Re: what could cause your bilirubin to be high 25
One thing that all patients presenting to a physician need to know is that doctors don't diagnose people based on the symptoms alone. This often frustrates patients because they will ask, "Well, my stomach is hurting, why can't you tell me what's wrong?" The reason is because many symptoms and signs people experience are NOT specific, meaning that for any given symptom you can have SCORES of different possibilities. So for example fevers/chills/sweats in one patient might end up being pneumonia while the exact same symptoms in another patient might be lymphoma.
Keeping that in mind, you can imagine that a bilirubin of 25 can have a LOT of different explanations. First of all, 25 isn't all that high, but it is something that needs to be investigated. Because there are so many different possibilities, the doctor's first step will be to focus on the most common and most important ones first and do tests to try to rule these in or out. Once the first line of testing is done, there is not a satisfactory explanation, then more testing will be done. This leads to the second thing that frustrates patients. After even two or three rounds of testing, a cause isn't found. This is when the doctor says I'm not sure what's causing the problem, but I know from my previous testing it is NOT something that is life-threatening or serious at this point in time, and we will watch you clinically. This often prompts patients to go and see three or four different doctors who often tell you the same thing.
Whether a bilirubin of 25 is significant requires a full history and physical to be done including your age, past/present/treated/untreated medical problems, risk factors for liver disease (e.g. alcohol intake), medications, allergies, etc. etc. Once that is done, one has to testing. The best first step is to do a FRACTIONATED bilirubin which takes the total bilirubin and divides it in to indirect and direct bilirubin. In general, a predominantly high DIRECT bilirubin tends to suggest the liver's FUNCTION is fine, but there is a blockage somewhere (e.g. a stone) which is not allowing the bilirubin to get in to the system properly or there is no blockage but the bile is STAYING in the liver and not getting out. INDIRECT bilirubin which is high is a more complicated matter and it either means the liver is having trouble doing its job, or else there is a secondary process unrelated to the liver causing the bili to be high.
The most common cause of high DIRECT bilirubin is a gallstone. It's hard to say what the most common reason for high INDIRECT bilirubin is, but it's probably a harmless condition known as Gilbert's disease.
In your case, the doctor will do a number of blood tests including fractionated bilirubin, an abdominal ultrasound and some other blood tests to look for common causes of liver disease such as Hepatitis B/C, Hemochromatosis and also take a history of your alcohol use and medications.