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The Symptoms of Elevated Liver Enzymes, Right Side Pain and Fatigue

author image Cheryl Orr
Cheryl Orr is a board-certified anesthesiologist who began writing professionally in 2010. She has been published in "Anesthesiology" and the "Journal of Clinical Anesthesia." She authored "General Anesthesia for Trauma" in the reference text "TRAUMA: Emergency Resuscitation, Perioperative Anesthesia, Surgical Management," published in 2007. Orr earned her medical degree from the University of Pittsburgh.
The Symptoms of Elevated Liver Enzymes, Right Side Pain and Fatigue
Right upper quadrant abdominal pain usually originates in the gallbladder or liver.

Health care workers mentally divide the abdomen into quadrants to localize complaints of abdominal pain. The organs and structures contained in each quadrant can cause regional or generalized abdominal pain and give the first clues about the origin of abdominal illnesses. The right side of your abdomen contains your liver, gallbladder and parts of your intestines, including the appendix. The triad of right-sided abdominal pain, elevated liver enzymes and fatigue, narrows the list of possible causes to those organs in the right-upper quadrant of the abdomen. The most likely sources of such symptoms include your liver and gallbladder.

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Obstructive Cholelithiasis

The pear-shaped gallbladder sits just under the liver in the right-upper quadrant of the abdomen. Gallstones form in 35 percent of women and 20 percent of men before age 75, reports the medical reference, "Textbook of Family Medicine."

If you have stones in your gallbladder, you may remain asymptomatic, but sometimes the stones block the duct that leads from the gallbladder and liver into the intestine. This condition, called "obstructive cholelithiasis," produces pain because the gallbladder becomes inflamed and irritates the sensitive lining of the abdominal cavity or surrounding structures. Liver enzymes, measured in the blood, start to rise as the liver becomes inflamed and the liver cells suffer damage. Fatigue commonly occurs when the body faces the stress of inflammation. Jaundice, a less common finding, results from severe or ongoing liver involvement.

Viral Hepatitis

The hepatitis viruses cause inflammation and damage to the cells of the liver. A burning, right-sided abdominal pain accompanied by elevated liver enzymes and fatigue present as common complaints of the infectious hepatitis illnesses.

Contaminated food or water causes infection with hepatitis A, although transmission also occurs through contact with bodily fluids. Hepatitis B and C spread through sexual or other close contact, involving the exchange of bodily fluids, as does hepatitis D. Hepatitis E spreads by the gastrointestinal route through fecal-oral contamination.

Fatty Liver

Non-alcoholic fatty liver disease refers to a condition of fat accumulation in the liver. The American Liver Foundation explains that risk factors for fatty liver, and for progression to the more serious non-alcoholic steatohepatitis, include obesity, high cholesterol and diabetes.

The accumulated fat enlarges the liver, damages liver cells and stretches the liver's sensitive capsule. Abdominal pain on the right side of the abdomen, elevated liver enzymes and fatigue present along with nausea, weakness and jaundice.


Cancers of the liver or gallbladder also cause elevated liver enzymes, pain in the right-upper quadrant and the non-specific finding of fatigue.

Liver cancer occurs more often in people who have a history of hepatitis or cirrhosis. The more rare gallbladder cancer often remains undetected until it has progressed and spread, leading to a poor prognosis.

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