Fatty liver disease is extra fat stored in liver cells, now called metabolic dysfunction-associated steatotic liver disease (MASLD) when linked to obesity, diabetes or high lipids. Most people have no symptoms, but some develop inflammation and scarring that can progress to cirrhosis.
Key symptoms
- Usually no symptoms
- Tiredness
- Mild ache in the right upper belly
- Found by abnormal liver tests or imaging
What you find on exam
- Weight, BMI and waist size
- Blood pressure
- Enlarged liver on palpation
- Signs of advanced liver disease such as spider angiomas or ascites
Tests
- Liver tests, lipids, HbA1c and platelet count
- Ultrasound showing a bright, fatty liver
- FIB-4 score to estimate scarring risk
- Elastography if FIB-4 is not low; rule out alcohol, hepatitis B and C
Treatment basics
- Weight loss of 7 to 10 percent through diet and exercise
- Limit or avoid alcohol
- Control diabetes, blood pressure and lipids, including statins when indicated
- Resmetirom or GLP-1 receptor agonists such as semaglutide for selected patients with significant scarring
Red flags
- Jaundice, ascites or confusion
- Low platelets or high FIB-4 suggesting advanced scarring
- Vomiting blood or black stools
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.