Which cause may be responsible for pain radiating to the right shoulder after a cholecystectomy? Select all that apply. One, some, or all responses may be correct. $$ \square $$ Myocardial infarction $$ \square $$ Pericarditis after surgery $$ \square $$ Gallstone left accidentally $$ \square $$ Irritation of the phrenic nerve $$ \square $$ Carbon dioxide used in surgery

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After a cholecystectomy, pain radiating to the right shoulder can be attributed to several factors. Let's evaluate each of the provided options:

1. **Myocardial Infarction**: While a myocardial infarction (heart attack) can cause shoulder pain, it typically affects the left shoulder. Right shoulder pain is less common but not impossible. However, in the context of a recent cholecystectomy, this is not the most directly related cause.

2. **Pericarditis After Surgery**: Pericarditis involves inflammation of the pericardium (the sac surrounding the heart) and can cause referred shoulder pain. Although it's a possible complication, it's relatively uncommon after a cholecystectomy.

3. **Gallstone Left Accidentally**: A retained gallstone can lead to abdominal pain and complications, but it does not typically cause referred pain to the right shoulder.

4. **Irritation of the Phrenic Nerve**: This is a well-recognized cause of referred right shoulder pain. The phrenic nerve innervates the diaphragm, and its irritation can lead to shoulder pain, a phenomenon known as Kehr's sign.

5. **Carbon Dioxide Used in Surgery**: During laparoscopic surgeries like cholecystectomy, carbon dioxide gas is used to inflate the abdomen. Excess gas can irritate the diaphragm, leading to referred pain in the right shoulder.

**Correct Answers:**
- □ Irritation of the phrenic nerve
- □ Carbon dioxide used in surgery

**Summary:**
Pain radiating to the right shoulder after a cholecystectomy is most commonly due to irritation of the phrenic nerve and the use of carbon dioxide gas during surgery. While other factors like myocardial infarction and pericarditis are possible, they are less directly related to the surgical procedure itself.

**Selected Options:**
- □ Irritation of the phrenic nerve
- □ Carbon dioxide used in surgery
Pain radiating to the right shoulder after a cholecystectomy is most likely caused by irritation of the phrenic nerve and the use of carbon dioxide gas during surgery.

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