A liver ultrasound shows the size, shape and texture of your liver, whether fat has built up in it, whether there are cysts, growths or gallstones, and how blood is flowing through it. It is very good at confirming fatty liver and at ruling out structural problems. What it cannot do is measure scarring — and if you are here because of an abnormal blood test, scarring is probably the question you actually want answered.
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Ultrasound sends sound waves into the abdomen and builds a live picture from the echoes. For the liver, that picture answers several questions at once:
A liver is not scanned in isolation. It comes as part of an upper abdominal ultrasound, which also covers the gallbladder, bile ducts, pancreas, spleen and kidneys — because the causes of abnormal liver blood tests are not always in the liver.
Most people reading this have not had symptoms. They had a blood test for something else, and the liver function tests (LFTs) came back abnormal — often a raised ALT or GGT — or the report mentioned possible fatty liver.
The liver is famously silent. It has no pain fibres in the tissue itself, so it can be substantially affected before anything feels wrong. That is precisely why an unexpected blood result is unsettling: there is nothing to feel, and nothing to reassure yourself with.
One thing worth knowing straight away, because it cuts both ways: UK guidance is explicit that routine liver blood tests should not be used to rule out fatty liver disease, and should not be used to assess for advanced scarring either. Normal LFTs do not mean a normal liver, and abnormal LFTs do not tell you how serious things are. They are a prompt to look properly, not an answer.
Fat changes how sound travels through liver tissue, and it does so in a way that is immediately visible to the person scanning.
Normally the liver and the right kidney sit next to each other on screen at a similar brightness. When fat accumulates, the liver reflects far more sound and appears strikingly brighter than the kidney beside it. That contrast — hepatorenal echo difference — is the classic sign, and it is usually obvious rather than subtle.
Fatty change is usually graded as mild, moderate or severe based on how bright the liver is and how well deeper structures can still be seen. That grading describes how much fat. It does not describe how much damage — which is the distinction that matters most and the one most often misread.
Our guide to fatty liver on ultrasound covers the condition itself in more detail.
This is the most important section on the page.
Fat is one thing. Fibrosis — scarring — is another, and it is what determines long-term outlook. A liver can be very fatty with no meaningful scarring, and a liver can carry significant scarring without dramatic fatty change.
A standard 2D ultrasound cannot reliably detect early, microscopic fibrosis, and it cannot measure how stiff the liver tissue is. It can show the late consequences of scarring — a shrunken, irregular liver, an enlarged spleen, altered portal vein flow — but by then the process is well advanced. Early and moderate fibrosis is essentially invisible to it.
So if your question is how much damage has been done, the honest answer is that a standard ultrasound does not settle it. The tests that do are:
These are arranged through your GP or a hepatologist. We do not offer them, and we will tell you so rather than imply a scan has answered a question it has not.
Patients arriving with liver anxiety are almost exclusively driven by an unexpected flag on a GP blood test — usually elevated liver function tests, or a mention of suspected fatty liver — rather than by physical symptoms. The liver is notoriously silent. They often walk in frightened of cirrhosis, asking outright: is my liver permanently damaged? and is this still reversible?
The conversation we have most frequently is about the limitations of standard ultrasound when it comes to scarring. We can very easily identify hepatic steatosis — the fat makes the liver appear strikingly brighter than the adjacent kidney on the screen. But a standard 2D ultrasound cannot reliably detect early, microscopic fibrosis or measure tissue stiffness.
So we make sure people leave understanding both halves of it. The scan is excellent for confirming fatty liver and for ruling out masses or structural problems. It alone does not definitively settle the fibrosis question. To accurately stage any potential scarring, you will need a specialised FibroScan or advanced fibrosis blood panels through your GP — and we would rather say that plainly than let someone walk out believing they have had the all-clear.
Describes general patterns among the patients we see, not any individual case. Any abnormal result should be discussed with your GP.
In many cases, yes — and this is the part worth holding onto if you arrived here worried.
Simple fatty liver, without significant scarring, responds well to changes in weight, diet, alcohol intake and physical activity. Gradual weight loss in the region of seven to ten per cent of body weight is associated with meaningful reduction in liver fat, and improvement can be visible on a repeat scan.
Early fibrosis can also improve when the underlying cause is addressed. Established cirrhosis is not reversible, though its progression can be slowed and its complications managed — which is exactly why finding out where you sit on that spectrum matters more than knowing how bright the liver looked.
See a doctor promptly rather than booking a scan if you have: yellowing of the skin or the whites of the eyes, vomiting blood or passing black tarry stools, a swollen abdomen developing over days or weeks, confusion or unusual drowsiness, or severe upper abdominal pain with fever. These need medical assessment, not an outpatient scan appointment.
Preparation: do not eat for six hours before the appointment. Water is fine and you should stay hydrated. Fasting empties the gallbladder and reduces bowel gas, both of which make the liver and bile ducts far easier to see.
The scan: you lie on your back, warmed gel is applied, and a probe is moved across the upper abdomen. You will be asked to take a deep breath in and hold it at points — this pushes the liver down below the ribs where it can be seen properly. It takes around 20 to 30 minutes and is painless.
Results: you receive instant verbal results at the appointment from the consultant performing your scan, with the written report following within 24 hours. We can send it to your GP at your request, which matters here, since the next step is usually theirs to arrange.
| Ultrasound | FibroScan | Fibrosis blood panel | |
|---|---|---|---|
| Detects liver fat | Yes | Yes, and quantifies it | No |
| Stages scarring | No | Yes | Yes, by risk category |
| Finds cysts, masses, gallstones | Yes | No | No |
| Available at our clinic | Yes, £235 | No | No |
It can show signs of established cirrhosis — a small, irregular liver, an enlarged spleen, altered blood flow or free fluid. It cannot reliably detect early or moderate scarring before those changes appear, which is why a FibroScan or fibrosis blood panel is used to stage scarring properly.
It is a common combination. It may mean the cause is not structural, or that changes are too early to see. UK guidance is explicit that normal liver blood tests should not be used to rule out fatty liver or advanced scarring, and the reverse applies too. Take the report back to your GP for the next step.
Yes. Do not eat for six hours beforehand. Water is fine. Fasting keeps the gallbladder full and reduces bowel gas, which makes the liver and bile ducts much easier to assess.
It describes how much fat is visible, not how much damage there is. Mild fatty change is common and often reversible with changes to weight, diet, alcohol and activity. It does not tell you whether there is scarring.
Simple fatty liver frequently improves, and gradual weight loss of around seven to ten per cent of body weight is associated with a meaningful reduction in liver fat. Early scarring can improve too. Established cirrhosis cannot be reversed, though its progression can be slowed.
No. You can book directly with us. Bring any recent blood results if you have them, and we can send the report to your GP afterwards at your request.
An upper abdominal ultrasound, which includes the liver, is £235. You receive instant verbal results at the appointment, with the written report following within 24 hours.
If your fatty liver is alcohol-related, our guide to fatty liver and how cutting back helps the liver recover covers what changes over weeks and months. See our upper abdominal ultrasound page for what is included, or our comparison of ultrasound, MRI, CT and X-ray if you are weighing up which test you need.
CQC-registered clinic · HCPC-registered sonographers · BMUS member · ICO-registered. Reports can be shared securely with your NHS GP or specialist at your request.
