Fatty Liver on scan - what does this mean and what can you do about it?

One of the commonest incidental findings on scan of the liver is fatty infiltration of the liver or rather, increased steatosis of the liver.

It comes with so little explanation that has led many to lose their sleep as to what this implies.

In reality, it is not an innocent finding, although to a large degree, many of the people that have this outcome on their scan results may not need to worry, as it is often self-limiting.

Liver is described as infiltrated by fat - when more than 10-20% of the liver mass has been replaced by fat - making the liver appear "echobright" on ultrasound.

Among causes of this anomaly are the following:

1. alcohol excess
2. obesity
3. hyperlipidaemia (high levels of fat in the blood)
4. diabetes
5. genetic (familial)
6. rapid weight loss
7. drug side effects

fatty liver is divided into 2 broad forms:

alcoholic and non-alcoholic fatty liver diseases

When the fat is allowed to continue to build up, this can progress to injure the liver leading to "hepatitis" - either alcoholic hepatitis or non-alcoholic steatohepatitis - at this point, the liver becomes vulnerable to further injury, loses its function and symptoms start to manifest such as increased tiredness, night time poor sleep and day time somnolence; also there may or may not be yellowish discoloration of the skin/eyes. leg or abdominal swelling etc. The loss of function of the liver can come along with several other complications. When hepatitis continue unabated, then the liver cells become replaced by a scar tissue - fibrotic mass - termed cirrhosis. So, you see, cirrhosis is not only due to alcohol excess, but can also occur in persons who may never have had alcohol.

Above is the natural progression of fatty liver - an innocent incidental finding.

The goal therefore, is to reverse the situation as soon as you become aware of this finding on any scan examination of your abdomen.

The liver can completely recover its full function when fatty liver is reversed, and in some cases of early inflammation.... once cirrhosis has developed, irreversible damage has ensued and further management would be to manage complications and routine check ups to ensure early detection of liver cancer.

Heavy alcohol drinking leads to inability of the liver to metabolise fat and this leads to fat accumulation. If one stops drinking, this can lead to complete recovery of the liver and accumulated fat will disappear within 6 weeks of abstinence!


For non alcoholic liver disease, once discovered, it is likely that your doctor will request certain further investigations in order to determine whether or not there is associated inflammation in your liver.

Once the test - such as liver function test rules out any inflammation, there are specific management strategies for the different likely causes - but generically, the following can help:

Limit or avoid alcoholic beverages

Lose weight via engagement in regular physical activity - in a controlled way - as too rapid weight loss has its own complications as well

So far, the only effective strategy that has been shown to improve non alcoholic fatty liver disease apart from treating specific causes has been weight loss.

Good luck

Nimzing Gwamzhi Ladep, PhD (Hepatology, Imperial College London)