Physician's Assistant

Clinic letter Mon 06 October 2025 08:47

Last Modified: 26 weeks ago

MRN:

Content:

Diagnosis:
Primary Sclerosing Cholangitis (PSC)

Other Medical Diagnoses
History of inflammatory bowel disease with previous pouch surgery
Weight loss (intentional through dietary modification and exercise)

Medications:
Current medications not specifically detailed in consultation

Investigations:
Stool elastase test - requested to exclude pancreatic insufficiency
Pouchoscopy - results pending, expected within next month
Planned investigations:
- MRCP to restage PSC
- MRI small bowel
- Upper endoscopy (deferred pending discussion with St Mark's team)

Plan:
1. MRCP
2. MRI small bowel
3. Upper endoscopy planned (to be coordinated with St Mark's)
4. Follow-up in 6 months
5. Stool elastase test to exclude pancreatic insufficiency
6. Await pouchoscopy results

Dear Colleague,

I reviewed Ms Pittman in clinic today. She has a scheduled appointment at St Mark's in November (previously October 27th, now November 7th) for surgical consultation.

Ms Pittman reports feeling well overall and is dietary-dependent for symptom management. She has successfully achieved weight loss through dietary modification and resuming rowing exercise 4-5 times weekly. Her bowel frequency remains at 4 movements daily with some urgency, and she reports altered taste and slightly fishy-tasting stools, prompting investigation for pancreatic insufficiency.

She denies abdominal pain, jaundice, or other concerning hepatobiliary symptoms. The St Mark's team has organised restaging investigations including MRCP and MRI small bowel, which are appropriate given the interval since last assessment. Upper endoscopy was discussed but deferred pending team discussion.

I have arranged stool elastase testing and she will return the sample tomorrow. Pouchoscopy results are awaited within the month. Follow-up is planned in 6 months.

Kind regards

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Summary:

Investigations:

Clinic letter Mon 06 October 2025 08:47

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