Total bile acids (TBA on the lab test) are synthesized in the liver and combined with taurine or glycine to become conjugated bile acids, which are then secreted by the liver cells into the bile, and then with the bile to the intestine, where they are hydrolyzed into free bile acids by the action of bacteria in the intestine. Therefore, TBA can reflect the condition of the liver, and the total serum bile acid (TBA) in a normal person is <10 μmol/L. What are the causes of increased total bile acid? An increase in total bile acids can be classified as physiological or pathological. Physiological increases tend to appear as a mild increase that is transient after a meal and usually returns to normal within a certain period of time after eating. There are many reasons for pathological increase: various liver damage, liver failure and liver diseases such as liver cancer, cirrhosis, acute jaundiced hepatitis, chronic liver disease and drug-induced liver damage, as well as biliary obstruction, pyloric insufficiency and portal shunt conditions can cause pathological increase in total bile acids. As can be seen, there are many causes of elevated total bile acids, and patients need to be examined to determine the true cause.