Hepatic steatosis

Last reviewed: 1 Sep 2023
Last updated: 30 Mar 2023



History and exam

Key diagnostic factors

  • absence of significant alcohol use
  • mild abnormality in liver function tests
  • truncal obesity
More key diagnostic factors

Other diagnostic factors

  • fatigue and malaise
  • right upper quadrant abdominal discomfort
  • hepatosplenomegaly
  • signs of chronic liver disease
Other diagnostic factors

Risk factors

  • obesity
  • insulin resistance or diabetes
  • dyslipidemia
  • hypertension
  • metabolic syndrome
  • rapid weight loss
  • medications
  • total parenteral nutrition (TPN)
  • diseases associated with hepatic steatosis
More risk factors

Diagnostic investigations

1st investigations to order

  • serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT)
  • total bilirubin
  • alkaline phosphatase
  • gamma glutamyl transferase
  • CBC
  • metabolic panel
  • lipid panel
  • prothrombin time and INR
  • serum albumin
  • autoimmune liver disease screen
  • iron studies
  • hepatitis B surface antigen, surface antibody, and core antibody
  • hepatitis C virus antibody
  • alpha-1 antitrypsin level and phenotype
  • liver ultrasound
More 1st investigations to order

Investigations to consider

  • fasting insulin
  • homeostatic model assessment (HOMA) calculation
  • abdominal MRI
  • elastography
  • liver biopsy
  • ceruloplasmin
  • HFE gene mutation testing
  • anti-M2 mitochondrial antibody
More investigations to consider

Emerging tests

  • cytokeratin-18 fragments

Treatment algorithm


without end-stage liver disease

end-stage liver disease



Shahid M. Malik, MD
Shahid M. Malik

Clinical Assistant Professor of Medicine

Division of Gastroenterology, Hepatology and Nutrition

Department of Medicine

Program Director, Transplant Hepatology Fellowship Program

Starzl Transplantation Institute

University of Pittsburgh Medical Center




SMM declares that he has no competing interests.

Rachel Zhuang, MD


General Internal Medicine

University of Pittsburgh Medical Center




RZ declares that she has no competing interests.

Kapil B. Chopra, MD, FACP, FAASLD, AGAF
Kapil B. Chopra

Professor of Medicine

Medical Director of Comprehensive Liver Program and Liver Pancreas Institute

University of Pittsburgh School of Medicine

University of Pittsburgh Medical Center




KBC declares that he has no competing interests.

Peer reviewers

Philip Newsome, PhD, FRCPE

Senior Lecturer in Hepatology & Honorary Consultant Physician

Liver Research Group

Institute of Biomedical Research

The Medical School

University of Birmingham




PN declares that he has no competing interests.

Stephen A. Harrison, MD, LTC, MC

Chief of Hepatology

Department of Medicine

Gastroenterology & Hepatology Service

Brooke Army Medical Center

Fort Sam Houston

Associate Professor of Medicine

University of Texas Health Science Center




SAH is an author of a reference cited in this topic.

Robert D. Goldin, MBCHB, MD, FRCPath

Reader in Liver and GI Pathology

Imperial College at St. Mary's




RDG declares that he has no competing interests.

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