For most games, saving is done at particular checkpoints so that you don’t notice the discrepancies and they mostly just load the world from those checkpoints the exact same as if it were a completely new level, make any story-related changes (like one other poster said, the game keeps track of flags and variables), reload your inventory, etc. But by and large most games don’t ‘save’ every single little detail and reload essentially as much of a blank slate world as they can get away with.
Bethesda games on the other hand, have the world as-is from your disk drive as a starting point, and then when you save they record all the *differences* between your current world state and the world’s on-disk state that you got from steam or a CD or whatever. Then when you reload the game, they load the world from disk, then apply each of those *differences* one-by-one. This is part of the reason they’re so easy to corrupt, but also, the worlds are gigabytes in size, you don’t want to also have gigabytes of save files as well, so just keeping track of just the differences is an easy way to store that fully dynamic save data.
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