Acute Cholecystitis Treatment in Singapore

• Clinical assessment:
  • Medical and Symptom History: Evaluation includes the onset, location, duration, and severity of abdominal pain; its relationship to meals; nausea or vomiting; fever; chills; jaundice; previous gallstone attacks; previous abdominal surgery; medical conditions; medications; and risk factors for gallstone disease.
  • Physical Examination: The clinician assesses the abdomen for right upper-quadrant tenderness, guarding, abdominal distension, fever, and other signs of systemic illness. A positive Murphy-type finding may support the diagnosis when consistent with the overall clinical picture.
  • Laboratory Assessment: Blood tests may include complete blood count, inflammatory markers, liver enzymes, bilirubin, kidney function, electrolytes, and pancreatic enzymes when clinically indicated.
  • Severity and Complication Assessment: Patients are evaluated for systemic inflammatory response, organ dysfunction, sepsis, gallbladder gangrene, perforation, abscess formation, bile-duct obstruction, and pancreatitis.
  • Preoperative Assessment: Patients being considered for surgery may undergo cardiovascular, respiratory, anaesthetic, nutritional, and metabolic assessment, particularly when they are older, have significant comorbidities, or present with severe disease.
• Imaging Tests:
• Abdominal Ultrasound: Usually the initial imaging investigation. It can identify gallstones, gallbladder wall thickening, gallbladder enlargement, pericholecystic fluid, and other findings that support acute cholecystitis.

CT Scan: May be used when ultrasound is inconclusive or when complications such as perforation, abscess, gangrene, or alternative abdominal pathology are suspected.

MRI/MRCP: Magnetic resonance imaging and magnetic resonance cholangiopancreatography may be used when additional assessment of the gallbladder or bile ducts is required.

Hepatobiliary Scintigraphy: A HIDA scan may be considered in selected patients when the diagnosis remains uncertain after clinical assessment and ultrasound.

Endoscopic Ultrasound or ERCP: These may be considered when common bile duct stones or other biliary obstruction is suspected. ERCP can also treat bile duct stones that require removal.

MediRehab (a chain of Rehab centres, part of MediGence) provides comprehensive tele-rehabilitation services designed to support patients with Acute Cholecystitis in singapore. These Services include:

• Early Mobilisation: Walking and gentle movement are generally encouraged after stabilisation or surgery as tolerated to support recovery and reduce complications associated with prolonged inactivity.
• Gradual Activity Progression: Physical activity can usually be increased progressively after laparoscopic or open surgery according to the surgical team's recommendations.
• Postoperative Wound and Pain Management: Patients should follow instructions regarding incision care, pain control, lifting restrictions, and signs of infection after cholecystectomy.

• Medication treatment for acute cholecystitis generally focuses on controlling pain, supporting hydration and correcting electrolyte abnormalities, and treating suspected bacterial infection when indicated. Clinicians may use analgesics such as nonsteroidal anti-inflammatory drugs and other pain medicines based on the patient's condition, while selecting antibiotics based on severity, suspected organisms, local resistance patterns, allergies, kidney function, and institutional protocols.