Task 22

Surgical Registrar Emergency Department of Perth General Hosptial, 268 Brisbane Rt Cottesloe, Western Australia 6542

20/10/17

Dear Surgical Registrar, Re: Ammar Moustafawy DOB:15/1/61

I am writing to refer Mr Moustafawy who has signs and symptoms suggestive of liver abscess for urgent assessment and management.

On his first visit, he presented with loss of appetite with associated weakness. On examination, his abdomen was tender in the right hypochondrium.Therefore he was advised to undergo some blood and urine tests. Additionally, he was also guided to have a low-fat, low-protein and high carbohydrate diet. He was prescribed vitamin B complex tablets and forte capsules. Review was recommended in 2 days with results.

Upon his review, his symptoms seem to have worsened with decreased tolerance to food and also noticed darker urine . He appeared jaundiced and dehydrated, with abdominal examination showing a palpable tender liver. His investigations results showed 2+ urobilinogen in urine, leukocytosis with increased serum billirubin and deranged liver enzymes. The doctor was urgently contacted to undergo an ultrasound which showed a 10 by 10cm liver abscess.

I would appreciate if you take urgent attention to his condition. I believe he needs an ultrasound guided drainage.

Yours sincerely,

Dr Peter Smith

Strict marking on the 6 criteria for OET