High total and direct bilirubin may be caused by obstructive jaundice, other diseases and so on. 1. Obstructive jaundice: bile duct stones are a common cause of elevated total and direct bilirubin, with common bile duct stones and common hepatic duct stones being more common. 2. Other diseases: for example, malignant tumors, such as pancreatic head cancer, cancer of the lower part of the common bile duct and duodenal papilloma, may lead to elevation of total bilirubin and direct bilirubin. Normally direct bilirubin passes through the bile duct into the intestines and out of the body; however, biliary obstruction can cause direct bilirubin to flow back into the bloodstream, resulting in elevated direct bilirubin. There are many other reasons for elevated total and direct bilirubin, and it is recommended that patients seek medical attention to determine the cause of the disease and standardize treatment to avoid delays.