Acute Pancreatitis: The combination of abdominal pain, elevated lipase (273), and elevated liver enzymes (AST 149, ALT 332) points towards acute pancreatitis, especially given the significant elevation in lipase, which is a more specific marker for pancreatic injury.

Acute Hepatitis: The significant elevation in ALT (332) suggests liver injury, which could be due to viral hepatitis, drug-induced liver injury, or other causes of acute hepatitis. The elevation in AST and total bilirubin (9.3) also supports this diagnosis.
Gallstone Pancreatitis: Given the elevated liver enzymes and lipase, gallstone pancreatitis is a possible diagnosis, especially if there are gallstones obstructing the ampulla of Vater, leading to pancreatic enzyme elevation.
Biliary Colic or Cholecystitis: The abdominal pain and elevated liver enzymes could also suggest biliary colic or cholecystitis, particularly if there is evidence of gallbladder disease.

Budd-Chiari Syndrome: Although less likely, Budd-Chiari syndrome (hepatic vein thrombosis) could present with abdominal pain and elevated liver enzymes. It's a critical diagnosis not to miss due to its high mortality if untreated.
Hepatic Artery Thrombosis: In patients with risk factors (e.g., recent liver transplant), hepatic artery thrombosis could present similarly and is a diagnosis that would be catastrophic if missed.
Sphincter of Oddi Dysfunction: This condition can mimic pancreatitis or biliary colic and is important to consider, especially in patients with recurrent episodes of abdominal pain.

Autoimmune Hepatitis: Although rare, autoimmune hepatitis could present with elevated liver enzymes and should be considered, especially if other causes are ruled out.
Wilson's Disease: A rare genetic disorder leading to copper accumulation in the liver, which can cause liver enzyme elevation and abdominal pain.
Alpha-1 Antitrypsin Deficiency: A genetic disorder that can lead to liver disease and pancreatitis, presenting with elevated liver enzymes and abdominal pain.