Mild elevations of liver enzymes can occur after surgery, particularly upper abdominal procedures.
Elevations that are less than two times the upper limit of normal are frequently transient and do not require investigation.
More severe elevations suggest hepatocellular injury, which can result from a number of causes, including hypoxemia, viral or bacterial insult, trauma, and chemical toxicity (Table 45-9: Causes of Potoperative Liver Dysfunction).
The nature and site of the surgical procedure is an important risk factor for postoperative liver failure (e.g., abdominal surgery appears to reduce hepatic blood flow significantly).
Cardiac surgery in patients with cirrhosis is not well tolerated. Cardiopulmonary bypass exacerbates pre-existing hepatic disease by unknown mechanisms.