Because nonalcoholic fatty liver disease causes no symptoms in most cases, it frequently comes to medical attention when tests done for other reasons point to a liver problem. This can happen if your liver looks unusual on ultrasound or if you have an abnormal liver enzyme test.
Tests done to pinpoint the diagnosis and determine disease severity include:
- Complete blood count
- Liver enzyme and liver function tests
- Tests for chronic viral hepatitis (hepatitis A, hepatitis C and others)
- Celiac disease screening test
- Fasting blood sugar
- Hemoglobin A1C, which shows how stable your blood sugar is
- Lipid profile, which measures blood fats, such as cholesterol and triglycerides
Imaging procedures used to diagnose nonalcoholic fatty liver disease include:
- Plain ultrasound, which is often the initial test when liver disease is suspected.
- Computerized tomography (CT) scanning or magnetic resonance imaging (MRI) of the abdomen. These techniques lack the ability to distinguish nonalcoholic steatohepatitis from nonalcoholic fatty liver disease, but still may be used.
- Transient elastography, an enhanced form of ultrasound that measures the stiffness of your liver. Liver stiffness indicates fibrosis or scarring.
- Magnetic resonance elastography, which combines magnetic resonance imaging with patterns formed by sound waves bouncing off the liver to create a visual map showing gradients of stiffness throughout the liver reflecting fibrosis or scarring.
Liver tissue examination
If other tests are inconclusive, your doctor may recommend a procedure to remove a sample of tissue from your liver (liver biopsy). The tissue sample is examined in a laboratory to look for signs of inflammation and scarring. A liver biopsy may be painful in some patients, and it does have small risks that your doctor will review with you in detail. This procedure is performed by a needle insertion through the abdominal wall and into the liver.
A Mayo Clinic radiologist views an image obtained via magnetic resonance elastography (MRE) of the liver, showing areas of scarring (fibrosis) in red.
Aug. 11, 2017
- Chalasani N, et al. The diagnosis and management of non-alcoholic fatty liver disease: Practice guideline by the American Gastroenterological Association, American Association for the Study of Liver Diseases and American College of Gastroenterology. Gastroenterology. 2012;142:1592.
- Feldman M, et al. Nonalcoholic fatty liver disease. In: Sleisenger & Fordtran's Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. 10th ed. Philadelphia, Pa.: Saunders Elsevier; 2016. http://www.clinicalkey.com. Accessed May 10, 2016.
- Rinella M. Nonalcoholic fatty liver disease: A systematic review. Journal of the American Medical Association. 2015;313:2263. http://jama.jamanetwork.com/ Accessed May 10, 2016.
- Spengler E, et al. Recommendations for diagnosis, referral for liver biopsy, and treatment of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis. http://www.mayoclinicproceedings.org/article/S0025-6196(15)00510-8/abstract. Mayo Clinic Proceedings. 2015;90:1233. Accessed May 10, 2015.
- Barbara Woodward Lips Patient Education Center. Nonalcoholic fatty liver disease. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2009.
- Venkatesh SK, et al. Magnetic resonance elastography of liver: Technique, analysis and clinical applications. Journal of Magnetic Resonance Imaging. 2013;37:544.
- Kim D, et al. Advanced fibrosis in nonalcoholic fatty liver disease: Noninvasive assessment with MR elastography. Radiology. 2013;268:411.
- Sheth SG, et al. Nonalcoholic fatty liver disease: Natural history and management. http://www.uptodate.com/home. Accessed May 10, 2016.
- Boyer TD, et al. Nonalcoholic fatty liver disease. In: Zakim & Boyer's Hepatology: A Textbook of Liver Disease. 6th ed. Philadelphia, Pa: Saunders Elsevier, 2012. http://www.clinicalkey.com. Accessed May 10, 2015.
- Molloy JW, et al. Association of coffee and caffeine consumption with fatty liver disease, nonalcoholic steatohepatitis and degree of hepatic fibrosis. Hepatology. 2012;55:429.
- Malhi H, et al. Nonalcoholic fatty liver: Optimizing pretransplant selection and posttransplant care to maximize survival. Current Opinion in Organ Transplantation. 2016, 21:99.
- Heimbach J, et al. Combined liver transplantation and gastric sleeve resection for patients with medically complicated obesity and end-stage liver disease. American Journal of Transplantation. 2013; 13:363.
- Watt KD (expert opinion). Mayo Clinic, Rochester, Minn. Personal communication. July 7, 2016.
- Ludwig J, et al. Nonalcoholic steatohepatitis: Mayo Clinic experiences with a hitherto unnamed disease. Mayo Clinic Proceedings. 1980;55:434.
- Uppal V, et al. Pediatric non-alcoholic fatty liver disease. Current Gastroenterology Reports. 2016;18:24.
Nonalcoholic fatty liver disease