Surgical Registrar

via Emergency Department

Perth General Hospital
268 Brisbane Rd
Cottesloe 6542
Western Australia

20/10/17

Dear Doctor,
Re: Mr. Ammar Mostafawy DOB:15/01/1961

I am writing to refer Mr. Moustafawy, a 57-year-old male who is a process technician in a

copper mine in the Pilbara region. I suspect he is suffering from liver abscess which requires
your urgent attention and management.

Mr. Moustafawy works on rotation and returned from the Philippines 2 weeks ago. He is a
heavy smoker and heavy drinker but he exercises regularly. Apart from a history of typhoid
fever 8 years ago, he has no significant medical or family history.

Initially, he presented to me 2 days ago because he had not been feeling well and had felt a
sense of weakness and nausea over the previous 3 days. He had stopped drinking and reduced
smoking markedly one week ago. His examination was otherwise normal except for tenderness
over the right hypochondrium. Therefore, blood and urine tests were ordered and he was
prescribed vitamin B and essential forte and advised to increase carbohydrates intake.

Unfortunately, his condition deteriorated over the next 2 days. Today, he is dehydrated, jaundiced
and febrile with chills and rigors. His temperature reached 39°C and his liver is enlarged and
tender as well. His blood test showed leukocytosis and deranged liver functions in addition to
increased urobilinogenin the urine test. The Flying Doctors Agency was contacted and through
their ultra sound machine a 10x10 cm liver abscess could be diagnosed.

I started him on intravenous fluids and antibiotics (Rocephine and Flagyl) and arrangements
were made to evacuate him by the Flying Doctors to your centre.

I would appreciate your urgent attention to his condition as I believe he will need uItrasound-
guided drainage.

Yours Sincerely,

Dr. Peter Smith (GP)