Dr.

S Leyshon
Emergency Department Medical Officer
PA hospital Wooloonabba

24 August 2019

Dear Dr. Leyshon,

Re: Mr. Brian Morgan, DOB: 02/02/96

I am writing to refer Mr. Morgan, a 23-year-old university student, who presented with signs and
symptoms of the possibility of acute appendicitis. Your urgent assessment would be highly appreciated.

On 23/08/19, Mr. Morgan presented with a 24-hour history of central abdominal pain and cramp
associated with nausea and several loose bowel motions. On examination, generalized central
abdominal tenderness was observed. Therefore, he was advised to take a rest, plenty of fluid, and
analgesics.

On today’s visit, Mr. Morgan’s abdominal pain was reported to worsen with vomiting several times. On
examination, there was a slight flushed abdomen and tenderness at the right side of the abdomen with
mild guarding. Therefore, maxolon 10mg was prescribed and blood tests were ordered. In the
afternoon, his condition has worsened and his pain was radiated to the right iliac fossa. On assessment,
his temperature was 38.8C and his blood pressure was high at 140/90 mmHg. On examination, there
was localized tenderness at the right iliac fossa and rebound tenderness. Also, his bowel sounds were
diminished. Regarding his blood test results, the white cell count was increased (18,000 mm3).

In view of the above, I believe that Mr. Morgan needs your urgent surgical assessment and operation if
needed.

Please contact me if you have any queries.

Yours sincerely,

Dr. Kay