High direct bilirubin, indirect bilirubin and total bilirubin but normal ultrasound and normal aminotransferases may be caused by physiological reasons such as strenuous exercise and overwork, but it may also be caused by pathologic reasons such as bilirubin blood abnormalities and extrahepatic diseases. 1. Physiological reasons: in the case of strenuous exercise, overwork, eating a large amount of high-fat food, etc., may also lead to high direct bilirubin, indirect bilirubin, total bilirubin phenomenon, but generally does not have an impact on the function of the liver, so the transaminase is normal. 2. Pathologic causes: (1)Abnormal bilirubin metabolism: Generally, for those who have hemolytic jaundice and decreased ability of liver cells to metabolize bilirubin, direct bilirubin, indirect bilirubin and total bilirubin may be high, but due to the different severity of the disease, for the less severe disease, ultrasound examination may be normal, and aminotransferase may be normal. (2) Extrahepatic diseases: For those who suffer from pancreatic head occupying lesions, cholecystitis, biliary tract malignant tumors, etc., it may also affect the excretion of bile, and it is easy to have high direct bilirubin, indirect bilirubin and bilirubin, and some patients may have normal ultrasound or normal aminotransferases. It is recommended that patients go to the hospital in a timely manner, complete the relevant examinations under the guidance of the doctor, to clarify the cause of the disease, and follow the doctor’s instructions to the cause of the treatment.