Most patients with metabolic-dysfunction-associated steatotic liver disease (MASLD, formerly NAFLD) are asymptomatic in early stages; findings are often incidental on health check-ups. Key features relate to metabolic disturbance and hepatic fat accumulation:

• Splenomegaly, thrombocytopenia: congestive hypersplenism
• Fatigue: commonest, linked to hepatocyte energy impairment
• Right upper-quadrant dull pain or discomfort: from stretched Glisson capsule
• Loss of appetite/early satiety: reduced gastric accommodation with post-prandial fullness
• Weight gain or central obesity: background of metabolic syndrome
• Skin pruritus: retained bile acids irritating peripheral nerves
• Spider naevi, palmar erythema: decreased oestrogen clearance → peripheral vasodilatation
• Ascites, leg oedema: combined hypoalbuminaemia and portal hypertension (advanced stage)
• Jaundice: impaired bilirubin uptake/conjugation/excretion (significant fibrosis/cirrhosis)
• Poor concentration, somnolence: rising blood ammonia, subtle hepatic encephalopathy