23/01/2007

Dr Andrew McDonald

General Surgeon

North Melbourne Private Hospital

86 Elm Road

North Melbourne 3051

Dear Dr McDonald,

Re: Mrs Daniela Starkovic, 45 years old

I am writing to refer Mrs Starkovic who requires your professional assistance for assessment and a
possible cholecystectomy for her ongoing issues with cholelithiasis following complaints of abdominal
pain.

Mrs Starkovic first presented on 20/01/07 with abdominal pain. Ten days prior, she had experienced
epigastric pain radiating to the right side. The pain was constant, occurred an hour after the dinner and
was associated with nausea. She doesn’t like to eat fatty foods, and had no accompanying vomiting or
regurgitation.

Last night, Mrs Starkovic had a recurrence of a much worse abdominal pain. That episode lasted for two
hours, was constant and had colicky features. She even vomited once and took two aspirin tablets but to
no avail. On examination, mild tenderness was noted in the right upper abdomen. Today though there
was no pain however, she appeared anxious regarding the possibility of cancer. The ultrasound of
abdomen revealed a small contracted gall bladder with multiple gallstones. Therefore, she was
reassured regarding the non-likelihood of cancer but for further management, she is being referred to
your hospital.

Kindly assess her and if required, perform a cholecystectomy.

If you have any queries, please feel free to contact me.

Sincerely,

Dr Talha