Fatty Liver Disease Symptoms — When to See a Doctor in Australia

MASLD is highly prevalent in Western countries and is often asymptomatic. Fatigue is the most common symptom, but advanced stages can lead to cirrhosis, hepatocellular carcinoma (HCC), and liver failure.

Simple steatosis — fat accumulation in liver cells without significant inflammation or scarring — is almost always symptom-free. A person can have 20%, 30%, or even 50% of their liver affected by fat and feel entirely normal. This is why the majority of MASLD diagnoses are incidental — discovered during blood tests or imaging performed for an unrelated reason.

While MASLD often produces no symptoms in its early stages, some patients report non-specific symptoms that, in the context of metabolic risk factors, should prompt GP assessment:

Persistent fatigue: The most common symptom associated with MASLD across all stages. Not the tiredness of a busy week — a persistent, background fatigue that does not resolve with rest. Because fatigue is non-specific, it is rarely attributed to liver disease without investigation. But in someone with obesity, type 2 diabetes, or metabolic syndrome, fatigue should prompt liver assessment.

Right upper abdominal discomfort: A dull ache, sense of pressure, or heaviness under the right ribcage may reflect liver enlargement (hepatomegaly) from fat accumulation. Not all patients with fatty liver have a palpably enlarged liver, and not all liver enlargement is painful — but persistent right-sided abdominal discomfort warrants assessment.

Abdominal bloating: Often associated with metabolic syndrome broadly, but can reflect liver enlargement or early portal hypertension in more advanced disease.

Unexplained weight changes: Difficulty losing weight despite effort, or unexplained changes in body composition, can be associated with the metabolic dysregulation underlying MASLD.

The following symptoms suggest MASLD has progressed to significant fibrosis, cirrhosis, or liver failure. They require prompt — in some cases urgent — medical review:

Jaundice: Yellowing of the skin or the whites of the eyes. Indicates impaired bilirubin processing — a sign of significant liver dysfunction. Always requires investigation.

Dark urine: Urine that appears brown, amber, or tea-coloured beyond what could be explained by dehydration. Reflects bilirubin excretion via urine — a sign of liver dysfunction.

Pale or clay-coloured stools: Indicates reduced bile flow into the intestine — may reflect bile duct obstruction or cirrhosis.

Swollen abdomen (ascites): Fluid accumulation in the abdominal cavity — a sign of portal hypertension from cirrhosis. The abdomen appears distended and feels fluid-filled rather than bloated from gas.

Easy bruising or prolonged bleeding: The liver produces clotting factors. When liver function is severely impaired, bruising occurs more easily and cuts bleed longer than expected.

Confusion or personality changes (hepatic encephalopathy): Advanced cirrhosis impairs the liver's ability to clear toxins from the blood, causing neurological symptoms ranging from confusion and personality changes to coma in severe cases.

About 90% of people who develop hepatocellular carcinoma — a type of liver cancer — have cirrhosis. This is why it is so important to learn what is causing fat buildup in your liver and get treated.

In 2025, the Gastroenterological Society of Australia published a consensus statement highlighting the major role for primary care in prevention, early detection, and management of MAFLD. Adults with obesity, type 2 diabetes, or two or more metabolic risk factors should be assessed for MAFLD.

You should see your GP for a liver health assessment — even without symptoms — if you have:

• Type 2 diabetes (65–75% prevalence of MASLD in this group)
• Obesity (BMI above 30) or significant central abdominal fat
• Two or more of: high blood pressure, high triglycerides, low HDL cholesterol, pre-diabetes, metabolic syndrome
• A history of elevated liver enzymes on any blood test
• A family history of liver disease, cirrhosis, or liver cancer
• Been prescribed a GLP-1 medication (Ozempic, Wegovy, or Mounjaro) for weight management or diabetes
• A history of significant alcohol use even if now reduced

The assessment your GP should perform is a FIB-4 score calculation from routine bloods — ALT, AST, platelets, and age. This requires no additional tests if you have had a recent blood panel.

In most patients, MASLD is first suspected from:

Elevated liver enzymes on blood tests: ALT, AST, or GGT above the normal range without another clear cause. This is the most common trigger for further investigation.

Incidental finding on ultrasound: A bright or echogenic liver on abdominal ultrasound — performed for an unrelated reason — is consistent with fatty infiltration.

The diagnostic pathway then follows the FIB-4 score:

• Below 1.3: low risk, monitor annually.
• Between 1.3 and 2.67: indeterminate, liver elastography recommended.
• Above 2.67: high risk, hepatologist referral.

Liver elastography — FibroScan or equivalent — provides the most comprehensive non-invasive assessment: liver stiffness (kPa) measuring fibrosis, and CAP score (dB/m) measuring fat content. Available across Australia, increasingly with no GP referral required.

Find a liver elastography clinic near you →