Most people discover they have fatty liver during routine physical exams. Many patients show no clear symptoms or signs at diagnosis, with fatigue being the most common complaint. However, the severity of fatigue doesn't correlate directly with the degree of liver tissue ischemia. Fatigue manifests as a general state of weakness, with patients often reporting prolonged discomfort and drowsiness. Some may experience discomfort in the upper right abdomen.The primary finding during physical examinations is obesity. Over 50% of obese patients may exhibit hepatomegaly. A minority may develop spider angiomas and palmar erythema. As the condition progresses to cirrhosis, complications such as ascites, bleeding from ruptured esophageal varices, or hepatic encephalopathy may occur.
Diagnosis relies on serum tests, imaging studies, and ultrasound. Physical examination reveals mild to moderate hepatomegaly. Serum tests show elevated transaminases, hyperlipidemia, and increased low-density lipoprotein (LDL) cholesterol. Triglycerides exceed 1.7 mmol/L (mmol/L), while high-density lipoprotein (HDL) cholesterol is below 1.9 mmol/L.fasting blood glucose > 7.1 mmol/L, and postprandial blood glucose > 7.8 mmol/L. Diffuse fatty liver exhibits characteristic ultrasound features: hyperechoic foci, also termed "bright liver." Ultrasound diagnosis achieves 90% sensitivity for fatty liver with >50% fat content. Liver biopsy remains the gold standard for pathological diagnosis.