Fatty liver disease usually begins insidiously and progresses slowly. Most patients have no obvious discomfort in the early stage, and the condition is often discovered incidentally during physical examination or imaging for other reasons. When symptoms do appear, they are generally non-specific and easily overlooked.
- Fatigue
The liver is an important organ for energy metabolism. When liver cells are filled with fat, their ability to synthesize glycogen and other energy substances decreases, resulting in insufficient energy supply and a persistent feeling of tiredness. - Discomfort or dull pain in the right upper abdomen
As fat accumulates, the liver enlarges and the tension of its capsule increases. The capsule is rich in nerve endings, so the stretching can cause vague distension, dull pain, or a dragging sensation under the right ribs. - Abdominal bloating and digestive upset
The liver secretes bile to help digest fats. When function is impaired, patients often experience early satiety, belching, or aversion to greasy foods; some complain of vague abdominal distension. - Nausea and poor appetite
These are more common in patients with fatty hepatitis. Inflammatory cytokines and delayed bile secretion can reduce appetite; occasionally mild nausea occurs, especially after a fatty meal. - Unintentional weight change
A minority of patients with severe steatosis lose weight because of markedly reduced food intake, while those with concurrent metabolic syndrome may continue to gain weight. - Signs of advanced liver damage
If fatty hepatitis or fibrosis progresses, the following may appear:
- Itchy skin
- Spider naevi on the chest or shoulders
- Red palms
- Lower-limb edema or ascites
- Jaundice (yellowing of sclera and skin)
- Splenomegaly and easy bruising
Because early fatty liver is almost silent, anyone with obesity, type 2 diabetes, dyslipidemia, or long-term alcohol use should have regular liver imaging and biochemical check-ups even in the absence of symptoms.
| Stage / Finding | Common Manifestations |
|---|---|
| Early (simple steatosis) | Often asymptomatic; mild fatigue, vague right-upper-quadrant fullness |
| Moderate steatosis | Intermittent right-side discomfort after meals, easy tiring, dyspepsia |
| Fatty hepatitis (NASH/MASH) | Persistent fatigue, nausea, anorexia, possible low-grade fever |
| Fibrosis | Dull abdominal pain, decreased exercise tolerance, possible itching |
| Compensated cirrhosis | Spider naevi, red palms, palpable firm liver, mild platelet drop |
| Decompensated cirrhosis | Ascites, leg edema, jaundice, variceal bleeding, confusion |