If someone has a fatty liver with hepatomegaly(per abdominal ultrasound) with insulin resistance and elevated alt level of 69(but other liver tests,cholesterol, triglycerides are normal) will you order a fibroscan ? or there is usually no need ?

The fibroscan will give you more information about your liver,namely presence of scarring and possibly the extent of the fatty infiltration. However I don't think it will change your treatment but may help in follow-up. I usually left the decision up to the hepatologist or gastroenterologist I consulted on the case in order to give the patient the best care.