Surgical Register

Emergency Department
Perth General Hospital
268 Brisbane Rd Cottesloe
Western Australia
6542

20 October 2017

Dear Doctor,

Re: Mr. Ammar Moustafawy, 56 years of age

I am writing to refer Mr. Ammar Moustafawy, a 56-year-old technician, who is presenting with signs and
symptoms of liver abscess. Your urgent assessment and management would be highly appreciated.

Mr. Moustafaway works on routine and returns from Phillipines for the past two weeks. He is a heavy
smoker and a heavy drinker.

On 18/10/17, he presented to me with a complaint of feeling unwell, loss of appetite and lack of energy
along with nausea which started 3 weeks before. On examination, there was tender at the right
hypochondrium with no organomegaly. Therefore, he was advised to increase carbohydrate diet and
vitamin B complex and essential forte capsules were prescribed. Additionally, blood, urine and stool
tests were ordered.

On today’s visit, his condition has worsened with chills and rigors along with darker urine. His
temperature was 39C along with jaundiced and dehydrated. Examination revealed tender and palpable
liver with no ascites. His investigations revealed that there was increased urobilinogen in urine test and
increased serum bilirubin along with leukocytosis and deranged liver enzymes. Therefore, he was given
IV fluids, Rocephin and Flagyl and Flying Doctor Service was contacted. The ultrasound result showed
enlarged liver with cystic lesion in the right lobe of the liver.

In view of the above, Mr. Moustafaway needs to be referred to an emergency department for urgent
assessment including ultrasound guided drainage.

I would be grateful if you could take over his care.

Yours sincerely,

Dr. Kay