Conditions
Fatty liver: what it means and what you can do
Fatty liver is a buildup of fat in the liver. It rarely causes symptoms and is often found through high liver enzymes on a blood test or on an ultrasound. It is linked to excess weight, diabetes and high cholesterol, or to alcohol. By video, the doctor evaluates you, gives you a lab order and helps you make a plan.
Is it an emergency? Call 911.
Is this an emergency?
This is not an emergency service. Call 911 or go to the nearest emergency room if you have:
- Vomiting blood, rectal bleeding or black stools
- New or worsening confusion
- Yellow skin or eyes that appear or worsen quickly
- A belly that suddenly swells, or severe belly pain
- Shortness of breath
Help lines
At a glance
Fatty liver
Common symptoms
- Tiredness
- Discomfort in the upper right side of the belly
- Other names
- Metabolic dysfunction-associated steatotic liver disease (MASLD) · Nonalcoholic fatty liver disease (NAFLD) · Hepatic steatosis
- Usual test
- Liver enzymes (ALT and AST); liver imaging by referral, when needed
- Treatment
- Gradual weight loss, stopping alcohol and controlling diabetes, cholesterol and blood pressure, as the medical evaluation indicates
- Possible complication
- Liver fibrosis and cirrhosis
On this page(8)
What is fatty liver?
There are two main types. Metabolic dysfunction-associated steatotic liver disease (MASLD, formerly called nonalcoholic fatty liver disease) does not come from alcohol: it is more common in people with overweight or obesity, type 2 diabetes or insulin resistance, high triglycerides or cholesterol, and high blood pressure. Alcohol-associated liver disease comes from heavy drinking.
In some people the fat causes inflammation and damage, and over the years it can scar the liver (fibrosis) and lead to cirrhosis. That is why it is worth addressing even if you feel fine.
It matters in Puerto Rico: according to the CDC, 14.4% of adults had diagnosed diabetes in 2021, the highest of any U.S. state or territory, and diabetes is one of the main risk factors for fatty liver.
How we handle fatty liver by video
You see Dr. Diana Nieves Castro, a Puerto Rico-licensed general practice physician with several years of emergency-department experience, in English or Spanish. She goes over the results that brought you in, your health conditions, how much alcohol you drink, and the medicines, supplements and natural remedies you take, because some herbal remedies can damage the liver.
We evaluate, diagnose and treat. If needed, we give you a lab order for a lab near you: liver enzymes (ALT and AST), blood sugar, cholesterol and other tests for your case, such as hepatitis testing to rule out another cause. If the doctor thinks you need an ultrasound or other liver imaging, or a specialist’s evaluation, we refer you.
She also helps you manage what feeds a fatty liver: type 2 diabetes, prediabetes and high cholesterol. If appropriate, the doctor prescribes and we send your prescription to your pharmacy.
Your doctor
Dr. Diana Nieves Castro, MD
General practice physician
Several years of emergency-department experience.
Founding Executive Director of The Health Initiative.
Your visit in 3 steps
Request a visit online 24/7 — we confirm your time by email or text This is how you see a doctor online with us.
Request your visit.
Book a visit and choose "Doctor visit". Have your recent results ready. You pay by card when you request it.
See the doctor by video.
We send you a secure video link. It works on your phone, tablet or computer.
Get your plan.
If needed, you get a lab order or a referral for imaging. If appropriate, the doctor prescribes and we send your prescription to your pharmacy.
What the visit costs
A doctor visit costs US$79, the same price for every age, with no membership. If the doctor orders tests, we go over the results with you in a US$49 follow-up visit, for existing patients only. You pay by card when you request the visit, and you get a full refund if the visit can’t take place. We do not bill insurance. See all prices. The service is run by The Health Initiative, a nonprofit.
Fatty liver symptoms
Fatty liver rarely causes symptoms, which is why so many people find out from a blood test. When there are symptoms, the NIH lists:
- Tiredness
- Discomfort in the upper right side of the belly
Fatty liver treatment, and when tests are ordered
If it is metabolic, what helps most is gradual weight loss: according to the NIH, losing 3% to 5% of your body weight can reduce liver fat, and reducing inflammation and scarring may take losing 7% to 10%. Losing weight too fast can make the liver worse. Eating better, moving more and controlling blood sugar, cholesterol and blood pressure all help at the same time.
If it is from alcohol, the most important step is to stop drinking. The doctor helps you find support, such as counseling or a recovery program. Even when fatty liver isn’t caused by alcohol, drinking adds damage.
Tests. Doctors often suspect fatty liver when ALT and AST come back high. The doctor orders repeat tests and checks for other causes, and refers you for imaging when the liver needs to be seen or scarring measured. Before taking supplements or "liver cleanse" remedies, ask the doctor.
When to go to the ER
These signs can mean advanced liver damage. For your safety, go to the emergency room or call 911. See when to go to the ER.
- Vomiting blood, rectal bleeding or black stools
- New or worsening confusion, or unusual sleepiness
- Yellow skin or eyes that appear or worsen quickly
- A belly that suddenly swells, or severe belly pain
- A fever over 101 °F (38.3 °C) with a swollen belly
- Shortness of breath
How we care for you
We evaluate, diagnose and treat; if needed, we give you a lab order for a lab near you.
We see adults and children of all ages. Patients under 21: a parent with patria potestad (parental authority) or a legal guardian is on camera for the whole visit and shows photo ID.
Real-time video visit. We send you a secure video link. It works on your phone, tablet or computer.
If appropriate, the doctor prescribes and we send your prescription to your pharmacy. We do not prescribe controlled substances.
You must be physically in Puerto Rico during the visit (visitors, tourists and cruise passengers are welcome).
In an emergency, call 911.
Frequently asked questions
Can fatty liver be reversed?
What do high liver enzymes mean?
Can you order a liver ultrasound by video?
Will you review liver results another doctor ordered?
About this page
Author: The Health Initiative
Medical care provided by Dr. Diana Nieves Castro, MD (PR license 24027)
Disclosure: Founding Executive Director of The Health Initiative
Published: 2026-10-02 · Updated: 2026-10-02
Sources (6)
- Fatty Liver Disease (MedlinePlus, NIH) (opens in a new tab) (accessed 2026-10-02)
- NAFLD & NASH: Symptoms & Causes (NIDDK, NIH) (opens in a new tab) (accessed 2026-10-02)
- NAFLD & NASH: Diagnosis (NIDDK, NIH) (opens in a new tab) (accessed 2026-10-02)
- NAFLD & NASH: Treatment (NIDDK, NIH) (opens in a new tab) (accessed 2026-10-02)
- Cirrhosis (MedlinePlus, NIH) (opens in a new tab) (accessed 2026-10-02)
- Diagnosed diabetes by state and territory, 2021 (CDC, Preventing Chronic Disease) (opens in a new tab) (accessed 2026-10-02)