High direct bilirubin is not always the result of disease. It may also occur if alcohol was consumed prior to the liver function test. The patient does not necessarily have clinical symptoms and the ultrasound examination of the liver is normal at this time. Moreover, high direct bilirubin Dbil and normal total bilirubin Tbil indicate that the indirect bilirubin is normal at this time, which is most likely caused by impaired bilirubin excretion and is related to bile duct obstruction. In the early stages of these diseases, it is possible to have high direct bilirubin and normal total bilirubin, such as cholelithiasis or even bile duct cancer. As the disease progresses, the direct bilirubin will increase significantly when the obstruction worsens, and the total bilirubin will also rise gradually. In addition, after biliary tract surgery, direct bilirubin may also appear mildly elevated, and if it is reviewed regularly, it can also be found that direct bilirubin will gradually decrease and return to normal, which is a normal phenomenon after surgery, such as patients after cholecystectomy. In addition, slightly elevated Tbil and Dbil are often found in normal people during physical examinations, and may also be indicative of somatic liver dysfunction jaundice, also known as Gilbert’s syndrome. The user’s medical history should be pursued in detail, and previous liver function test reports should be asked if transaminases and ALP and GGT are normal. In general, without a history of alcohol consumption, obvious liver damage, hepatitis, liver disease, etc., and a mildly fluctuating long-term elevation of bilirubin, the condition is considered to be constitutional hepatic dysfunctional jaundice (Gilbert’s syndrome), which generally does not require treatment, mainly to avoid bad lifestyle habits and disease factors, and dynamic follow-up can be observed.