liver disease.

Results should be considered alongside symptoms, blood-test results, medical history and metabolic risk factors.

Fat changes the way liver tissue reflects ultrasound waves.

A sonographer or reporting clinician may describe the liver as having increased echogenicity, which means it appears brighter than expected on ultrasound.

The report may use terms such as:

• Fatty change
• Fatty infiltration
• Hepatic steatosis
• Increased liver echogenicity

These descriptions should always be interpreted as part of the wider clinical picture.

An ultrasound finding of fatty liver does not automatically mean that significant liver damage or cirrhosis is present.

A standard liver ultrasound may suggest the presence of fatty liver, but it has limitations when determining severity.

Some ultrasound reports may describe appearances as mild, moderate or severe. However, conventional ultrasound does not precisely quantify the amount of fat in the liver and is not designed to accurately stage fibrosis.

This distinction matters because liver fat and liver scarring are not the same thing.

Someone can have fatty liver without advanced fibrosis, while fibrosis risk may require separate assessment.

A standard ultrasound may identify structural changes associated with more advanced liver disease, but it does not reliably measure the extent of fibrosis.

If liver scarring needs to be assessed, further investigations may include:

• Blood-based fibrosis scores
• Enhanced Liver Fibrosis testing
• Transient elastography or FibroScan
• Other specialist imaging
• Hepatology assessment

NICE recommends assessing fibrosis risk in people with fatty liver where appropriate rather than relying on routine liver blood tests alone.

If a liver ultrasound shows fatty change, your GP or another healthcare professional may therefore consider whether additional fibrosis assessment is needed.

A liver ultrasound and a liver blood test answer different questions.

What Does a Liver Ultrasound Check?

A liver ultrasound mainly looks at structure.

It may assess:

• Liver size
• Liver shape
• Liver texture
• Fatty liver changes
• Cysts
• Some focal abnormalities
• Bile ducts
• Relevant blood vessels
• Nearby upper-abdominal structures

It does not directly measure how well the liver is carrying out all of its normal functions.

What Do Liver Blood Tests Check?

Liver-related blood tests look at biochemical markers associated with liver-cell injury, bile flow and aspects of liver function.

Depending on the test panel, this may include markers such as liver enzymes, bilirubin, albumin and other liver-related measurements.

VitalScan offers a dedicated Liver Health Blood Test for people who have been advised to assess liver-related blood markers.

Blood tests cannot directly show fat within the liver.

This is why an ultrasound and a blood test should not be treated as interchangeable investigations.

Yes.

Normal routine liver blood tests do not necessarily rule out fatty liver.

Some people with hepatic steatosis have liver-related blood results within the normal range.

NICE advises against using routine liver blood tests alone to exclude fatty liver or assess whether advanced fibrosis is present.

A person may therefore have:

Normal liver blood tests + fatty liver on imaging

or

Abnormal liver blood tests + no clear fatty change on ultrasound

The results need to be interpreted together with medical history and other clinical information.

Not necessarily.

Simple steatosis means that excess fat has accumulated within liver cells.

For many people, this does not automatically mean that advanced liver damage is present.

However, in some people, liver fat is associated with inflammation. Over time, ongoing inflammation and injury can contribute to fibrosis and eventually more advanced liver disease.

This is why assessment focuses on both the presence of liver fat and the person’s wider risk of liver scarring.

An ultrasound finding of fatty liver is usually one part of the assessment rather than the final answer.

Your report may need to be considered alongside:

• Liver blood-test results
• Alcohol intake
• Medicines
• Weight and waist measurement
• Blood pressure
• Cholesterol or triglycerides
• Blood glucose or diabetes status
• Other metabolic risk factors
• Family and medical history

A healthcare professional can then decide whether further testing is appropriate.

For some people, management may focus on metabolic health and lifestyle factors.

Others may need additional testing for fibrosis or investigation of another possible cause of abnormal liver findings.

An ultrasound itself does not determine treatment.

An ultrasound finding of fatty liver is usually one part of the assessment rather than the final answer.

Your report may need to be considered alongside:

• Liver blood-test results
• Alcohol intake
• Medicines
• Weight and waist measurement
• Blood pressure
• Cholesterol or triglycerides
• Blood glucose or diabetes status
• Other metabolic risk factors
• Family and medical history

A healthcare professional can then decide whether further testing is appropriate.

For some people, management may focus on metabolic health and lifestyle factors.

Others may need additional testing for fibrosis or investigation of another possible cause of abnormal liver findings.

An ultrasound itself does not determine treatment.

Fatty liver can often improve, particularly at an earlier stage.

Management usually focuses on the factors contributing to fat accumulation and wider metabolic health.

Depending on the individual, this may involve:

• Weight management where appropriate
• Regular physical activity
• A balanced diet
• Managing diabetes
• Managing cholesterol
• Managing blood pressure
• Reviewing alcohol intake
• Reviewing medicines where clinically appropriate

Changes should be appropriate for your individual health, particularly if you have existing medical conditions or take regular medicines.

If more advanced liver disease is suspected, management may require specialist assessment.

A liver ultrasound can provide information about more than fatty liver alone.

Depending on the examination and findings, it may assess:

• Liver size and contour
• Liver texture
• Simple liver cysts
• Some focal liver abnormalities
• Dilated bile ducts
• Relevant blood vessels
• Gallbladder abnormalities

VitalScan’s liver ultrasound can also include assessment of the gallbladder where clinically appropriate.

This can be particularly useful because discomfort beneath the right ribs is not always caused by the liver.

Gallstones and other gallbladder problems can produce symptoms in a similar area.

Where gallbladder symptoms are the main concern, a targeted gallbladder ultrasound may be more appropriate.

Fatty liver itself often causes no symptoms and does not usually require emergency treatment simply because it has been identified on a scan.

However, some symptoms should not wait for a routine private ultrasound.

Seek emergency medical help

Call 999 or go to A&E if you:

• Vomit blood
• Develop black, tar-like stools and feel faint or very unwell
• Become newly confused or unusually difficult to wake
• Develop severe symptoms that appear life-threatening

Seek urgent medical advice

Contact your GP urgently or NHS 111 if you develop:

• New yellowing of the skin or whites of the eyes
• Significant or rapidly increasing abdominal swelling
• Severe or rapidly worsening abdominal pain
• Persistent vomiting
• A marked deterioration in how you feel

A routine private scan should never delay urgent medical assessment.

A liver ultrasound is performed externally across the upper abdomen.

You will usually lie on an examination couch while ultrasound gel is applied to your skin.

The sonographer then moves a handheld ultrasound probe across the upper abdomen to create images of the liver.

During the examination, you may be asked to:

• Change position
• Take a deep breath
• Hold your breath briefly

Ultrasound does not use ionising radiation.

After the scan, the images are reviewed and a written report is provided according to the clinic’s reporting pathway.

Preparation depends on the exact ultrasound examination being performed.

For some upper-abdominal scans, you may be asked not to eat for a period beforehand. This can help improve imaging of structures including the gallbladder and upper abdomen.

Always follow the preparation instructions provided with your appointment rather than fasting for longer than advised.

You can also read our guide on how to prepare for an ultrasound.

No.

Ultrasound uses sound waves to create images.

Unlike X-rays and CT scans, a standard ultrasound examination does not expose you to ionising radiation.

If you have been advised to investigate your liver, have abnormal results that need structural imaging or need further assessment of a possible fatty liver finding, VitalScan offers private Liver Ultrasound in Milton Keynes.

The scan can assess:

• Liver size and shape
• Liver texture
• Changes consistent with fatty liver
• Visible cysts and other structural abnormalities
• Bile ducts
• Relevant vessels
• Nearby upper-abdominal structures where appropriate

Your liver ultrasound report can then be shared with your GP, gastroenterologist or another healthcare professional if further interpretation or follow-up is required.

Explore VitalScan Liver Ultrasound

A liver ultrasound may be useful when structural imaging of the liver is required.

It may help identify changes consistent with fatty liver, but it does not measure liver function and cannot reliably assess the full extent of fibrosis on its own.

If your main question relates to liver enzymes or other blood markers, a Liver Health Blood Test provides different information.

Some people may need both imaging and blood testing.

If you are unsure which investigation is appropriate, speak to a healthcare professional or contact the VitalScan team before booking.

Check our latest offer and explore our Liver Ultrasound service.

Explore Liver Ultrasound.

Fatty liver is common and often develops without obvious symptoms.

A liver ultrasound can provide useful information about the structure and appearance of the liver and may identify changes consistent with fatty liver.

Liver blood tests provide different information and may help assess biochemical markers related to liver health.

Neither investigation answers every question on its own.

If fatty liver is identified, the result should be considered alongside your medical history, metabolic health and relevant blood tests. Further assessment may sometimes be needed to understand the risk of fibrosis or investigate another underlying cause.

VitalScan offers dedicated Liver Ultrasound and Liver Health Blood Test services in Milton Keynes.

Concerned About Fatty Liver or Your Liver Health?

Check our latest offer and explore Liver Ultrasound

Liver Ultrasound at VitalScan

If blood testing has also been recommended:

Liver Health Blood Test

Before attending your scan:

How to Prepare for an Ultrasound

This article provides general information and does not replace personalised medical advice, diagnosis or treatment. A routine private scan should not delay urgent or emergency medical assessment.