Cirrhosis can be suggested in the ultrasound, and if it's not seen, it's an unlikely diagnosis. That said, the most definitively test would indeed by a liver biopsy. But, given the clinical picture, this does not present like a typical cirrhotic patient.
Non-alcoholic fatty liver, or NASH, is best treated with lifestyle changes, including weight loss.
If the diagnosis continues to be non-revealing, another referral can be sought with a GI physician.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin Pho, M.D.
KevinMD.com
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