CHIEF COMPLAINT: Abdominal pain

PRESENT ILLNESS: Patient is a [**Age over 90 **] year old man who was discharged recently from
[**Hospital1 18**] ([**2173-11-19**]) after recovering from cholangitis who presented
again on [**2173-12-4**] with a 24-hour history of vague abdominal
discomfort with a fever to 101.0.

MEDICAL HISTORY: 1. Coronary artery disease status post CABG in [**2161**].
2. Atrial fibrillation on Coumadin.
3. Vestibular schwannoma treated with chemotherapy at [**Hospital 14852**].
4. History of a hiatal hernia.
5. Total radical resection of the prostate.
6. Bilateral inguinal hernia repairs

MEDICATION ON ADMISSION: Amlodipine 5
Trazodone 50
Metoprolol 25 [**Hospital1 **]
ASA 81
Plavix 75
Warfarin
Protonix 40
Colace

ALLERGIES: Procardia

PHYSICAL EXAM: Temp 102.0  HR 91  BP 134/45  RR 24  SaO2 97% room air
Alert, oriented
Irregularly irregular rhythm
CTA b/l
Soft, nontender, nondistended. Slightly tender diffusely, +BS
hyperactive.
Rectal guiac negative.

FAMILY HISTORY: none

SOCIAL HISTORY: The patient denies any tobacco use, but admits to occasional
alcohol use. He lives alone and is retired. He has a supportive
family (niece, nephew).
Acute cholecystitis,Atrial fibrillation,Paralytic ileus,Long-term (current) use of anticoagulants,Aortocoronary bypass status,Unspecified essential hypertension
Acute cholecystitis,Atrial fibrillation,Paralytic ileus,Long-term use anticoagul,Aortocoronary bypass,Hypertension NOS
Admission Date:  [**2173-12-5**]              Discharge Date:   [**2173-12-13**]


Service: SURGERY

Allergies:
Procardia

Attending:[**First Name3 (LF) 1481**]
Chief Complaint:
Abdominal pain

Major Surgical or Invasive Procedure:
Percutaneous cholecystostomy tube


History of Present Illness:
Patient is a [**Age over 90 **] year old man who was discharged recently from
[**Hospital1 18**] ([**2173-11-19**]) after recovering from cholangitis who presented
again on [**2173-12-4**] with a 24-hour history of vague abdominal
discomfort with a fever to 101.0.

Past Medical History:
1. Coronary artery disease status post CABG in [**2161**].
2. Atrial fibrillation on Coumadin.
3. Vestibular schwannoma treated with chemotherapy at [**Hospital 14852**].
4. History of a hiatal hernia.
5. Total radical resection of the prostate.
6. Bilateral inguinal hernia repairs

Social History:
The patient denies any tobacco use, but admits to occasional
alcohol use. He lives alone and is retired. He has a supportive
family (niece, nephew).


Family History:
none

Physical Exam:
Temp 102.0  HR 91  BP 134/45  RR 24  SaO2 97% room air
Alert, oriented
Irregularly irregular rhythm
CTA b/l
Soft, nontender, nondistended. Slightly tender diffusely, +BS
hyperactive.
Rectal guiac negative.

Pertinent Results:
[**2173-12-4**] 08:50PM   WBC-7.9# RBC-4.08* HGB-13.0* HCT-35.4* MCV-87
MCH-31.8 MCHC-36.7* RDW-13.7
[**2173-12-4**] 08:50PM   NEUTS-89* BANDS-2 LYMPHS-3* MONOS-6 EOS-0
BASOS-0 ATYPS-0 METAS-0 MYELOS-0
[**2173-12-4**] 08:50PM   PLT COUNT-141*
[**2173-12-4**] 08:50PM   PT-21.7* PTT-34.0 INR(PT)-3.4
[**2173-12-4**] 09:06PM   LACTATE-4.0*
[**2173-12-4**] 08:50PM   GLUCOSE-173* UREA N-16 CREAT-1.0 SODIUM-134
POTASSIUM-3.6 CHLORIDE-99 TOTAL CO2-21* ANION GAP-18
[**2173-12-4**] 08:50PM   ALT(SGPT)-26 AST(SGOT)-25 ALK PHOS-64 TOT
BILI-0.9
[**2173-12-4**] 08:50PM   LIPASE-45

Brief Hospital Course:
The patient was admitted and had a right upper quadrant
ultrasound which showed sludge (s/p previously placed biliary
stent) and a small amount of wall edema. No ductal dilatation,
no U/S [**Doctor Last Name 515**] sign. He was admitted to the Crimson surgery
service for antibiotics, IV fluids and serial exams. ERCP was
contact[**Name (NI) **] and saw the patient. The patient had a HIDA scan which
showed non-filling of the gallbladder. The patient underwent
placement of a percutaneous cholecystostomy tube by
Interventional Radiology. Immediately following the procedure he
had shaking chills and was transferred overnight to the ICU for
close monitoring. Cultures from the bile sample grew E. Coli.
Blood cultures were negative. He was transferred to the floor
and recovered well with chest physical therapy, getting out of
bed to chair. Bowel function slowly returned to [**Location 213**] after a
few days of ileus. The patient did complain of intermittent pain
at the chole tube site, sometimes radiating up toward his right
chest. EKGs were without any changes, 3 sets of cardiac enzymes
were negative, and the patient was otherwise asymptomatic. A
PICC line was placed for a 2 week course of IV Zosyn. His
aspirin and Plavix (for cardiac stents) were restarted on
hospital day 7. His creatinine level increased from baseline 1.1
to 1.8. The previously administered vancomycin was discontinued
and he was adequately hydrated. He tolerated a regular diet,
supplemented with Boost. Physical therapy worked with the
patient. He was deemed fit for discharge to rehab on hospital
day 9.

Medications on Admission:
Amlodipine 5
Trazodone 50
Metoprolol 25 [**Hospital1 **]
ASA 81
Plavix 75
Warfarin
Protonix 40
Colace

Discharge Medications:
1. Amlodipine 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

2. Albuterol Sulfate 0.083 % Solution Sig: One (1)  Inhalation
Q6H (every 6 hours) as needed for shortness of breath or
wheezing.
3. Trazodone 50 mg Tablet Sig: One (1) Tablet PO HS (at bedtime)
as needed.
4. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
5. Bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal
DAILY (Daily) as needed.
6. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1)
Injection [**Hospital1 **] (2 times a day): Continue until ambulating
regularly.
7. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
8. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
9. Warfarin 1 mg Tablet Sig: One (1) Tablet PO ONCE (once):
Titrate to INR 2.0-3.0.
10. Piperacillin-Tazobactam 4.5 g Recon Soln Sig: One (1) Recon
Soln Intravenous  Q8H (every 8 hours) for 6 days.
11. Protonix 40 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO once a day.
12. Colace 100 mg Capsule Sig: One (1) Capsule PO twice a day:
Hold for loose stools.


Discharge Disposition:
Extended Care

Facility:
[**Hospital6 459**] for the Aged - [**Location (un) 550**]

Discharge Diagnosis:
Acute cholecystitis


Discharge Condition:
Stable


Discharge Instructions:
Please call or return if you have a fever >101.4, persistent
nausea/vomiting, persistent diarrhea/constipation, redness
swelling or purulent drainage at the percutaneous
cholecystostomy tube, any problems with the drainage tube, or
any other concerns.

Followup Instructions:
Please see Dr. [**Last Name (STitle) **] in 1 week. Call [**Telephone/Fax (1) 2981**] to arrange
an appointment.

Please follow up with your primary care doctor and cardiologist
as directed.



Completed by:[**2173-12-13**]

Name:  [**Known lastname 15776**],[**Known firstname 5204**]                Unit No:   [**Numeric Identifier 15777**]

Admission Date:  [**2173-12-5**]              Discharge Date:   [**2173-12-13**]

Date of Birth:  [**2079-12-8**]             Sex:   M

Service: SURGERY

Allergies:
Procardia

Attending:[**First Name3 (LF) 203**]
Addendum:
Pt is also fo follow-up ERCP in [**1-14**] weeks from now.




Discharge Disposition:
Extended Care

Facility:
[**Hospital6 609**] for the Aged - [**Location (un) 1409**]

                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 206**] MD [**MD Number(1) 207**]

Completed by:[**2173-12-13**]
{'Acute cholecystitis,Atrial fibrillation,Paralytic ileus,Long-term (current) use of anticoagulants,Aortocoronary bypass status,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: Abdominal pain

PRESENT ILLNESS: Patient is a [**Age over 90 **] year old man who was discharged recently from
[**Hospital1 18**] ([**2173-11-19**]) after recovering from cholangitis who presented
again on [**2173-12-4**] with a 24-hour history of vague abdominal
discomfort with a fever to 101.0.

MEDICAL HISTORY: 1. Coronary artery disease status post CABG in [**2161**].
2. Atrial fibrillation on Coumadin.
3. Vestibular schwannoma treated with chemotherapy at [**Hospital 14852**].
4. History of a hiatal hernia.
5. Total radical resection of the prostate.
6. Bilateral inguinal hernia repairs

MEDICATION ON ADMISSION: Amlodipine 5
Trazodone 50
Metoprolol 25 [**Hospital1 **]
ASA 81
Plavix 75
Warfarin
Protonix 40
Colace

ALLERGIES: Procardia

PHYSICAL EXAM: Temp 102.0  HR 91  BP 134/45  RR 24  SaO2 97% room air
Alert, oriented
Irregularly irregular rhythm
CTA b/l
Soft, nontender, nondistended. Slightly tender diffusely, +BS
hyperactive.
Rectal guiac negative.

FAMILY HISTORY: none

SOCIAL HISTORY: The patient denies any tobacco use, but admits to occasional
alcohol use. He lives alone and is retired. He has a supportive
family (niece, nephew). 

### Response:
{'Acute cholecystitis,Atrial fibrillation,Paralytic ileus,Long-term (current) use of anticoagulants,Aortocoronary bypass status,Unspecified essential hypertension'}
