When to consider a Fatty Liver Biopsy

A fatty liver biopsy is an invasive operation used to remove a sample of a liver tissue.

The most common reason for doing a fatty liver biopsy is when the level of your liver enzyme, ALT, is at normal range, but on the other hand, a liver ultrasound scan suggests a non-alcoholic fatty liver.

Who is it for?

Liver biopsy isn’t required in most cases, but it’s sometimes necessary. There is in-fact a scenario where the ALT enzyme level is at normal range, but an ultrasound test suggests a fatty liver.

This is where the data from the blood test and the ultrasound doesn’t add-up, and a liver biopsy can confirm or disregard an existence of a fatty liver, and see not only the amount of fat, but also if there is an inflammation, scar tissue, and necrosis (deal liver cells).

Patients with Insulin Resistance (a pre-diabetic state), or other problems related to Glucose Metabolism, are at higher risk for a complication to an advanced liver diseases.

Learn more about Fatty Liver Diagnosis

You can learn everything about fatty liver diagnosis by clicking here.

Liver and Abdominal Ultrasound Preparation

A abdominal or liver ultrasound plays a crucial role on diagnosing many liver diseases, including a fatty liver. To get an accurate results, it’s very important to understand and know how you should prepare for a liver ultrasound.

Liver Ultrasound Preparation guidelines

  • Do not drink or eat at least 6 hours before the test.
  • On the day before the test, do not eat – fresh fruits and vegetables, fried and oily food, milk, eggs, bread.
  • What you should eat – cooked vegetables, puree, marmalade, honey, roasted bread, soup, and rice.
  • No medications are needed to be taken before the ultrasound.
  • The liver ultrasound scan is completely painless.

Here is its estimated procedure

  • Lying onto an ultrasound table.
  • A special gel will be spread upon your abdomen.
  • The tester will move a tool called “transducer” (looks like a small wand) over the gel, that will create and capture the most relevant images.
  • The tester will process and look at the images, and will enter his conclusions.

Total estimated time of the test: 20-30 minutes.

A typical scene from a Liver Ultrasound room

Learn more about liver ultrasound, and take a look at fatty liver pictures.

Fatty Liver on Ultrasound & Fatty Liver Images

One of the common ways to diagnose liver disorders and diseases (including fatty liver) is an abdominal ultrasound test.

Using fatty liver ultrasound, it is possible to analyze and confirm the existence or non-existence of fatty liver.

The abdominal ultrasound is a painless test that uses sound waves to produce images of your liver, and the entire process usually takes less than 15 minutes, and it is required to fast for at least 6.

For accurate results, you should avoid eating fresh fruits, fried food, milk, eggs, and bread the day before the liver ultrasound test.

How an Abdominal Ultrasound room typically looks like

fatty liver on ultrasound

You will be asked to lie on your back for this test. A special Ultrasound Gel will be rubbed on your abdomen to help send the sound waves better and produce correct liver ultrasound images. Your health-care provider will then move the ultrasound sensor around different area of your abdominal, including your liver. He may ask you to hold your breath at times and/or change positions.

The liver ultrasound pictures helps your doctor to confirm or rule out fatty liver disease, how your liver functions, and whether it’s enlarged or not. In other words, it’s a very useful tool for diagnosing a fatty liver.

Healthy Liver Ultrasound picture

Fatty Liver Images

In the liver ultrasound picture sample above, it shows a typical healthy liver, at normal size, with no signs of a liver disorder. A liver specialist would come to the conclusion that the liver is perfectly normal.

Now lets take a look of a Fatty Liver on Ultrasound

Fatty Liver Images

You can actually see fatty liver images in the ultrasound above (the black area is fat that covers the liver). Fatty Liver is a very common reason for performing an abdominal ultrasound. In fact, it’s the most common liver disease in the world so performing a fatty liver ultrasound is one of the things many people go through to diagnose the disease.

I also recommend you to read full details on liver ultrasound preparation.

Fatty Liver Diagnosis

Fatty Liver diagnosis is somewhat tricky, because you don’t have any symptoms to begins with. And if you don’t have any noticeable symptoms, it’s very hard to actually get diagnosed. You might as well have fatty liver for years and even decades without even knowing it.

Most people who have been diagnosed with the disease were because of a routine blood test.

The First Blood Test

The first blood is the most important one. It’s the test that starts the diagnosis process. Without it, you’d have a “sleeper” disease within your liver.

A blood test can detect a liver disorder by evaluating the liver enzyme levels – ALT. If the blood test results show an high levels of ALT, it’s a sign there is an issue with your liver.

This is the time were your physician will most likely ask you to redo the blood test. But this time it will be very focused on the liver.

Second Blood Test

This blood test has two goals:

  • Rule out common liver conditions, such as Hepatitis B and Hepatitis C.
  • Include other tests to check your liver condition more closely.

The most important blood tests that check your liver’s condition are ALT (also called SGPT), AST (also called SGOT), and Bilirubin.

If Hep B and Hep C have been ruled out, high levels of ALT and/or AST may suggest a fatty liver. You can read in more details about liver function’s blood test here.

Liver Ultrasound

After the blood tests, you will need to do an abdominal ultrasound scan. This will allow for a close examination of your liver tissue to confirm whether you have a fatty liver and its severity.

More details on Fatty Liver Ultrasound >>

* Note: In rare cases where there is no clear sign of a fatty liver even though a blood test shows high liver enzyme levels, a liver biopsy might be needed.


If you’d like, we have a special tool we built specifically to help with fatty liver diagnosis. We simply call it Fatty Liver Self-Diagnosis tool. Simply answer few questions and we’ll try to decide if you have a fatty liver or not. It’s completely FREE of charge.