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British Liver Trust
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Ultrasound question about coarse texture

Hi guys,

I had an upper abdominal ultrasound today and everything was fine except a finding on my liver. The results just say "The liver is coarse in texture, consistent with fatty infiltration". The lady just told me that it is fatty liver and that i need to lose weight and eat better and abstain from alcohol.

I was wondering though as all the information I can find online says that a coarse texture of the liver means definite scarring and fibrosis (not fatty liver and much more serious). Should I be worried about this because I am! Do I need a second opinion on the images?

I have attached one of the pictures from the scan if anyone with professional or better knowledge than me could help me out please?



15 Replies

Hi, my advice is to a) not try to self diagnose. Don't look at your ultrasounds. I had a bank of them last week but the only one I looked at was the one showing the multiple gallstones they found. I can't make out what the ultrasound is, I'm not trained to interpret it. Surely you'll be under the care of a go or consultant who will go through the results with you in depth? If not request a referral to specialist.

The liver is a hardy organ and the person doing the ultrasound gave sound advice. Change your diet. Do exercise. Stop drinking completely and give your liver the break it needs. After a year go get another set of scans and you'll probably wonder what you were worrying about. My liver had fat infiltration bit this year I've made many changes. Liver is now completely clear. You'll no doubt have had blood tests done? What were the results like? High gamma gt? ALT? AST? BILIRUBIN? do you drink too much? Take this as a wake up call. Changing lifestyle won't kill you. It may just make all the difference but most of all, don't worry. From this point in it all depends how much you want a life. Without the horrific problems a damaged liver can cause. Just take a while reading of others problems on this site. This is your wake up call. Start taking N-AC 1200mg every day.

And good luck.

1 like

Hi what is N-AC? Is it a supplement? I have diagnosed fatty liver, is it safe for that?please Advise, 🌝


N-Acetyl Cysteine is a supplement. It's just an amino acid. I took creatine and NAC, are a low fat healthy diet and started working out 6 days a week for 3 months and have no fat on scan anymore and also dropped the colesterol from 5.9 to 4.3 :)


You are lucky, I have severe fibromyalgia and can exercise much at all, just have to hope doing the rest is enough.


What is nac 1200


The fat in your liver has caused the fibrosis. The lady was probably right, but only she not us know if you are overweight and could improve your nutrition? Is she right, could you do with losing weight and re-thinking what you eat and drink. She is right about the alcohol, everyone with even a hint of liver fibrosis should give up alcohol as it will only add to the liver damage.

What led you to having a scan in the first place?


its doesnt say that you have Fibrosis, its suggests fat. but an ultrasound is open to interpretation, its not a very good test when it does show something.

If I were you I would get a Fibroscan, its a much better test and will tell you what you have or do not have. also early Fibrosis can resolve over time.


Hi there, this a not a professional opinion, but from personal experience.

A fatty liver is kind of like the warning sign of the start of cirrhosis, however if you change your diet and stop drinking the liver can repair the coarse tissue and the liver will return to normal.

However if your diet doesn't change then the scarring becomes permanent and the liver can not repair the tissue classing it as cirrhosis if the damage can not be repaired.

Hope that helps.

1 like

Hi every one thanks for the swift and helpful replies.

I had an ultrasound done 2 years ago almost exactly to the day which showed my liver was normal then. However over the last 2 years I have drank much more frequently than I ever have before (although I have done a few 3 month periods of no drinking at all in between). I am currently overweight by 2.5 stone and my diet hasnt been terrible but it's not been great either. I've lost 1 stone in the last 2 months and plan on losing the other 2.5 in the the coming months. I've not drank for 2 months and don't plan on drinking heavily again in the future, I can easily stop so that's not an issue.

To be honest I was just extremely worried that the nurse yesterday mentioned that my liver is coarse, as when i researched what this meant there is nothing but TERRIBLE things online - i cant find any instances where fatty liver means coarse texture, only that coarse texture means fibrosis and/or cirrhosis which i found extremely worrying!


they cant really tell from an ultrasound, usually fat shows as a bright echo, but its possible you have both. You need better scans, a Fibroscan or a biopsy to find out more. Also for fat to show in your liver it has to be pretty well established.If your enzymes are good then that means your Liver isnt inflammed yet, inflammation is what causes the scarring.


hi there! when I first got diagnosed, I made the HUGE mistake of looking online at everything..boy did my specialists throw a fit. They then gave me permission to only look at 2 different sites, reminding me that every case is unique, as it every patient's background, ethnicity, diet and the like. After that, I did as I was told and trusted them.

Some of those sites seem to really cater to hypochondriacs (not implying that you are) but again, your doctor or nurses know what they are looking at and who you are as a person. A website, even with a questionnaire, does not.

Coarse is not necc. bad. or terribly bad. I've been told that my liver looks really great, with just slight ridging on the edges..if they only went by that, they would have missed my illness completely. For me, its what it's doing, or, should I say NOT doing, that tells the tale.

I've been diagnosed with end stage liver disease, Cirrhosis and Hep C. I am now on the transplant waiting list. I have had every test under the sun..I HAVE to trust that my team at Addenbrookes know best, otherwise I'd go crazy.

If you are truly concerned, get a second opinion. but as someone else already said, do not try and diagnose yourself..when we do that, we always see the worst :)

Hoping you have a good outcome and you feel better soon! A change in diet and stopping drinking always makes the liver a happier organ :) lol

cheering you on!!


Hi Kristian,

There's a lot of detail missing here.

1) Firstly - Why are you having the ultrasound done? Has there been suspicion of liver issues?

2) Have you had any other tests? Blood tests in particular? If so what were the results?

3) What symptoms caused you to go to the doctor in the first place?

I ask because these details are important so you can know what the best thing to do next actually is.

There are a number of causes of liver disease ranging from viruses (Hepatitis A, B, C etc) to Alcoholic liver disease, to fatty liver to autoimmune liver disease. Basically if you have a liver disease (from whatever cause) the liver will become inflamed - this inflammation is called hepatitis (don't confuse this with the viruses called Hepatitis which also cause the inflammation (hepatitis)!). If the hepatitis goes on long enough, i.e. the liver stays inflamed for long enough then scar tissue forms - This is called fibrosis. If the condition continues long enough and the entire liver is comprehensively scarred then you have cirrhosis - which is a liver made up almost entirely of scar tissue.

Fatty liver is mostly caused by lifestyle (including alcohol) - although not always - essentially we are doing to ourselves what people used to do to geese to get fois gras. The way to stop it and reverse it is to reduce alcohol consumption, eat much more healthily and exercise. The liver has a remarkable ability to self-repair and regenerate but you do need to deal with the root causes as early as possible.


As you haven't yet supplied enough information it's difficult to tell what is happening.....


I went to a doctor in the US in 2012, had various blood tests which showed high liver enzymes. The ultrasound report said pretty much the same thing as yours did. The doctor made the mistake of assuming that I was probably overdoing it on food and not excercising enough and so looked at all the test results with that in mind. She sent me off with advice to exercise more and eat better. She had ordered blood tests for almost every liver related issue and all the tests had come back clear.

18 months later however I was diagnosed with cirrhosis caused by autoimmune hepatitis (AIH) (your immune system attacks the liver). It was the one thing she hadn't thought to test for as it's quite uncommon.

The point here is that one extra test in 2012 and we may have caught the autoimmune hepatitis 18 months before we did and at the time I may well not have had cirrhosis but a level of fibrosis which it may have been possible for the liver to reverse. Instead the disease went unchecked for 18 months.

You need to get some clarity - by all means feel free to cite my case - the wording of my ultrasound report was almost exactly the same - so go and talk to a doctor.

Having said all that of course, if you have liver disease then there should be some other manifestation in terms of blood results or other symptoms. IF your blood tests are normal and you have no symptoms and the doctors have considered all possible liver issues then it is possible you have fatty liver disease - it's on the rise - so you need to sort your lifestyle out pronto. In fact sort it out anyway!

Sorry it's so long but hope it helps. Best of luck.



Thank you for the detailed response MisterX! I'll try and clear up a bit more info for you.

3 out of the 5 times I've had my LFTs done in the last 12 months they've been elevated, but all of them 3 times the bloods were taken were during times when i was drinking heavily in the preceding days. Whenever I've had them taken after abstaining from alcohol for a few weeks they've all been within healthy ranges. But they have been raised probably half the time when tested in the year or two preceding this also - but again, I wonder if a very unhealthy lifestyle was causing this as when I had follow ups they usually came back down.

I've had all sorts of blood tests over the past year and autoimmune screens were part of them, everything has been fine - the only thing that has come up is that I have high cholesterol/raised triglycerides.

I referred myself for the ultrasound privately so wasn't sent by my GP. The reasons I wanted it was to check on my insides because of a very odd abdominal water retention and severe IBS/bloating problem I have (which GP's have no idea what is causing it, but I'm told it's just a weird functional problem and not serious - its not ascites or anything of the sort) but also because I'm a bit of a hypochondriac and I'm very worried about the state of my liver as I drank extremely heavily over the course of 18 months and I was a heavy user of recreational drugs from 2010-2012 (I don't take them any more), so I wanted to have a check up for peace of mind.

I have a follow up with my new GP (I moved house) on Monday which I will ask him about the results, and I also have a gastroenterologist appointment in 3 weeks (originally for bloating/IBS/water retention) where I will put the ultrasound results to them and see what they can do/say. I also plan on getting a Fibroscan when the Loveyourliver roadshow makes it within 1 or 2 hours of my hometown later this year.

Does that clear things up?



Yes that does thanks,

In that case I would say that fatty liver is a reasonable starting point - given that the various screens would have shown the various viral reasons for getting liver disease and you're clear for autoimmune hep.

Under the circumstances I would suggest you need a sustained period off alcohol, change your diet and get some exercise - exercise especially important to reduce triglycerides. It's a good idea to do some activity after meals as part of your routine.

If you're seeing a gastroenterologist I'd lay all this before him.

The thing with liver problems is that you want to a) Stop whatever is causing the injury to the liver to b) allow the liver to regenerate.

So if it is being caused by lifestyle you're going to have to bite the bullet (high fibre, low fat preferably) and sort it out. Trust me - you do not want to get to the point of cirrhosis and it doesn't sound like you're there.

So at this stage, if I were in your shoes, I'd feel reassured that the chances are that it's something you can get on top of, control and probably reverse - and that the gastroenterologist will be the right person to talk to about this.

Hope that helps. Best of luck.


PS - Start getting creative with oatmeal - it will help - especially if you put nuts and things in it :)


Thanks very much for all of your help - some reassurance is very good right now. I will definitely work towards fixing this issue and make sure I follow up all leads - its a been a long time coming and to be honest I feel that this has given me the shock that I needed to get off my ass and sort it.

I'm very sorry to hear about your condition by the way, I wish you all the best with it.

Thanks again for taking the time to help me out :)

I love oatmeal btw, I like to make it with some milk, some greek yoghurt and a bit of chocolate flavoured protein powder with some chopped bananas and nuts :D mad!


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