A patient with cholecystitis undergoes laparoscopic surgery and is placed in supine position postoperatively. The patient develops shoulder pain. This is due to which complication?

1. A

   Decreased bowel sounds

2. B

   Referred pain from CO₂ gas irritation

3. C

   Urethral stricture

4. D

   Wound infection

Appeared in: NORCET 10 Mains

Explanation

Listen in Hindi

• Laparoscopic procedures involve insufflating the abdomen with carbon dioxide (CO2) gas to create a working space.
• This gas can remain in the abdomen post-surgery and rise to irritate the diaphragm.
• The phrenic nerve, which innervates the diaphragm, originates from the same spinal segments (C3-C5) as the nerves that supply sensation to the shoulder.
• The brain misinterprets the signal from the irritated diaphragm as pain originating in the shoulder, a phenomenon known as referred pain.
• This is a very common, expected, and temporary side effect following laparoscopic surgery.

Why Other Options Were Wrong

• Option A: Decreased bowel sounds (hypoactive bowel sounds or paralytic ileus) are common after abdominal surgery due to anesthesia and bowel manipulation, but this condition causes abdominal discomfort, distention, and nausea, not referred shoulder pain.
• Option C: A urethral stricture is a narrowing of the urethra, which is a urological issue. It is not a complication related to a cholecystectomy (gallbladder removal).
• Option D: A wound infection typically appears 3 to 6 days after surgery. Its signs are localized to the incision site (redness, warmth, swelling, purulent drainage) and may be accompanied by systemic symptoms like fever, not isolated shoulder pain shortly after the procedure.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Postoperative complications of laparoscopic surgery to guide bedside assessment, documentation, and the next nursing action.
• Nurses must be able to differentiate this common, benign referred pain from more serious causes of shoulder pain, such as a pulmonary embolism or intra-abdominal bleeding.
• Patient education is a key nursing role. Reassuring the patient that this pain is expected and temporary can significantly reduce anxiety and improve their postoperative experience.
• Encouraging early ambulation is a primary nursing intervention to hasten the absorption of CO2 gas and resolve the associated shoulder pain.

How to Approach the Question

• First, analyze the question to identify the key clinical details: the procedure is 'laparoscopic surgery' and the primary symptom is 'shoulder pain' in the postoperative period.
• Next, recall the specific steps and common side effects associated with laparoscopic surgery. The use of CO2 gas for insufflation is a critical piece of knowledge.
• Evaluate each option based on this context. Consider the pathophysiology and typical presentation of each potential complication.
• Eliminate options that are anatomically or chronologically inconsistent. A urethral stricture is unrelated. A wound infection presents later and with different signs. Decreased bowel sounds affect the GI tract, not the shoulder.
• Connect the remaining option to the clinical picture. The CO2 gas used in laparoscopy is known to irritate the diaphragm, and the phrenic nerve refers this irritation as pain to the shoulder. This provides a direct and logical link between the procedure and the symptom.

Concept Tested & Keywords

• Concept Tested: Postoperative complications of laparoscopic surgery
• Stem keywords: cholecystitis, laparoscopic surgery, postoperative, shoulder pain
• Lead-in keywords: due to which complication
• Clinical cues: The combination of 'laparoscopic surgery' and 'shoulder pain' is a classic presentation of referred pain from CO2 insufflation.

Question ID

Q5EoSeCGvCr4A7gklFkclg

Copy ID

Reference Book

E6 Nursing Fundamentals Potter Perry 12e Part 6 p. 200-202

E6 Pathology- ROBBINS & COTRAN PATHOLOGIC BASIS OF DISEASE 10TH Ed p. 876-878