Noticing yellowing of the eyes or being told that your bilirubin level is high can understandably cause concern. You may wonder whether it means liver disease, hepatitis, gallstones, or something more serious.
The good news is that high bilirubin has several possible causes, and not all of them indicate permanent liver damage. Bilirubin is a yellow substance produced when old red blood cells are broken down. Your liver normally processes it and helps remove it from the body through bile.
When bilirubin builds up in the blood, the skin or whites of the eyes may become yellow. The right evaluation can help identify why this is happening and whether treatment is needed.
Bilirubin is a waste product formed naturally when red blood cells reach the end of their normal lifespan. It travels to the liver, where it is processed and eventually eliminated through bile and the digestive system.
A blood test may measure:
The pattern of these results, together with other liver blood tests and your symptoms, can provide important clues about the underlying cause.
Yellowing of the whites of the eyes, known as jaundice, occurs when bilirubin levels become high enough to accumulate in body tissues.
Jaundice may also cause the skin to look yellow. Some people notice other changes, such as dark urine, pale stools or itching.
However, yellow eyes do not automatically mean that the liver has failed. Jaundice can develop because of problems occurring before bilirubin reaches the liver, within the liver itself, or after bile leaves the liver.
Doctors generally consider several broad categories when investigating elevated bilirubin.
Sometimes the body breaks down red blood cells faster than usual. This can produce more bilirubin than the liver can process efficiently.
This may occur with certain types of anaemia, blood disorders, or increased red blood cell destruction. Blood tests can help determine whether this is contributing to the elevated bilirubin.
The liver plays a central role in processing bilirubin. Conditions affecting liver cells can therefore cause bilirubin to rise.
Possible causes include:
Importantly, bilirubin should not be interpreted on its own. Results such as ALT, AST, GGT, ALP and albumin can provide additional information about liver health.
Bilirubin leaves the liver through the bile ducts. If bile flow becomes blocked or restricted, bilirubin can accumulate in the blood.
Possible causes include:
When bile flow is affected, jaundice may occur together with dark urine, pale stools, itching or pain in the upper abdomen.
In some otherwise healthy people, a mildly elevated bilirubin level is caused by Gilbert syndrome. This is a common inherited condition in which the liver processes bilirubin somewhat more slowly.
People with Gilbert syndrome may have occasional mild yellowing of the eyes, particularly during periods of fasting, dehydration, illness, stress, or lack of sleep.
Gilbert syndrome usually does not cause serious liver damage. However, a healthcare professional should confirm the diagnosis rather than assuming that every mild bilirubin elevation is due to Gilbert syndrome.
A bilirubin result becomes much more useful when interpreted alongside other tests.
| Test | What It May Help Assess |
|---|---|
| ALT | Injury or inflammation affecting liver cells |
| AST | Liver cell injury, although it can also be affected by other tissues |
| ALP | Possible problems involving bile flow, among other causes |
| GGT | Can provide additional information about the liver and bile ducts |
| Albumin | Helps assess the liver's ability to produce certain proteins |
No single blood test can provide a complete picture of liver health. The results need to be interpreted together with your symptoms, medical history, and examination.
If bilirubin is elevated or you have jaundice, the next step depends on the pattern of your blood tests and your symptoms.
Your doctor may repeat bilirubin testing and request direct and indirect bilirubin measurements. Additional liver function tests and a complete blood count may also be useful.
If liver inflammation is suspected, blood tests for hepatitis A, hepatitis B, or hepatitis C may be recommended depending on your circumstances.
An abdominal ultrasound is commonly used to look at the liver, gallbladder, and bile ducts. It may help identify gallstones, changes in the liver, or evidence suggesting impaired bile flow.
Depending on the findings, additional imaging may sometimes be needed.
If the cause remains unclear or there is concern about a bile duct problem, your specialist may recommend additional imaging or procedures. The appropriate test depends on what the initial results show.
No. Elevated bilirubin can occur for reasons that do not involve permanent liver damage.
For example, Gilbert syndrome can cause mild bilirubin elevation without significant liver injury. Bilirubin can also rise temporarily during certain illnesses or when red blood cells are being broken down more rapidly.
On the other hand, persistent or significantly elevated bilirubin, particularly when accompanied by abnormal liver tests or other symptoms, deserves medical assessment.
Yellow eyes or skin should not be ignored, particularly when the cause is not already known.
Seek prompt medical assessment if jaundice occurs with:
These symptoms can sometimes indicate a liver, gallbladder, bile duct, or pancreatic problem that requires timely evaluation.
Some causes of elevated bilirubin produce few or no symptoms. This is why an abnormal blood test should be interpreted rather than dismissed simply because you feel healthy.
If the elevation is mild and the rest of your blood tests are reassuring, your doctor may recommend monitoring or a limited number of additional tests. If several liver or bile-related results are abnormal, a more detailed evaluation may be appropriate.