Hi, How are you? Where are you writing from? A raised ALT and AST level indicates that liver cells are undergoing some sort of injury. Fatty liver can be caused by excessive alcohol intake (Alcoholic steato hepatitis, ASH) or due to excessive fatty food intake and sedentary life style (Non-alcoholic steato hepatitis, NASH). ASH is usually the beginning stages of alcohol induced liver damage and is completely reversible if the patient refrains from alcohol. NASH is being much more commonly diagnosed currently owing to poor dietary habits and sedentary life styles of people. High caloric intake, high fatty food intake and poor exercise regimens lead to deposition of fat goblets in the liver tissue leading to fatty liver (which shows up as increased echo texture on USG). This is also completely reversible in the initial stages if caloric intake is limited and exercise regimens are adhered to. If left un-checked, patients usually become obese, diabetic and in final stages may lead to cirrhosis of the liver which will necessitate a liver transplant. Paradoxically one of the other main causes of fatty liver is rapid weight loss . Also pregnancy could exacerbate it. None of the 5 things you ve stated normally cause raised ALT levels but an over dose of pain killers esp tylenol and some other NSAID s can potentially cause a reversible raise in ALT levels. So you should probably be off the painkiller for a couple of days before the liver panel. I would suggest a healthy diet and exercise regimen also. Although there is no time limit on when to get a repeat scan, I would suggest one, once you have succeeded in losing some weight. Hope this helped and please do not hesitate to contact me for further details - rxsuresh@gmail.com