Patient description: A 54-year-old obese woman admitted to the emergency department with abdominal pain that started 4 days ago with nausea and vomiting. The epigastric pain radiates to the right upper quadrant, getting worse after eating fatty food. The patient experienced similar pain twice in the past year. Her past medical history is remarkable for hypercholesterolemia and 2 NVDs. She has 2 children, and she is menopausal. She does not smoke, drink alcohol, or use illicit drugs. She is mildly febrile. Her BP is 150/85, HR 115, RR 15, T 38.2, SpO2 98% on RA. She is an obese woman with no acute distress. On palpation, she experiences epigastric tenderness and tenderness in the right upper quadrant without rebound. Bowel sounds are normal. Laboratory analysis is remarkable for elevated ESR and leukocytosis with a left shift. The ultrasound revealed several gallstones, biliary sludge and CBD stones. The smallest stone is 14mm.

Clinical trial eligibility criteria: eligible ages (years): 18.0-70.0,  Non-alcoholic Fatty Liver Disease (NAFLD) NAFLD patients: 1. "Presence of NAFLD": This will be defined by the presence of at least two of the following (a) suggestion of liver fat by an imaging study (ultrasound, CT scan, MRI or MR spectroscopy) performed in the 6 months prior to enrollment; (b) elevated aminotransferase levels (ALT > 31 U/L for men or > 19 U/L for women, or AST > 30 U/L) on at least two occasions in the 6 months preceding enrollment; and (c) presence of the metabolic syndrome, defined according to the modified AHA/NCEP criteria. Biopsies are not required; however, previous biopsy done within the 6 months prior to the initiation of the study will be considered diagnostic if typical findings of NAFLD are described and other causes of liver disease are ruled out; 2. Individuals who are 18-70 years old; 3. Written informed consent  Serum ALT > 3 times ULN at baseline. 2. Evidence of another form of liver disease including viral hepatitis, autoimmune hepatitis, cholestatic liver disease, Wilson's disease, Alpha-1-antitrypsin deficiency, hemochromatosis or DILI. 3. History of excess alcohol ingestion, averaging more than 30 gm/day (3 drinks per day) in the previous 10 years, or history of alcohol intake averaging greater than 10 gm/day (1 drink per day: 7 drinks per week) in the previous one year. 4. Evidence of liver cirrhosis on labs or imaging. 5. History of gastrointestinal bypass surgery or ingestion of drugs known to produce hepatic steatosis in the previous 6 months. 6. Significant systemic or major illnesses other than liver disease. 7. Positive test for anti-HIV. 8. Active substance abuse. 9. Pregnancy or inability to practice adequate contraception in women of childbearing potential 10. Evidence of hepatocellular carcinoma. 11. Any other condition which, in the opinion of the investigators, would impede competence or compliance. 12. Serum creatinine >1.5 mg/dl. 13. Starting medications that have been shown to cause drug induced liver injury (eg, augmentin, statins.) within one month prior to enrollment. Medications that have been known to cause DILI but have taken for more than one month prior to enrollment (such as statins) should not be an exclusion. Healthy Controls: 1. Individuals who are 18-70 years old 2. Normal Liver enzymes 3. Negative hepatitis B surface antigen, and hepatitis C antibody 4. BMI (18.5 9) kg/m2 5. Written informed consent Presence of the metabolic syndrome, defined according to the modified AHA/NCEP 2. Taking concomitant medications