Otherwise well apart from, unremarkable other than ...
I am writing to refer Mrs. Starkovic, a patient of mine to you. Mrs Starkovic is married with two children and is currently suffering from cholelithiasis. She is otherwise well apart from a history of migraines.
Mrs. Starkovic initially presented on 20/01/07 with a ten-day-history of radiating epigastric pain to the right side after dinner and nausea. The previous night, 19/01/07, she had similar pains but more severe which lasted for two hours. She also vomited once. Her physical examination was unremarkable, other than the mild tenderness on the right upper quadrant of the abdomen.. Liver function tests and a biliary ultrasound were carried out.
On review today, the patient reported that she had not experienced any further attacks.. Her investigations showed mildly elevated alkaline phosphate, a small contracted gallbladder and multiple gallstones. Please note, Mrs. Starkovic is anxious about the possibility of cancer about which she was reassured.
I would appreciate your assessment and management in view of a possible cholecystotomy.
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