Dr Andrew Macdonald

General surgeon
North Melbourne private hospital
86 elm road north Melbourne 3051
RE:Mrs Daniela Starkovic

Drear Dr Andrew,
Thank you for seeing Mrs Starkovic , a 45-year-old patient whose features is consistent
with cholelithiasis.
Initially, Mrs Starkovic presented with epigastric pain which radiated to the right side . It
persisted for one hour . Her past medical history is unremarkable apart from having
migraines .

Last night ,she had a similar episode of pain which was worse than before . It lasted for
two hours and was colicky in nature . She vomited only once and took two aspirin
tablets . Unfortunately , the pain was not relieved . On examination,there was mild
tenderness in the right upper quadrant of her abdomen .Hence, several investigations
were ordered .

Today , her test results revealed ,mildy increased ALP level along with bilirubin trace in
urine and her ultrasound showed small contracted gall bladder with multiple gallstones .
Therefore, a diagnosis of choleithiasis was established .
It would be greatly appreciated ,If you see this patient for further assessment and
possible treatment . In addition,Mrs starkovic probably needs reassurance because she
is convinced that her illness is related to cancer.

Yours sincerely
Doctor