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British Liver Trust
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Fatty Liver and Possibly Fibrosis Don't Know

Hi All, I have been recently diagnosed with fatty liver by ultra sound scan. The report says 'The liver is slightly increased in echogenicity consistant with fatty liver change with hypoechoic areas adjacent to the inferior border of liver adjacent to the gall bladder suggestive of fat sparring.' Can any body explain me what does this mean in simple terms? Is that whole liver is fatty liver or only that hypoechoic area? How serious it is? Do anybody recommend to have fibroscan?

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It means that you have some suspected clumpy areas of fat.

It is pretty difficult to go much further with an ultrasound, because the fat shows as a bright echo and could mask Fibrosis underneath. That said most people who are diagnosed with ultrasound seem to be ok from all the journeys I have followed.

No harm in getting a Fibroscan, but that will not probe these clumpy areas. The Fibroscan measures about an index finger size piece right in the middle of the right lobe. An MRI might be a better idea to check the clumps out.


Thanks Ralph for your post. Can that Clumpy areas be Fibrosis or cirrhosis? Can ultrasound report state if any fibrosis/Cirrhosis like behavior predicted during ultrasound scan? I have had my blood test done recently one month before. The results are: Bilirubin 11, ALT 18, ALP 117 and Albumin 52. Can you please tell me from these results what can be the possibilities?

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if the radiologist thought there were positive Fibrosis signs it would have written something like "suggestive of Fibrosis." The radiologist is tying the whole sentence to the fat, so I think it means "some patchy fat echos across from the gallbladder" I know these tests and their conclusions can be frustrating and anything apart "all normal" causes great stress. Try to relax a little, fatty liver is nearly always reversible. It very common for little "lesions" and birth marks, cysts etc to be inside the body, some people even find out they have "Duplex Kidneys" but mostly these issues are nothing to worry about.

The ALP is a little on the high end there, it would be better to have a GGT reading too, but at a guess I would say it would be elevated, because of the evidence of fatty liver on the ultrasound. Fatty Liver and high GGT and ALP go together pretty well.

Albumin is good, the upper limit is 50, so you are above that, this a reading that you dont want low, because a healthy Liver produces it for you, a failing Liver cant produce, so Albumin drops.

Bilirubin 11

If thats umol then its right in the middle of healthy, so another positive.


Hi. I have had both tests. Multiple ultrasounds and 1 Fibroscan. Most of the time the radiologist states that what he/she sees can be tied to fatty liver. Then had persistent elevated liver enzymes and alk phos for over three years. Was sent by GI to have first Fibroscan which in less than 5 mins diagnosed me with stage 4 liver disease.

Because of the huge inconsistency in the test results doc then performed a laporoscopy with biopsies. Before the biospy results came back the surgeon told my husband that she saw inflamed liver with fibrosis and very little fatty liver changes. My last liver biopsy showed no fatty liver.

So now I have no clue who to believe. These results basically contradict the ultrasound and Fibroscan. I am leaning toward the surgeon who actually visualized my liver. Still continue with chronic ruq abd pain with bouts of severe pain. When the severe pain comes on if labs are drawn then my liver enzymes and alk phos are all in the 300-450 range. They then return to my baseline which is 80-200. Thought maybe the intense pain was a cbd stone but they did not see anything. Don't know where to go from here because I feel like I can't trust ultrasound or Fibroscans. Was reading up on Sphincter of Oddi dysfunction and it fits my pain problem and also the elevations in blood work but my GI doc states that it is very rare. Also think maybe they should check me for undiagnosed celiac disease.

In any case that is the problem with ultrasounds. Many people that have autoimmune diseases who have ultrasounds are wrongly diagnosed with FLD when in fact the changes they see are due to the disease.


Its not a matter of trust in the tests, its understanding them. All tests they perform tell them something and have a use, otherwise they wouldnt be doing them, if there was no point. Sometimes its about what they dont find.

A Fibroscan can be affected by inflammation, it makes the score higher than what it should be . Of course it gives some great info seeing the actual Liver and getting some cells. So no fatty changes should rule out NASH. They have found Fibrosis which the Fibroscan also found and also the Ultrasound did find something that they thought was fat at the time, but now probably not.

ultrasounds are not the best tool for the Liver, how ever they do give some information and most of the time they are adequate to diagnose fatty liver and monitor its progress.

So moving forward, they now wont waste time treating you for NASH and are already exploring other causes. Sometimes it can be a slow process getting the cause.


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