Liver Health in Australia: A Complete Patient Guide

What Your Liver Does

Your liver is the largest internal organ in your body, sitting just under the ribs on the right side. It performs hundreds of jobs: filtering toxins out of your blood, making proteins your body needs, producing bile to help digest fats, storing energy, and regulating blood sugar and cholesterol. Almost everything you eat, drink, or take as a medication is processed by the liver.

The liver is unusual in that it can regenerate — losing a portion of liver tissue typically triggers regrowth of healthy cells. But when the liver is damaged repeatedly over a long time, that regeneration can't keep up, and scar tissue builds up. Scar tissue is called fibrosis. Severe scarring is called cirrhosis. The whole point of monitoring liver health is to catch fibrosis before it becomes irreversible.

The Most Common Liver Conditions in Australia

Fatty Liver Disease (MAFLD / MASLD)

By far the most common liver condition in Australia today. Roughly 37% of Australian adults have some degree of fatty liver — more than 5 million people. The condition has had several names: NAFLD (non-alcoholic fatty liver disease) became MAFLD (metabolic-associated fatty liver disease) became MASLD (metabolic dysfunction-associated steatotic liver disease) in 2023. They're essentially the same condition.

Fatty liver is closely linked to type 2 diabetes, obesity, high blood pressure, abnormal cholesterol, and metabolic syndrome. Most people with fatty liver feel completely well — there are usually no symptoms until the disease is advanced. This is why screening matters. The inflammatory form (MASH — formerly NASH) is when the liver is actively being damaged and is the form that progresses to fibrosis and potentially cirrhosis.

Hepatitis B

Hepatitis B is a viral infection that can cause chronic liver damage. In Australia, roughly 1% of the population lives with chronic hepatitis B — about 250,000 people. The infection is much more common in people born in countries where hepatitis B is endemic, including parts of East Asia, Southeast Asia, sub-Saharan Africa, and Pacific Island nations.

Hepatitis B is silent for most people most of the time. Long-term monitoring is the most important part of management — typically blood tests every 6–12 months and elastography every 1–2 years to check for fibrosis progression. Treatment is available and effective; the 2024 WHO guidelines lowered the threshold for starting treatment, meaning more patients now qualify for antiviral therapy.

Hepatitis C

Hepatitis C has been transformed by modern treatment. Direct-acting antiviral medications cure more than 95% of patients in a single 8–12 week course. In Australia, anyone with hepatitis C can access treatment subsidised through the PBS, regardless of disease stage. The question now is not whether to treat but how to find the people who don't yet know they have it.

After successful hepatitis C treatment, ongoing liver monitoring is still important for patients who had significant fibrosis at the time of treatment — fibrosis can persist or progress even after the virus is cleared.

Alcohol-Related Liver Disease

Long-term excessive alcohol use is a major cause of liver damage in Australia. The good news: significant reduction or cessation can reverse early-stage damage and stabilise more advanced disease. The general guidance from the NHMRC is no more than 10 standard drinks per week and no more than 4 in a single day — but for people with established liver disease, even lower limits or abstinence are appropriate.

How Doctors Check Your Liver

Five tests cover most clinical scenarios:

• Liver function tests (LFTs): a blood panel including ALT, AST, GGT, ALP, bilirubin, and albumin. Routine and inexpensive. Shows current liver enzyme activity but doesn't directly measure scarring.
• FIB-4 score: a calculation using age, AST, ALT, and platelet count. Estimates probability of advanced scarring. Free if the bloods are already being done.
• Ultrasound: shows liver structure, detects significant fatty changes, identifies gallstones or other structural issues. Doesn't directly measure fibrosis.
• Liver elastography (FibroScan or iLivTouch): measures liver stiffness in kPa. The non-invasive standard for assessing fibrosis. Takes 10–15 minutes. No needles, no recovery time.
• Liver biopsy: a small needle sample of liver tissue. Used only when other tests can't give a clear answer or when specific information is needed (autoimmune workup, certain trial eligibility). Increasingly uncommon for routine fibrosis staging.

Understanding Your Elastography Results

If you've had an elastography scan, your report includes three numbers:

• kPa (liver stiffness): the main number. Higher means stiffer liver, which usually means more scarring. For fatty liver, below 8 is reassuring; 8–12 is intermediate and warrants review; above 12 needs specialist input.
• CAP or UAP (liver fat): reflects how much fat is in your liver. Graded S0 (no significant fat) to S3 (severe). Different devices report different units (CAP for FibroScan in dB/m, UAP for iLivTouch in dB/m), but the S0–S3 grade is comparable.
• IQR ratio: tells you whether the result was reliable. Below 30% is reliable. Above 30% means the measurements varied too much — your doctor may suggest a repeat scan.

What You Can Do for Your Liver

Most liver health improvements come from the same things that improve overall metabolic health:

• Weight management: for fatty liver, losing 7–10% of body weight reduces liver fat and inflammation. This is the single most effective lifestyle intervention.
• Diet: Mediterranean-style eating patterns are consistently associated with better liver outcomes. Reducing ultra-processed foods, added sugars, and refined carbohydrates is supported by the evidence.
• Physical activity: 150 minutes of moderate exercise per week improves liver fat independent of weight loss.
• Alcohol: reduce or eliminate, especially if there's any existing liver disease.
• Medication review: some medications are processed by the liver and may need dose adjustment in liver disease — talk to your GP about anything you're taking long-term.
• Coffee: regular coffee consumption (2–3 cups daily) is associated with lower liver disease risk in multiple studies. Not a treatment, but a useful observation if you already drink coffee.
• Vaccination: hepatitis A and B vaccines are recommended for adults with chronic liver disease who haven't been vaccinated.

When to See a Specialist

Most liver conditions are well-managed in primary care. Specialist input (a hepatologist or gastroenterologist) is appropriate if:

• Your FIB-4 score is above 2.67, or your elastography kPa is above 12.
• You have evidence of cirrhosis on imaging or clinical assessment.
• Your liver enzymes are persistently and significantly elevated despite lifestyle changes.
• You have chronic hepatitis B that may meet current treatment criteria.
• An autoimmune or drug-induced cause is suspected.
• You're considering or already on resmetirom or other emerging MASH therapies.

If You've Just Been Diagnosed

Three things to know if you've recently been told you have fatty liver, MAFLD, MASLD, or any other liver condition:

1. It's not an emergency. Most liver disease progresses over years, not weeks. You have time to work through what it means and what to do.
2. The diagnosis is also a baseline. Knowing where you are now lets you measure improvement. Many patients see substantial fibrosis stabilisation or regression with metabolic improvement over 1–2 years.
3. Lifestyle works. The evidence for sustained weight loss, dietary improvement, and reduced alcohol affecting liver disease trajectory is strong. The interventions are not glamorous, but they are effective.

Finding the Right Test Near You

Liver elastography is available across Australia in hospitals, specialist consulting rooms, imaging centres, and increasingly in larger GP super-clinics. The Find a Clinic page lists participating elastography services across Australia. Most clinics accept GP referrals; some accept self-referral. Costs vary — generally $150–$330 — depending on the device, the clinic, and whether the scan is bundled with abdominal ultrasound.