Routine physical found elevated liver enzymes. follow-up blood work showed lingering hepa antibodies. ultrasound today, and i saw black spots on my liver - waiting for radiology report. thoughts?

Proper workup: The veins in the liver look like black spots on imaging. Hepatitis a antibodies (igg and sometimes igm) can stick around indefinitely after you recover. Ur workup will probably continue with a repeat of the labs off alcohol and rx's, if the transaminases not normalized, there's testing for hepatitis b, c, iron overload, wilson's, autoimmune hepatitis & perhaps in the end an rx for aerobic fitnes.

Likely not related.: These are likely not related as a hep a infection doesn't cause chronic illness. It resolves in 6-12 months with little if any sequelae. It can relapse, and can even have fulminant episodes resulting in death, but these are rare. Your ab's are likely igg, confirming immunity, or igm meaning recent infection, and the spots on your liver might be nonspecific. Check u/s with your dr. To be sure.

Time heals: Unless you have been a heavy alcoholic or have specific liver insults, including morbid obesity, the elevated enzymes could just be temporary. Hepatitis a antibodies are good - they tell you you had it in the past, but not now (that would be antigens). The liver is very resiliant and may recover from a possible temporary viral insult. Look for diabetes and see if the ultrasound points anywhere.

Family practice : I doubt hepatitis a caused a persistent elevation of your liver enzymes. The u/s is to look for gallbladder thickening and stones. Avoid alcohol if you drink. Tylenol (acetaminophen) is metabolized in the liver so avoid that. Wait for the u/s report.

Black spots: You were probably seeing either blood vessels or maybe some cysts. Both of which are nothing to worry about.