Ultrasound report says echogenic liver with fatty infiltration. what does this mean? what do i need to do?

This is essentially: fat deposition throughout the liver tissue. There are numerous potential causes, for example obesity and certain medications(e.g. Steroids). Sometimes there is no identifiable cause(idiopathic) . It is generally a benign and potentially reversible condition. Speak with your doctor about potential etiologies in your case, and next steps.