Fatty Liver on Ultrasound: What It Means and What to Do
Medically reviewed by Daniela Stan MSc Medical Ultrasound, Consultant Sonographer & Clinical Director — July 2026
What Is Fatty Liver?
Fatty liver disease, or hepatic steatosis, is a condition in which excess fat accumulates in the liver cells (hepatocytes). It is broadly divided into two types: alcoholic fatty liver disease (AFLD), caused by excessive alcohol consumption, and metabolic dysfunction-associated steatotic liver disease (MASLD — formerly known as non-alcoholic fatty liver disease, NAFLD), which is associated with obesity, type 2 diabetes, high cholesterol, and metabolic syndrome.
MASLD is now the most common liver condition in the UK, affecting an estimated 25–30% of the adult population. The majority of people with fatty liver have no symptoms and are unaware of the condition until it is identified on an abdominal ultrasound performed for another reason.
How Fatty Liver Appears on Ultrasound
On ultrasound, a fatty liver appears brighter (more echogenic) than normal liver tissue — a finding described as increased hepatic echogenicity or a "bright liver". As fat content increases, the liver becomes progressively more echogenic relative to the right kidney (which is used as a reference). In more advanced cases, the increased echogenicity causes attenuation of the ultrasound beam, making the deeper parts of the liver difficult to visualise.
Ultrasound grading of fatty liver is semi-quantitative: mild steatosis produces a slight increase in echogenicity; moderate steatosis produces a clearly increased echogenicity with some beam attenuation; severe steatosis produces marked echogenicity with significant beam attenuation and poor visualisation of the portal vein walls. These grades are reported in our written reports.
Causes and Risk Factors
The main risk factors for MASLD include obesity (particularly central adiposity), type 2 diabetes or insulin resistance, hypertriglyceridaemia, hypertension, and metabolic syndrome. Alcohol consumption is the primary cause of AFLD — NICE guideline PH24 defines hazardous drinking as more than 14 units per week for women and men. Certain medications (including corticosteroids, tamoxifen, and amiodarone) can also cause drug-induced steatosis.
From Our Practice: The Incidental Finding
A pattern we see regularly in our upper abdominal ultrasound service is the patient who books a scan for right upper quadrant pain or bloating and receives an incidental finding of moderate hepatic steatosis. They had no idea their liver was affected. In these cases, we explain the finding clearly at the end of the scan — what it means, what the likely causes are, and what the recommended next steps are. The written report includes a recommendation to discuss the finding with their GP, who can arrange liver function tests and a cardiovascular risk assessment. In several cases, this has been the first step in a diagnosis of type 2 diabetes or metabolic syndrome that had not previously been identified.
Drawn from typical cases seen at our Marylebone clinic. This is a composite scenario representative of patterns we encounter regularly.
What Happens After a Fatty Liver Diagnosis?
A finding of hepatic steatosis on ultrasound should be followed up with your GP. The recommended investigations include liver function tests (LFTs), fasting glucose and HbA1c, fasting lipid profile, and a cardiovascular risk assessment. If LFTs are significantly abnormal, or if there are features suggesting more advanced liver disease (cirrhosis or portal hypertension), further investigation — including fibroscan (transient elastography) or liver biopsy — may be recommended.
Simple fatty liver (steatosis without significant inflammation or fibrosis) does not require medication. The primary treatment is lifestyle modification.
Can Fatty Liver Be Reversed?
Yes — for most patients with MASLD, fatty liver is reversible with sustained lifestyle changes. A weight loss of 5–10% of body weight has been shown in multiple randomised controlled trials to significantly reduce hepatic fat content and improve liver function tests. A Mediterranean-style diet, regular aerobic exercise (150 minutes per week of moderate-intensity activity, per NICE guideline PH44), and alcohol reduction are the cornerstones of management. For patients with MASLD and type 2 diabetes, GLP-1 receptor agonists (such as semaglutide) have demonstrated significant reductions in hepatic steatosis in clinical trials.
Liver Ultrasound at Sonoworld
Our upper abdominal ultrasound scan includes a comprehensive assessment of the liver, gallbladder, bile ducts, spleen, kidneys, and pancreas. It is available from £235 at our Marylebone clinic. No GP referral is required. Findings are explained verbally at the end of the scan and a written report is sent within 24 hours.
Frequently Asked Questions
Is fatty liver serious?
Simple fatty liver (steatosis without inflammation) is not immediately serious and is reversible with lifestyle changes. However, if left unmanaged, it can progress to non-alcoholic steatohepatitis (NASH), fibrosis, cirrhosis, and in rare cases liver cancer. Early detection and lifestyle modification significantly reduce this risk.
Can I have a liver ultrasound without a GP referral?
Yes. You can self-refer for an upper abdominal ultrasound at Sonoworld without a GP referral. If the scan identifies fatty liver or another abnormality, we recommend sharing the report with your GP for follow-up blood tests and clinical assessment.
Does fatty liver cause pain?
Simple fatty liver is usually asymptomatic. Some patients report a dull ache or discomfort in the right upper abdomen, but this is non-specific and can have many causes. Significant pain, jaundice, or swelling of the abdomen requires urgent clinical assessment.
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Ready to book your upper abdominal ultrasound scan?
Our consultant sonographers are available Monday to Saturday at our Marylebone clinic. No GP referral needed. Instant verbal results. Written report within 24 hours.
References
- NICE. Non-alcoholic fatty liver disease (NAFLD): assessment and management. NG49. 2016 (updated 2024). Available at: https://www.nice.org.uk/guidance/ng49
- Younossi ZM et al. Global epidemiology of nonalcoholic fatty liver disease. Hepatology. 2016;64(1):73–84. https://doi.org/10.1002/hep.28431
- Romero-Gómez M et al. Treatment of NAFLD with diet, physical activity and exercise. J Hepatol. 2017;67(4):829–846. https://doi.org/10.1016/j.jhep.2017.05.016
