CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 45 year old
male well known to the surgical service admitted on [**2153-8-6**] with possible cholangitis.  He had a complicated
surgical history that began with a Roux-en-Y gastric bypass
subtotal gastrectomy at an outside hospital in [**2152-5-10**].
The patient had complications of pancreatitis, duodenal stump
leak and stricture.  The patient underwent gastric bypass
revision and had hepaticojejunostomy at [**Hospital6 649**] in [**2152-12-10**] by Dr. [**Last Name (STitle) **] and Dr. [**Last Name (STitle) **].
Postoperatively the patient developed difficulty in eating
secondary to post prandial nausea and vomiting and dumping
syndrome as well as cholangitis.  Computerized tomography
scan and upper gastrointestinal series showed BSBO, a long
distal roux limb or a jejunostomy.  On [**2153-2-8**]
exploratory laparotomy was done and lysis of adhesions with
small bowel resection and jejunostomy and lymph node biopsy.
In [**2153-2-10**] the patient had continued nausea and
vomiting and upper gastrointestinal series revealed
persistent dilatation of the proximal jejunojejunostomy
between the pancreatic limb site.  At that time, he underwent
exploratory laparotomy, lysis of adhesions, small bowel
resection times three, redo jejunojejunostomy.  The patient
has done relatively well since, except for continued dumping
syndrome, requiring home total parenteral nutrition and
Octreotide.  On [**8-3**], the patient with weakness, fevers,
rigors in [**State 15946**] Intensive Care Unit admit, continued
hypotension to 60s, rigors, fevers to 104, right upper
quadrant pain.  The patient was stabilized with intravenous
fluids, reassured, resuscitated with Zosyn.  Transferred to
[**Hospital6 256**] for further evaluation.

MEDICAL HISTORY: The patient has a past medical history
of obesity, malnutrition, status post Roux-en-Y gastric
bypass revision in [**2152-12-10**], history of pancreatitis,
history of status post jejunojejunostomy, status post
multiple small bowel resections for small bowel resection
revisions, jejunostomy and gastroesophageal reflux disease,
right Porta-cath.

MEDICATION ON ADMISSION: Total parenteral nutrition,
Octreotide 400 t.i.d. subcutaneous.  Medications in the
hospital, Zosyn 3.375 q. 6, Pepcid 20 b.i.d., Atresia 400
t.i.d.

ALLERGIES: Adhesion tape, Benzoin.

PHYSICAL EXAM: 

FAMILY HISTORY: Non-contributory.

SOCIAL HISTORY: No smoking, no alcohol, no intravenous drug
abuse.
Cholangitis,Other and unspecified postsurgical nonabsorption,Postgastric surgery syndromes
Cholangitis,Intest postop nonabsorb,Postgastric surgery synd
Admission Date:  [**2153-8-6**]       Discharge Date:  [**2153-8-9**]

Date of Birth:   [**2108-1-21**]       Sex:  M

Service:  Purple - Surgery

HISTORY OF PRESENT ILLNESS:  The patient is a 45 year old
male well known to the surgical service admitted on [**2153-8-6**] with possible cholangitis.  He had a complicated
surgical history that began with a Roux-en-Y gastric bypass
subtotal gastrectomy at an outside hospital in [**2152-5-10**].
The patient had complications of pancreatitis, duodenal stump
leak and stricture.  The patient underwent gastric bypass
revision and had hepaticojejunostomy at [**Hospital6 649**] in [**2152-12-10**] by Dr. [**Last Name (STitle) **] and Dr. [**Last Name (STitle) **].
Postoperatively the patient developed difficulty in eating
secondary to post prandial nausea and vomiting and dumping
syndrome as well as cholangitis.  Computerized tomography
scan and upper gastrointestinal series showed BSBO, a long
distal roux limb or a jejunostomy.  On [**2153-2-8**]
exploratory laparotomy was done and lysis of adhesions with
small bowel resection and jejunostomy and lymph node biopsy.
In [**2153-2-10**] the patient had continued nausea and
vomiting and upper gastrointestinal series revealed
persistent dilatation of the proximal jejunojejunostomy
between the pancreatic limb site.  At that time, he underwent
exploratory laparotomy, lysis of adhesions, small bowel
resection times three, redo jejunojejunostomy.  The patient
has done relatively well since, except for continued dumping
syndrome, requiring home total parenteral nutrition and
Octreotide.  On [**8-3**], the patient with weakness, fevers,
rigors in [**State 15946**] Intensive Care Unit admit, continued
hypotension to 60s, rigors, fevers to 104, right upper
quadrant pain.  The patient was stabilized with intravenous
fluids, reassured, resuscitated with Zosyn.  Transferred to
[**Hospital6 256**] for further evaluation.

PAST MEDICAL HISTORY:  The patient has a past medical history
of obesity, malnutrition, status post Roux-en-Y gastric
bypass revision in [**2152-12-10**], history of pancreatitis,
history of status post jejunojejunostomy, status post
multiple small bowel resections for small bowel resection
revisions, jejunostomy and gastroesophageal reflux disease,
right Porta-cath.

MEDICATIONS ON ADMISSION:  Total parenteral nutrition,
Octreotide 400 t.i.d. subcutaneous.  Medications in the
hospital, Zosyn 3.375 q. 6, Pepcid 20 b.i.d., Atresia 400
t.i.d.

ALLERGIES:  Adhesion tape, Benzoin.

SOCIAL HISTORY:  No smoking, no alcohol, no intravenous drug
abuse.

FAMILY HISTORY:  Non-contributory.

PHYSICAL EXAMINATION:  Physical examination on admission
reveals vital signs 100.5, 76, 124/73, 16, 100% on room air.
Generally, the patient was alert and oriented times three in
no acute distress.  Head, eyes, ears, nose and throat, sclera
anicteric, atraumatic.  Nares, patent.  Neck was supple
without lymphadenopathy or thyromegaly.  Heart, regular rate
and rhythm with no murmurs, rubs or gallops.  Lungs clear to
auscultation bilaterally.  Abdomen, soft, nondistended,
mildly tender right upper quadrant, positive bowel sounds.
Neurological was nonfocal.  Extremities were without edema
and pulses 2+.

LABORATORY DATA:  On admission white count 8.4, hematocrit
36.8, platelets 136, PMNs 91.6, lymphocytes 5.1.  Sodium 138,
potassium 3.3, chloride 104, bicarbonate 22, BUN 17.3,
creatinine .8 and glucose 108.  AST 26, ALT 25, alkaline
phosphatase 103, albumin 4.4, total bilirubin 3.2, amylase
48, lipase 15.  Computerized tomography scan of the abdomen
showed air leak, pneumobiliary in left lobe adjacent to the
portal vein and without free fluid.

HOSPITAL COURSE:  The patient was followed by both Blue and
Purple Surgery throughout hospital course.  He was admitted
to Surgery Intensive Care Unit for short gut and dumping
syndrome, recurrent cholangitis.  The patient spent hospital
day #1 and 2 in Surgery Intensive Care Unit and was
transferred to the floor on hospital day #3.  After a while
in the Surgery Intensive Care Unit magnetic resonance
cholangiopancreatography was used to rule out stricture and
HIDA scan to evaluate biliary system.  Intravenous
antibiotics were continued and total parenteral nutrition was
continued.  HIDA scan was planned for rule out functional
obstruction.  [**Hospital1 **] also followed the patient for sugar
control.  Percutaneous transhepatic cholangiography was
attempted multiple times with multiple failed attempts to
access the biliary tree.  Magnetic resonance
cholangiopancreatography result showed no obvious stricture
or ductal dilatation.  The patient was started back on p.o.
[**2153-8-8**].  Ultimately the patient had no evidence of
infection, no evidence of leak.  The patient had Porta-Cath
placement during the hospital stay.  The patient had white
count of 4.6, hematocrit of 28 and platelets 447 on discharge
with chemistry to 142.1, 729, BUN 9 creatinine .7, glucose
161 with an ALT of 26, AST 17, total bilirubin 1.1,
phosphate 80.  The patient was discharged on [**2153-8-9**]
without event.

DISCHARGE MEDICATIONS:
1.  Octreotide .2 mg/ml injections q. 8 hours
2.  Cipro 500 mg p.o. b.i.d. for two weeks
3.  Vancomycin every 12 hours for four weeks, 1 gm

DISCHARGE STATUS:  The patient was discharged home.

FINAL DIAGNOSIS:  Cholangitis status post percutaneous
transhepatic cholangiography placement

CONDITION ON DISCHARGE:  Good.

FOLLOW UP:  Follow up with Dr. [**Last Name (STitle) **] and Dr. [**Last Name (STitle) **] and to
continue total parenteral nutrition and Vancomycin at home,
Ciprofloxacin to be started instead of Zosyn and return to
the hospital should the patient experience any more rigors,
fevers or abdominal pain.


                            [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 3799**], M.D.  [**MD Number(1) 3800**]

Dictated By:[**Last Name (NamePattern4) 10197**]
MEDQUIST36

D:  [**2153-10-18**]  19:40
T:  [**2153-10-18**]  19:52
JOB#:  [**Job Number 39266**]
{'Cholangitis,Other and unspecified postsurgical nonabsorption,Postgastric surgery syndromes'}


You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT.



### Clinical text :
CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 45 year old
male well known to the surgical service admitted on [**2153-8-6**] with possible cholangitis.  He had a complicated
surgical history that began with a Roux-en-Y gastric bypass
subtotal gastrectomy at an outside hospital in [**2152-5-10**].
The patient had complications of pancreatitis, duodenal stump
leak and stricture.  The patient underwent gastric bypass
revision and had hepaticojejunostomy at [**Hospital6 649**] in [**2152-12-10**] by Dr. [**Last Name (STitle) **] and Dr. [**Last Name (STitle) **].
Postoperatively the patient developed difficulty in eating
secondary to post prandial nausea and vomiting and dumping
syndrome as well as cholangitis.  Computerized tomography
scan and upper gastrointestinal series showed BSBO, a long
distal roux limb or a jejunostomy.  On [**2153-2-8**]
exploratory laparotomy was done and lysis of adhesions with
small bowel resection and jejunostomy and lymph node biopsy.
In [**2153-2-10**] the patient had continued nausea and
vomiting and upper gastrointestinal series revealed
persistent dilatation of the proximal jejunojejunostomy
between the pancreatic limb site.  At that time, he underwent
exploratory laparotomy, lysis of adhesions, small bowel
resection times three, redo jejunojejunostomy.  The patient
has done relatively well since, except for continued dumping
syndrome, requiring home total parenteral nutrition and
Octreotide.  On [**8-3**], the patient with weakness, fevers,
rigors in [**State 15946**] Intensive Care Unit admit, continued
hypotension to 60s, rigors, fevers to 104, right upper
quadrant pain.  The patient was stabilized with intravenous
fluids, reassured, resuscitated with Zosyn.  Transferred to
[**Hospital6 256**] for further evaluation.

MEDICAL HISTORY: The patient has a past medical history
of obesity, malnutrition, status post Roux-en-Y gastric
bypass revision in [**2152-12-10**], history of pancreatitis,
history of status post jejunojejunostomy, status post
multiple small bowel resections for small bowel resection
revisions, jejunostomy and gastroesophageal reflux disease,
right Porta-cath.

MEDICATION ON ADMISSION: Total parenteral nutrition,
Octreotide 400 t.i.d. subcutaneous.  Medications in the
hospital, Zosyn 3.375 q. 6, Pepcid 20 b.i.d., Atresia 400
t.i.d.

ALLERGIES: Adhesion tape, Benzoin.

PHYSICAL EXAM: 

FAMILY HISTORY: Non-contributory.

SOCIAL HISTORY: No smoking, no alcohol, no intravenous drug
abuse. 

### Response:
{'Cholangitis,Other and unspecified postsurgical nonabsorption,Postgastric surgery syndromes'}
