Asymptomatic patients with elevated serum transaminases, should be carefully screened for the presence of a significant treatable liver disease such as chronic active hepatitis, liver cirrhosis or hepatocellular carcinoma. Many of these patients might have fatty liver. They should have the following done: Abdominal ultrasound, hepatitis markers rectal snip and liver biopsy, which is very important in diagnosing the etiology of liver disease.