Speciality Referral

**Consultation with Specialist:** 1 November 2024, 14:30. Consultation with Dr. Anya Sharma, Consultant General Surgeon, regarding Mr. John Smith, DOB 12/03/1965. **Reason for Consultation:** Mr. Smith presents with a two-week history of worsening abdominal pain, associated with nausea and intermittent vomiting. He reports a change in bowel habits, with increased frequency and looser stools. The primary concern is to rule out a possible bowel obstruction or other surgical pathology. **Patient Presentation and History:** Mr. Smith is a 59-year-old male with a past medical history of HTN, T2DM, and a previous cholecystectomy. He is currently taking Lisinopril 20mg daily, Metformin 1000mg twice daily, and has no known drug allergies. Social history includes a 30-pack-year smoking history, but he quit smoking 5 years ago. He drinks alcohol socially. Recent changes include increased abdominal pain and altered bowel habits. **Clinical Findings:** Patient appears uncomfortable. BP 140/90, HR 95, RR 18, Temp 37.8. Abdomen is distended and tender to palpation in the lower quadrants. Bowel sounds are diminished. No rebound tenderness or guarding is noted. **Investigations and Results:** - CBC: WCC 12.5 - Electrolytes: Na 135, K 4.0 - LFTs: ALT 35, AST 30, Bilirubin 1.0 - CT Abdomen/Pelvis: Shows a possible small bowel obstruction. **Discussion with Specialist:** Dr. Sharma reviewed the patient's presentation, history, and imaging. She agreed with the suspicion of a small bowel obstruction and discussed the need for further evaluation and potential surgical intervention. She enquired about the patient's suitability for surgery given his co-morbidities. The discussion included the risks and benefits of both conservative management and surgical options. **Shared Decision Making and Plan:** After discussing the options with Mr. Smith, a decision was made to proceed with an exploratory laparoscopy. Dr. Sharma will perform the surgery. The patient was informed about the risks of surgery, including bleeding, infection, and potential complications. Post-operative care will be managed by the surgical team, with regular follow-up appointments scheduled. **Consideration for Takeover of Care:** Dr. Sharma agreed to take over the patient's care, including pre-operative assessment, surgical intervention, and post-operative management. The handover was seamless, with clear communication between the referring physician and the surgical team. **Specialist Concerns/Recommendations:** N/A **Further Actions/Follow-up:** Mr. Smith will be admitted to the surgical ward. Pre-operative investigations, including blood tests and ECG, will be performed. The surgical team will monitor the patient's progress and provide regular updates to the referring physician. Follow-up appointments will be scheduled with Dr. Sharma in the surgical outpatient clinic.