ABSTRACT
You are reviewing patients in the medical outpatient clinic. Your next patient has been referred by her general practitioner with the following letter. Please read the letter and then review the patient.
Dear Doctor,
Re: Mrs Katherine Weir
Age: 69 years
I would appreciate your advice on this lady who has been suffering with constipation for some time. I have treated her with Sennakot tablets and lactulose solution with only limited success. She has also been complaining of lethargy and I wonder whether she requires further investigation of her bowels. I previously organised a plain abdominal film which has confirmed constipation and blood tests are as follows: urea 9.8, creatinine 146, haemoglobin 10.6, white cell count 4.9, calcium 2.8, albumin 31.
Many thanks for your help.
Yours sincerely
