Viral Hepatitis: This is often the first consideration due to its prevalence and the fact that it can cause both an elevation in bilirubin (total and direct) and liver enzymes. Viral hepatitis can lead to inflammation of the liver, which in turn affects the liver's ability to process bilirubin and can cause damage that elevates liver enzymes.

Alcoholic Liver Disease: Chronic alcohol consumption can lead to liver inflammation and damage, resulting in elevated liver enzymes and bilirubin levels. The pattern of enzyme elevation (e.g., AST:ALT ratio) can sometimes help differentiate this from other causes.
Drug-Induced Liver Injury: Various medications and drugs can cause liver damage, leading to elevated liver enzymes and bilirubin. The history of medication use is crucial in diagnosing this condition.
Biliary Obstruction: Obstruction of the bile ducts can cause a buildup of bilirubin (particularly direct/conjugated bilirubin) and elevate liver enzymes. This could be due to gallstones, tumors, or other causes.

Acute Biliary Obstruction due to Gallstones: While included in the biliary obstruction category, it's crucial to identify this quickly due to the potential for severe complications like ascending cholangitis if not promptly treated.
Wilson's Disease: A genetic disorder that leads to copper accumulation in the liver, causing damage. It's rare but can present with elevated liver enzymes and bilirubin, and missing this diagnosis can lead to severe liver damage and other complications.
Autoimmune Hepatitis: An autoimmune condition where the body's immune system attacks liver cells, leading to inflammation and damage. Early diagnosis and treatment are crucial to prevent liver failure.

Budd-Chiari Syndrome: A rare condition caused by obstruction of the hepatic veins, leading to liver enlargement, ascites, and abdominal pain, along with elevated liver enzymes and bilirubin.
Primary Biliary Cholangitis (PBC): A chronic liver disease characterized by progressive destruction of the bile ducts within the liver, leading to cholestasis and, eventually, liver damage.
Primary Sclerosing Cholangitis (PSC): A disease that leads to scarring and narrowing of the bile ducts, causing liver damage and potentially leading to liver failure. It's often associated with inflammatory bowel disease.