CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 73-year-old
female, transfer from [**Hospital 1474**] Hospital on [**2141-6-29**] where she
presented on [**2141-6-26**] with nausea and vomiting, abdominal
pain, and bloody diarrhea.  CT scan at [**Hospital 1474**] Hospital
revealed a probable superior mesenteric artery occlusion at
which time the patient was transferred acutely to [**Hospital1 346**] for assessment and treatment by the
vascular surgery team.  The patient began experiencing
symptoms on [**2141-6-24**], first starting off with lower abdominal
pain, copious diarrhea and nausea and vomiting.  The patient
was admitted to [**Hospital 1474**] Hospital on [**2141-6-26**] after diarrhea
became bloody in nature.  At [**Hospital 1474**] Hospital the patient's
abdominal pain and abdominal physical examination worsened.
CT examination on [**2141-6-29**] revealed superior mesenteric
artery occlusion at which time the patient was transferred to
[**Hospital1 69**].  At [**Hospital 1474**] Hospital
the patient was also noted to have developed a new-onset
atrial fibrillation, which was thought to be the source of a
potential embolus to the superior mesenteric artery.

MEDICAL HISTORY: 1. Hypertension.  2.
Hypercholesterolemia.  3. Borderline diabetes mellitus.  4.
Status post appendectomy.  5. Status post exploratory
laparotomy for trauma in the past.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Acute vascular insufficiency of intestine,Congestive heart failure, unspecified,Atrial fibrillation,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia,Unspecified essential hypertension
Ac vasc insuff intestine,CHF NOS,Atrial fibrillation,DMII wo cmp nt st uncntr,Pure hypercholesterolem,Hypertension NOS
Admission Date:  [**2141-6-29**]       Discharge Date:  [**2141-7-14**]

Date of Birth:   [**2067-10-17**]       Sex:  F

Service:  Vascular Surgery

HISTORY OF PRESENT ILLNESS:  The patient is a 73-year-old
female, transfer from [**Hospital 1474**] Hospital on [**2141-6-29**] where she
presented on [**2141-6-26**] with nausea and vomiting, abdominal
pain, and bloody diarrhea.  CT scan at [**Hospital 1474**] Hospital
revealed a probable superior mesenteric artery occlusion at
which time the patient was transferred acutely to [**Hospital1 346**] for assessment and treatment by the
vascular surgery team.  The patient began experiencing
symptoms on [**2141-6-24**], first starting off with lower abdominal
pain, copious diarrhea and nausea and vomiting.  The patient
was admitted to [**Hospital 1474**] Hospital on [**2141-6-26**] after diarrhea
became bloody in nature.  At [**Hospital 1474**] Hospital the patient's
abdominal pain and abdominal physical examination worsened.
CT examination on [**2141-6-29**] revealed superior mesenteric
artery occlusion at which time the patient was transferred to
[**Hospital1 69**].  At [**Hospital 1474**] Hospital
the patient was also noted to have developed a new-onset
atrial fibrillation, which was thought to be the source of a
potential embolus to the superior mesenteric artery.

PAST MEDICAL HISTORY:  1. Hypertension.  2.
Hypercholesterolemia.  3. Borderline diabetes mellitus.  4.
Status post appendectomy.  5. Status post exploratory
laparotomy for trauma in the past.

PHYSICAL EXAMINATION:  Upon admission to [**Hospital1 346**] the patient was noted to have
regular rate and rhythm, clear to auscultation bilaterally.
Abdominal examination was remarkable for a very tender
abdomen with positive guarding, positive rigidity and
positive rebound tenderness.  Rectal examination was guaiac
positive.  Extremity examination was dorsalis pedis and
posterior tibial pulses palpable bilaterally.  Femoral pulse
was palpable bilaterally.  There were no carotid bruits
noted.

LABORATORY DATA:  On admission the patient was noted to have
a white count of 22, hematocrit 41.1, platelet count 273,
sodium 140, potassium 3.5, chloride 108, bicarbonate 26, BUN
16, creatinine 0.7, glucose 224, calcium 9.3, magnesium 2.1,
phosphorous 1.1.

Emergency angiogram was ordered and obtained which revealed
an occlusion of the superior mesenteric artery.

HOSPITAL COURSE:  After the angiogram results were received
the patient was taken emergently to the operating room for
superior mesenteric artery thromboembolectomy.  The patient
was noted to have no dead or necrotic bowel at the time of
exploratory laparotomy.  An occlusion was noted 1-2 cm distal
to the origin of the superior mesenteric artery.  Clot was
evacuated with [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] catheter and Dacron patch was
applied for closure.  The patient was closed primarily with
no plans for a second look operation due to strong palpable
and dopplerable pulses post thromboembolectomy and a
significant pinking up and reperfusion of the bowel with no
areas of transmural infarction noted.

The patient was discharged to the intensive care unit at this
time.  Intensive care unit course was remarkable for
continued abdominal tenderness as well as episodes of
diarrhea.  Postoperative angiogram on [**2141-7-5**] showed wide
patency of the superior mesenteric artery.  Repeat CT scan
also showed widely patent mesenteric vessels with portions of
bowel wall edema.  At this time the patient's symptoms and
radiologic findings were attributed to a reperfusion type
injury.

The patient's postoperative course was also significant for
episodes of agitation in the intensive care unit.  As the
patient's abdominal symptoms and diarrhea resolved, the
patient was transferred to the floor on [**2141-7-9**].  The
patient's postoperative course on the floor was unremarkable.
The patient was weaned off of TPN, started on clears, and
eventually advanced to a general diet which she tolerated
well.  The patient is currently on a post-gastrectomy type
diet of small portions of food, many meals per day.

The patient was also seen by physical therapy to be evaluated
for home safety.  The patient was also made therapeutic on
Coumadin for new-onset atrial fibrillation.  The patient's IV
heparin was discontinued on [**2141-7-13**].  Cardiology follow up
recommended echocardiogram in one month's time prior to
cardioversion attempt.  Until that time the patient is to
remain on Coumadin with a therapeutic INR between 2 and 3.
The patient is currently stable, tolerating p.o.

DISCHARGE STATUS:  To rehabilitation facility or to home with
help from her two daughters who are nurses.

DISCHARGE DIAGNOSES:  Superior mesenteric artery occlusion.

DISCHARGE MEDICATIONS:
1. Pepcid 20 mg p.o. b.i.d.
2. Coumadin 2.5 mg p.o. q.h.s.
3. Premarin 0.625 mg p.o. q.d.
4. Atorvastatin 20 mg p.o. q.d.
5. Nystatin oral suspension 5 mL p.o. q.i.d. p.r.n.
6. Metoprolol 25 mg p.o. b.i.d.
7. Captopril 12.5 mg p.o. t.i.d.
8. Miconazole powder 2% one application topically q.i.d.
p.r.n.
9. Clonidine TTS one patch q. week.
10. Albuterol inhaler 1-2 puffs q. 6 hours p.r.n.
11. Tylenol 325 to 650 mg p.o. q. 4-6 hours p.r.n.
12. Dilaudid 2 mg p.o. q. 2 hours p.r.n. for pain.

FOLLOW-UP PLANS:  The patient is to follow up with Dr.
[**Last Name (STitle) **] in one week.





                            [**First Name11 (Name Pattern1) 1112**] [**Last Name (NamePattern4) 2604**], M.D.  [**MD Number(1) 6223**]

Dictated By:[**Name8 (MD) 7190**]
MEDQUIST36

D:  [**2141-7-14**]  10:45
T:  [**2141-7-14**]  11:33
JOB#:  [**Job Number 51588**]


Name:  [**Known lastname **], [**Known firstname 3192**]                    Unit No:  [**Numeric Identifier 9604**]

Admission Date:  [**2141-6-29**]     Discharge Date:  [**2141-7-18**]

Date of Birth:   [**2067-10-17**]     Sex:  F

Service:  VASCULAR

Prior to planned discharge time, the patient spiked a
temperature up to 103.9.  This was on [**2141-7-16**].  Patient
quickly defervesced within the next couple of hours.  Patient
is being treated empirically with Flagyl p.o. for C.diff
colitis.  C.diff stool samples are pending.  Patient is
stable, ambulating well, tolerating p.o., no abdominal
tenderness.  Complete fever workup was negative.  Chest x-ray
was normal.  UA was clean.  Urine and blood cultures pending.
Wound was not erythematous.  Patient to continue p.o. Flagyl
regimen for 10 to 14 days.  Patient stable to go to nursing
home.






                          [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1548**], M.D.  [**MD Number(1) 1549**]

Dictated By:[**Name8 (MD) 820**]

MEDQUIST36

D:  [**2141-7-17**]  15:54
T:  [**2141-7-17**]  15:59
JOB#:  [**Job Number 9605**]
{'Acute vascular insufficiency of intestine,Congestive heart failure, unspecified,Atrial fibrillation,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia,Unspecified essential hypertension'}


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 73-year-old
female, transfer from [**Hospital 1474**] Hospital on [**2141-6-29**] where she
presented on [**2141-6-26**] with nausea and vomiting, abdominal
pain, and bloody diarrhea.  CT scan at [**Hospital 1474**] Hospital
revealed a probable superior mesenteric artery occlusion at
which time the patient was transferred acutely to [**Hospital1 346**] for assessment and treatment by the
vascular surgery team.  The patient began experiencing
symptoms on [**2141-6-24**], first starting off with lower abdominal
pain, copious diarrhea and nausea and vomiting.  The patient
was admitted to [**Hospital 1474**] Hospital on [**2141-6-26**] after diarrhea
became bloody in nature.  At [**Hospital 1474**] Hospital the patient's
abdominal pain and abdominal physical examination worsened.
CT examination on [**2141-6-29**] revealed superior mesenteric
artery occlusion at which time the patient was transferred to
[**Hospital1 69**].  At [**Hospital 1474**] Hospital
the patient was also noted to have developed a new-onset
atrial fibrillation, which was thought to be the source of a
potential embolus to the superior mesenteric artery.

MEDICAL HISTORY: 1. Hypertension.  2.
Hypercholesterolemia.  3. Borderline diabetes mellitus.  4.
Status post appendectomy.  5. Status post exploratory
laparotomy for trauma in the past.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Acute vascular insufficiency of intestine,Congestive heart failure, unspecified,Atrial fibrillation,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia,Unspecified essential hypertension'}
