If you had beginning cirrhosis from fatty liver from being obese would your blood work be completely normal and ultrasound only show fatty liver?

Not likely: Most likely, the liver enzymes would be elevated in the blood (alt and ast).

Fatty liver : Hepatosteatosis (fatty liver) in early stages would not show any changes in the blood though the ultrasound would show fatty changes. In later stages (stage 3/4) you may have some elevated liver enzymes secondary to onset of cirrhosis. Weight loss is the only cure for early disease.

Yes: Fatty liver is associated with obesity and prediabetes. In my practice i will approach this as a serious predictor of future health issues beyond the liver and will work with patients to change lifestyle and diet. Fatty liver does lead to cirrhosis and that can cause other issues. Early in the disease the liver enzymes in the blood can be normal although you may have ultrasound changes.