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Next is a clinic letter from matthew parnell 9 79 022 the diagnosis is ulcerative colitis diagnosed in 02/2008 most recent colonoscopy april 2025 normal colonic mucosa with no active inflammation 1 less than 5 mm ssr polyp in the ascending retrieved 1 subtle 15 millimeter flat elevated polyp in the ascending likely ssl emr performed and retrieved serial colonic biopsies taken but no evidence of macroscopic disease activity histology colonic biopsy series within normal limits ascending polyp hyperplastic 5 x 3 x 2 mm without dysplasia or malignancy full stop sessile serrated lesion from the ascending: 8 x 6 x 3 mm bisected no displaced or malignancy other medical diagnoses small duct primary sclerosing cholangitis diagnosed on biopsy 20 '14 hypertension medications list pentazid 2 1 g twice per day ursodeoxycholic acid 500 mg twice a day amlodipine 10 mg once a day ramipril 5 mg once a day plan colonoscopy in april 2026 given psc but not for polyps hi is that mister matthew parnell hi I'm doctor norman miller I'm 1 of the gastroenterology registrars here at jarrod I hope I've caught you at a reasonable time sorry I'm a bit late that's fine are you happy for us to talk or would I can call you back in 2 minutes if you provide are you sure fine great how are you good I'm glad in terms of a bowel perspective everything okay brill brill amazing how have you managed that okay yeah I found like a keto kind of caveman style diet brilliant great good for you that's fantastic and and in terms of your I can see your psc seems to be going okay that seems to be quite happy with you from the hepatology team yep and we're very happy with you from the I mean recent colonoscopy back in april I don't know if anyone told you the results no fine you're the you had 2 polyps removed neither of them had anything sinister or worrying in them 1 was a tiny little thing 5 x 3 x 2 millimetres and that was just a hypoplastic polyp so nothing precancerous there you had 1 precancerous polyp removed but it didn't have anything cancerous inside it when they sliced it open does that make sense your and then the biopsies from the rest of the: didn't show any sign of inflammation or activity in your ulcerative colitis it's obviously good so it looks like the pentaser that you're taking is working well to control things yep no of course good great I'm glad and we're talking about sort of once or twice a day with your bowels 1 great okay great and no blood or mucus bro fantastic I'm glad and the pentaza use 1 g twice a day and I oh sorry I was saying your pentaza you look from your repeat prescriptions it looks like you're taking 1 g so 2 tablets twice a day you can take them both at the same time if you want there's no evidence to show that spreading out the dose makes any difference so if it's easier for you that that exactly when you were first put on them probably that was the evidence but that's changed now that we know that doesn't make any difference so you can take them both in the morning if that's easier for you it's yeah it we it's all about the compliance system taking it is the most important thing taking that dose is the most important thing and we know there's a subset of people that forget in the evening when they've taken it in the morning and so end up only with half the dose and there's no evidence to show yep you can take both in the evening that's fine exactly that's exactly our. That's the reason isn't it if you sometimes forget it's better to have all of it in 1 go and it doesn't make any difference having it in 1 go versus spreading it out and you're more likely to remember it if you have it once yeah great brilliant and then in terms of because you've got psc we like to keep an eye on your: every year which is obviously annoying but I'll book you another 1 in in april next year as long as that's okay with you okay I'm sorry yeah exactly yeah I completely agree yeah you had some polyps last time so you're kind of the kind of person that makes small polyps it's worth having a really good look yeah so I'll book you again in a year's time I'll book you another clinic appointment in a year's time to make sure that next colonoscopy gets booked booked and then any queries or concerns in the meantime just get in contact with us and we can work out what to do and you know what to do with your flaring double your dose of pentasa use it for 6 weeks and hopefully that'll settle it down if it doesn't get better in the after the first 10 days get in contact with us we can send you out some steroids and things really fine great good touch me too wonderful brilliant well I'm sorry for interrupting your journey but go and enjoy the sun nice to talk to you bye bye so plan is number 1 colonoscopy april 2026 number 2 12 months follow-up number 3 if flaring double dose of pentaza used for 6 weeks if not improving contact the ibd nurses number 4 consolidate pentaza dose to single dose once per day to improve compliance number next follow-up in 12 months I don't if I already said that dear gp had the pleasure of speaking on the telephone to mister matthew parnell on behalf of doctor klimova k l I m o v a in gastroenterology clinic today full stop <\n\n> Very happy to hear this bowels have been well controlled lately on his pen on his pentaza full stop he opens his bowels once per day passing a formed stool without blood or mucus full stop <\n\n> His wider health has also been improving he's lost 13 pounds in weight intentionally through intermittent fasting and a keto style diet and his blood pressure is also well controlled at a 120 over 80 full stop <\n\n> I've congratulated him on the excellent lifestyle steps he's made and also was able to give him the results of his recent colonoscopy where 2 polyps were removed 1 was entirely benign but the other was a premalignant polyp which we've completely removed full stop <\n\n> I've explained that because of his primary sclerosing cholangitis he needs to have yearly colonoscopy follow-up and I'll take the liberty of arranging this for him today as well as follow-up in a year's time full stop <\n\n> He knows what to do if he flares which is to increase the dose of his pentaza and get in contact with us full stop <\n\n> We look forward to speaking him to him in a year's time but he's always welcome to get in contact with us sooner if he's flaring or has queries full stop yours sincerely

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Medical ST5 Miller Clerking
[Current Date] [Current Time]

Presenting Complaint:
[The reason for attendance in 1-3 words]

History of Presenting Complaint:
[Chronological narrative of current illness using short, clear sentences. Include:
- Onset, character, location, radiation, timing, exacerbating/relieving factors
- Associated symptoms
- Impact on daily activities
- Previous similar episodes
- Relevant collateral history from relatives/carers
- Any relevant background from other healthcare professionals
Do not repeat patient's name throughout. Be concise and tell a chronological story to the reader. Do not include subjective descriptions of the symptoms e.g. "severe" or use unnecessarily long words.]

Past Medical History:
[Bulleted list of significant medical conditions with relevant details:]
• [Condition with year if mentioned]
• Diabetes mellitus - latest HbA1c: [value] mmol/mol ([date])
• Asthma/COPD - latest spirometry: FEV1 [value], FVC [value] ([date])
• [Previous surgeries with dates]
• [Other significant medical history]

Drug History:
• [Drug name] [dose][units] [route] [frequency]
• [Example: Omeprazole 20mg PO OD]
• [Example: Clopidogrel 75mg PO OD]

Recently Stopped Medications: [If relevant]
• [Medication] - stopped [date/reason]

Allergy History:
[If allergies mentioned:]
• [Allergen] - [Reaction type] ([severity if mentioned])
• NKDA [if no known drug allergies stated]

Social History:
[Living situation. Who they live with, housing type, if mentioned]
[Mobility. Walking aids, stairs, transfers, if mentioned]
[Carers. Formal/informal care arrangements, if mentioned]
[Occupation. Current/previous if relevant, if mentioned]
[Smoking. Never/Ex-smoker/Current - pack years if mentioned]
[Alcohol. Units per week/Never/Ex-drinker - if mentioned]
[Functional Status: Impact on activities of daily living, if mentioned]

On Examination:
[General Appearance. Alert, well/unwell, distressed, if mentioned]
Observations:: [If mentioned - HR, BP, Temp, RR, O2 sats (do not use subscripts)]
• Abdomen: [Inspection, palpation, percussion, auscultation findings. If not commented upon, document as normal]
• Cardiovascular: [Heart sounds, murmurs, peripheral pulses, oedema. If not commented upon, document as normal]
• Respiratory: [Chest expansion, percussion, auscultation. If not commented upon, document as normal]
• Neurological: [If examined.]
• Other: [Any other relevant examination findings, if mentioned]

Investigations:
• [Test name] ([date, if mentioned, do not include include today's date on results, list without a date]): [Result without units]
• [Example: Hb 85]
• [Imaging type] ([date, if mentioned]): [Key findings]
• [Example: CT Abdomen/Pelvis (15/03/24): Sigmoid diverticulosis, no perforation]

Impression:
[Main diagnosis]
Differential Diagnoses: [Only if multiple possibilities discussed]
[Secondary issues. Relevant comorbidities affecting management. If mentioned]

Management Plan:
1. [A numbered list documenting the management plan to be undertaken, if mentioned, include:
- Immediate management/monitoring,
- Investigation requests,
- Treatment interventions - medications, procedures,
- Discharge planning/follow-up arrangements,
- Patient education/lifestyle advice,
- Referrals to other specialties if needed,
- Which ward or specialty the patient would be best admitted to e.g. "Respiratory Bed",
- Escalation plan that was discussed - whether the patient is suitable for CPR, ITU and/or NIV.]

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