I have a pain in my right side. I had an ultrasound done and everything appeared normal. The only thing that they saw in the blood work was that the liver enzymes were slightly elevated. They suggested that this could be hepatitis, even though I was vaccinated against hepatitis about four years ago because of a college project. The doctor said that the vaccine should still be in effect. What else could it be?

Sheba

In evaluating the pain in your right side, many factors associated with this pain are important. If I were your gastroenterologist, I would want to know: How long has the pain been present? How often does it occur? What does it feel like -- a sharp pain or a dull ache? How long do your painful episodes last? Are there other symptoms, such as fever, nausea or vomiting? Is the pain associated with meals? I would also need to know your age and medical history, including the medications you are taking. Elevated liver enzymes can be due to a myriad of causes. In association with episodic right-sided or upper abdominal pain, they often indicate gallbladder disease (gallstones). You've had an ultrasound, which you say was normal. Specifically, it would be important to know if stones and/or sludge (gravel) were found in your gallbladder on this test.

Other common causes of elevated liver enzymes are inflammation in the liver due to medications and hepatitis. You and your doctor should review the medications that you take.

In regard to hepatitis, the types most commonly found in the United States are caused by viruses. The hepatitis C virus is transmitted via blood or sexual contact. Before a test for this virus became available in the 1980s, it was the most common virus acquired from blood transfusions. Other people at risk for hepatitis C infection include intravenous drug users who share needles, those who engage in unprotected sex with multiple partners, those who have tattoos performed using unsterilized equipment, and health-care workers stuck by hepatitis C-contaminated needles.

You were probably vaccinated against either hepatitis A or B. If your vaccination was effective and you still have adequate levels of antibodies against the virus, you should not contract this type of hepatitis. In general, hepatitis B has the same mode of transmission as hepatitis C, while hepatitis A is acquired from infected water sources or by direct contact with recently infected people.

There are many other causes for elevated liver enzymes, and your doctor can decide what follow-up tests to perform to find out the cause in your specific case.