Background: Non-alcoholic hepatic steatosis disease (NAHSD) is increasingly recognized as a major global health concern, particularly due to its silent progression and significant impact on quality of life. The prevalence of NAHSD is particularly high in regions with widespread obesity and diabetes, conditions that are escalating in global incidence. Objective: This study aimed to evaluate the prevalence and severity of NAHSD and its association with hepatomegaly using ultrasonography in a Pakistani adult population. Methods: A cross-sectional study was conducted from November 2023 to March 2024 at the Department of Radiology, District Head Quarter’s Hospital, Swabi, Pakistan. A total of 70 adults presenting with clinical manifestations of hepatomegaly were enrolled. Ultrasonography was performed using a Toshiba Doppler machine equipped with a convex transducer (2.5—5.0 MH frequency). Liver size, shape, and echogenicity were assessed, and hepatic parenchyma was graded into three categories based on echogenicity. Data were analyzed using SPSS version 25, focusing on descriptive and inferential statistics. Results: The study comprised 41 females (58.6%) and 29 males (41.4%), with an age range from 19 to 69 years (mean age 43.79 ± 11.583 years). Hepatic steatosis was graded as mild in 20% (14), moderate in 5.7% (4), and severe in 1.4% (1) of patients with hepatomegaly. The majority, 72.9% (51), showed no signs of hepatic steatosis. Hepatomegaly was noted in 27% of patients (19). Conclusion: Ultrasonography is an effective diagnostic tool for assessing NAHSD and hepatomegaly, revealing a significant prevalence of these conditions among the studied population. Early screening and intervention are critical to managing and reducing the healthcare burden associated with NAHSD.