QQ.MW.1502. Mr Adam Knowles – Pancreatic Malignancy – Dr Mohaad Said Nouh - Submission - Electronic - Original

Dr Dev Desai
Gastroenterologist
City Hospital
Easton

30 August 2019

Dear Dr Desai,
Re: Mr Adam Knowles, DOB: 22 August 1951

I am writing to urgently refer Mr Knowles, a 68-year- old retired male, whose symptoms are suggestive of pancreatic malignancy for a further assessment.

Mr Knowles initially presented on 02 August 2019 with symptoms of dyspepsia which was not responsive to over-the-counter antacids. Examination was normal. He was initiated on omeprazole (20mg) twice daily for eight weeks.
On today’s review, Mr Knowles has developed diarrhoea, pale stool, abdominal pain, along with back pain, fatigue and weight loss of two Kg. Clinically, he has Jaundice and his abdomen was tender and slightly swollen. Pathology report revealed abnormal liver functions tests and elevated amylase.

Regarding Mr Knowles’ social history, he does not smoke for the past ten years and drinks socially. He is physically active and he had cholecystectomy in 2008.

I would greatly appreciate if you could evaluate Mr Knowles and provide a specific diagnosis. Please consider doing endoscopy if appropriate.

Please note that, a discussion about the tests results and the possible diagnosis was discussed with Mr Knowles. Should you require more information, please feel free to contact me.

Yours sincerely,
Doctor