Brief Answer: Rule out hepatitis Detailed Answer: Dear XXXXXXX Thanks for the query. With symptoms of discrete right upper quadrant pain and elevated liver enzymes, it is likely that it is related to liver inflammation, the cause is not clear and there are several possibilities. First, infections need to be ruled out, particularly Hepatitis B and C. Second, all liver offending medications, particularly acetaminophen, should be discontinued. Third, alcohol has to be discontinued, as it inflammes the liver. Fourth, the most common cause of elevated liver enzymes in a middle aged adult is non alcoholic steatohepatitis, or fatty liver infltration, which is a consequence of bad eating habits, lack of exercise and developing overweight or obesity. A liver ultrasound can be quite useful to see if there is fat deposited in the liver. If fatty liver seems to be the cause, then abstaining from all liver toxins, regular exercise and weight loss of around 8-10% of total body weight are the keys to success; serial liver tests should be followed. Vitamin E supplementation is also useful if fatty liver is the cause. Hope this helps, wish you the best, Dr Brenes-Salazar MD Mayo Clinic

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