Alt elevated (76, 63) after 2 blood tests and increased parenchymal echogenicity on us. Nafld or nash?

Continue workup. Now would be a great time to get really into aerobic fitness -- this is likely to reverse nash / nafld. You'll get checked for hepatitis c, wilson's, hemochromatosis, autoimmune hepatitis and a few others. Trust you're not taking meds or that they have been ruled out as causing the problems.
Your presumption. Could be right. Get checked for alcohol induced , viral or autoimmune hepatitis. Avoid taking tylenol, (acetaminophen) drinking alcohol. Take care! http://www.mayoclinic.com/health/elevated-liver-enzymes/my00508. http://www.herbalprovider.com/liver-enzymes.html.