Dr Dev Desai
Gastroenterologist
City Hospital
Easton
30th August 2019
Dear Dr Desai,
Re: Mr Adam Knowles
DOB: 22/08/1951
Thank you for seeing Mr Adam Knowles, a 68-year-old married man, who is a retired management
consultant, with clinical features suggestive of pancreatic malignancy. I am urgently referring him
for further assessment and management regarding an endoscopy.
Mr Knowles was diagnosed with depression four years ago, for which he takes uoxetine. He is a
social drinker and has ceased smoking for ten years.
Mr Knowles presented to the clinic on 02/08/2019 with heartburn and indigestion, which were not
improved by the over-the-counter antacids. He expressed his concerned regarding possible
hernia. Physical examination revealed normal. Omeprazole 20 mg twice daily for eight weeks was
therefore prescribed.
Today, Mr Knowles developed back pain, diarrhoea, pale stools and fatigue. His re ux symptoms
still noted. Additionally, he lost 2 kgs in four weeks. Examination showed icteric scleraes, jaundice
and slightly abdominal distension with tenderness. Blood samples revealed elevated bilirubin
levels, amylase levels, albumin levels, and slightly increased ALT and alkaline phosphatase. The
possible of pancreatic malignancy has been discussed.
In light of the above, it would be greatly appreciated if you could provide further assessment and
endoscopy.
If you have any questions, please do not hesitate to contact me.
Yours sincerely,
Doctor
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