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.

27 replies
add a comment
  1. Brianne
    Brianne says:

    I have normal enzyme tests and normal ultra sound tests, but I have extreme bloating. What could this be? I have consumed my fair share of alcohol over about an 8 year span. Should I be worried that I have liver damage and it’s just not showing up? The bloating started a few months ago and will not go away, even with change in my diet. Would a doctor consider a liver biopsy? Please help. I am driving myself crazy with worry.

  2. Amanda
    Amanda says:

    I am a 31 y/o female… I was diagnosed with fatty liver but my enzymes come back WNL, very frustrated as I have some pain on the right side just under my ribs, I am on many other meds, does this mean I will need a biopsy done? this is an old thread but hoping someone out there can help me on this one!

  3. Brenda
    Brenda says:

    I am a 47 yr old female. I found out through some medical records that I have a fatty liver. I don’t ever recall being told this . I have had pain in my right side near my ribs for a few years. Drs have been telling me it is nothing. I had my appendicts (sp) removed 35 yrs ago. I always thought it was my galbladder and the nurse practitioner, just recently requested an ultrasound. I got the results of the ultrasound and was told there is a dark spot on the lower right corner of my liver. What could this be? I have been referred to a Gastro Dr. What will the Gastro Dr do to find out what this is? I haven’t had any blood work done.
    Thank you in advanced,

  4. Suzanna Browne
    Suzanna Browne says:

    Try giving up animal products for a few months. Vegan with o oils to cook with. It worked for me and was easier than I thought it would be. Harder to give up cheese than meats or fish. Cook with vegetable stock instead of oils. Drink more water with some lime or lemon juice. Weight divided by 2 and that number of ounces of water per day to flush the system.

    Lots of doctors doing this these days.

    Good luck!

  5. Bob
    Bob says:

    My liver counts have been normal for the past three years. I had bloodwork and my AST was 54 and my ALT was 88. I had a retest a month later and my AST went to normal at 39 and my ALT was still high but had lowered to 79.
    My only change was that I exercize for 35 minutes 5 to 6 times per week. Is the downward trend a good sign or does the ALT, although lower, be of concern. I’ll be retested in two months. I’m trying not to stress.
    Thanks for any feedback

  6. Debbie
    Debbie says:

    Hi Doctor:

    Here are my ALT blood test dates and results:
    5/21/2009 6/18/2009 12/17/2009 4/2/2010 12/3/2010 3/18/2011 5/26/2011 8/19/2011 11/30/2011 3/6/2012
    SGPT/ALT 53 45 59 56 63 52 45 57 40 54

    My AST is normal range

    Had Ultrasound on 9/6/11

    1. Heterogeneously increased echogenicity throughout the liver, suggestive of fatty infiltration.

    ALSO – I have a Protien S Deficiency:
    PROTEIN S ACTIVITY 52 (Standard 60 – 140)
    Test results said low level could be liver disease.

    My internist is not looking at Protein S test and said we will do biopsy if next ALT is elevated.
    My hemotologist is not looking at liver tests and is putting me on coumadin.

    Can you please give me a suggestion as to what my next step should be?


  7. Donna
    Donna says:

    My alk level is 207 my my ast 79 & alt 167 I had an ultrasound & everything is normal. Dr. wants to do liver biopsy to see why levels so high. Is that really necessary?

  8. Doris get answers
    Doris get answers says:

    I have been told over 2 years that I had 3 liver lession and getting mri every 6 months and no changes, which is Good right? But the level as to alkaline phosphatase, ast, alt is going higher. Is there a test that should be done to see why this is happening.

  9. Matt
    Matt says:

    Hi I was diagnosed with fatty liver 3 years ago. Recently I had another ultrasound done and they found a lesion on the left lobe of my liver. I then had a CT scan done and the doctor told me that it only could confirm the lesion but he was unable to specify what type of lesion it was. My doctor suggested waiting 3 months and then having another CT scan done to see if the lesion grows in size. I am 30 yrs old and do not drink much, I have also completely changed my diet and am now working out every day. I am scared it could be cancer and do not know why he could not tell me what type of lesion it was. Should i consider a biopsy in the mean time? My AFP level of 1.7 and all other tests except for my enzyme levels were within normal ranges.
    Thank you

  10. silvia
    silvia says:

    Hello doctor

    For some days i had slight pain on my right abdomen, today i went to the doctor, and done ultrasonography..
    and the report is hepatomegaly… and written LIVER IS ENLARGED 145mm… I am only 24, female.. 5′ 3″‘…weight 80 kg

    pls doctor tell me is something serious??

    • Mark Bar-Gomel
      Mark Bar-Gomel says:

      Hello Silvia,

      Liver enlargement can be causes by many reasons. Have you done any liver functions blood test?
      If so, please share the results?

      Dr. Mark Bar-Gomel


Trackbacks & Pingbacks

« Show older commentsShow newer comments »

Leave a Reply

Want to join the discussion?
Feel free to contribute!

Leave a Reply

Your email address will not be published. Required fields are marked *