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Contact a clinician if a test report shows elevated liver enzymes or imaging mentions fatty liver—even if you feel well. Fatty liver is often silent, and fatigue or discomfort under the right ribs cannot confirm the cause. Jaundice needs urgent assessment; vomiting blood, black stools, or sudden confusion call for emergency care.
When should you contact a doctor?
Book a routine medical review for abnormal results or an imaging finding
Arrange a review if blood tests show elevated liver enzymes or a scan mentions fatty liver. These findings do not diagnose the cause or show the full extent of liver disease, but they should be interpreted by a clinician. The NHS notes that fatty liver is often discovered during tests done for another reason and advises people who think they may have it, or who have higher risk, to see a GP (NHS guidance on non-alcoholic fatty liver disease, last reviewed 31 July 2025).
You do not need to wait for symptoms. Bring the actual test or scan report, a list of medicines and supplements, and details about alcohol use to the appointment. Do not diagnose yourself from one enzyme result, an online score, or a consumer test.
Discuss symptoms and risk factors
Fatigue and discomfort in the upper-right abdomen can occur with fatty liver, but they are nonspecific and may have other causes. Risk factors include obesity, type 2 diabetes, insulin resistance, dyslipidemia, and metabolic syndrome. A clinician can consider these alongside symptoms and your medical history; neither pain nor a risk factor alone establishes a diagnosis (NIDDK: Symptoms & Causes of NAFLD & NASH).
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Get urgent help for jaundice
Yellowing of the skin or the whites of the eyes needs urgent medical assessment. The NHS advises urgent help for jaundice because it can indicate a serious condition (NHS guidance on jaundice). Yellowing may be less noticeable on brown or black skin, so check the whites of the eyes as well.
Use emergency services for severe warning signs
Vomiting blood, very dark or black stools, sudden confusion, or slurred speech warrant emergency care. Guidance describing these signs is directed particularly at people with diagnosed cirrhosis or alcohol-related liver disease; it is not a complete triage rule for every person with an abnormal liver test. Sudden severe illness, faintness, difficulty breathing, or difficulty staying awake also calls for immediate local emergency assessment. For UK readers, NHS guidance points to 999 for emergencies and NHS 111 or a GP for urgent advice; elsewhere, use your local urgent medical service or emergency number (NHS: Cirrhosis; NIDDK: Treatment for Cirrhosis; NHS: Alcohol-related liver disease).
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What do abnormal liver tests or a fatty-liver scan mean?
Elevated ALT or AST can prompt a clinician to consider fatty liver, but the result is not a diagnosis. Interpretation depends on the lab’s reference range, the pattern and trend of results, symptoms, medicines and supplements, alcohol exposure, and other health conditions. Normal ALT or AST also does not rule out MASLD (AASLD: Steatotic-What? Changes in Fatty Liver Nomenclature).
Routine ultrasound, CT, or MRI can show fat in the liver, but those images cannot by themselves determine whether there is inflammation or fibrosis (scarring). A scan showing fat is therefore a finding to discuss—not a complete assessment of severity.
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What might a clinician do next?
The evaluation may include your medical history, a physical examination, and additional tests. The clinician may review metabolic risk factors and alcohol exposure and investigate other possible causes of abnormal results. Depending on your situation, they may use blood-derived scores such as FIB-4 or APRI to help assess the likelihood of advanced fibrosis, or elastography to measure liver stiffness. A biopsy is not needed for everyone; it may be considered in selected cases, such as when advanced fibrosis or another liver disease is a concern (NIDDK: Diagnosis of NAFLD & NASH).
What the different tests can and cannot establish
| Assessment | What it can help show | What it cannot establish on its own |
|---|---|---|
| ALT and AST blood tests | Whether these liver enzymes are elevated and how results change over time. | They do not diagnose fatty liver or reliably rule out MASLD when normal. |
| Routine ultrasound, CT, or MRI | Whether fat is visible in the liver. | They cannot determine inflammation or fibrosis by themselves. |
| FIB-4 or APRI blood-derived scores | Help identify or rule out risk of advanced fibrosis when interpreted in context. | They are not a stand-alone diagnosis. |
| Elastography | Measures liver stiffness to support fibrosis-risk assessment. | It is part of an assessment, not a substitute for clinical interpretation. |
| Liver biopsy | May help clarify selected cases, including concern about advanced fibrosis or another liver disease. | It is not required for everyone with fatty liver. |
Which name might appear in your records?
The current terms are metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction-associated steatohepatitis (MASH). Older records and many established resources use nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH). You may encounter both sets of terms; the change in terminology is explained by the American Association for the Study of Liver Diseases (AASLD terminology overview).
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