How to refer a 68M with jaundice?

Dear Dr. Desai,

Re: Mr. Adam Knowles (DOB: 22/08/1951)

I am writing to thank you for seeing Mr. Knowles, a 68-year-old retired management consultant, who presented with jaundice and will be referred to you for an urgent assessment of his upper GI symptoms.

Mr. Knowles has a past history of cholecystectomy for gallstones in 2008. He has no regular medications and is a non-smoker and social drinker.

Last month, Mrs. Knowles presented to my office with heartburn and indigestion. He tried OTC antacids with little improvement. Therefore, I prescribed a trial of omeprazole 20 mg twice daily for 8 weeks and ordered blood tests.

Currently, Mrs. Knowles develops diarrhea, pale stools, abdominal pain on eating, and fatigue. He has also lost 2kg in a month. PE reveals a tender abdomen on palpation and yellow discoloration of the skin and eyes. Laboratory tests came back showing abnormal liver function with elevated enzyme and bilirubin levels.

Regarding the management of Mr. Knowles, I have discussed examination findings and blood results with him. I have also mentioned the possibility of pancreatic malignancy to him. I am referring him to you for an urgent assessment of his symptoms with possible endoscopy.

I appreciate the care you can provide to Mr. Knowles. Please do not hesitate to contact me if you require any further information.

Yours sincerely,