CHIEF COMPLAINT: diverticulitis

PRESENT ILLNESS: 57 yo M was transferred from [**Hospital3 7571**]Hospital with
sigmoid
diverticulitis and partial small bowel obstruction.  Wife
reports
that pt began experiencing abdominal pain and constipation on
Monday which progressed until pt admitted himself to the OSH on
Wednesday.  Pt underwent CT scan on [**1-9**] which demonstrated
sigmoid diverticulitis and partial SBO.  Pt left AMA on [**1-10**],
but
returned on [**1-11**] with bilious vomiting and diarrhea.  Pt was
made
NPO and antibiotics were started.  Cardiology was consulted and
performed an ECHO due to history of CAD with CABG.  Repeat CT on
[**1-13**] demonstrated increased small bowel thickening and possible
abscesses.  Due to concern over the patient's EtOH withdrawal in
the perioperative setting, the pt was transferred to [**Hospital1 18**] for
further care.

MEDICAL HISTORY: Alcoholism
CAD with 2-vessel CABG
Hypertension
Hypercholesterolemia
Oral cancer

MEDICATION ON ADMISSION: Flagyl 500 mg IV q 8 hours
Levaquin 500 mg IV daily
Lisinopril 20 mg daily
ASA 325 mg daily
Wellbutrin 150 mg po BID
Folic acid 1 mg po daily
Protonix 40 mg IV dialy
Coreg 25 mg po BID
Lorazepam 3 mg po q 4 hours + CIWA
Nicotine patch 21 mg dilay
Magnesium oxide 400 mg [**Hospital1 **]
KCl 40 mEq po BID
Xopenex nebs 1.25 mg QID

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Upon Discharge:
VS: 98.9, 92, 102/60, 20, 95RA
NAD, AAO x 3
NCAT
RRR, S1S2
CTAB
Soft, ND, minimally tender to deep palpation. No rebound or
guarding
No C/C/E

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Chronic alcoholic, 5 large gin and tonic/day
Tobacco abuse
Married.
Diverticulitis of colon (without mention of hemorrhage),Cardiac arrest,Unspecified intestinal obstruction,Alcohol withdrawal delirium,Abscess of intestine,Other pulmonary insufficiency, not elsewhere classified,Other convulsions,Other encephalopathy,Other and unspecified alcohol dependence, continuous,Unspecified essential hypertension,Pure hypercholesterolemia,Personal history of malignant neoplasm of other and unspecified oral cavity and pharynx,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Other and unspecified special symptoms or syndromes, not elsewhere classified,Tobacco use disorder
Dvrtcli colon w/o hmrhg,Cardiac arrest,Intestinal obstruct NOS,Delirium tremens,Intestinal abscess,Other pulmonary insuff,Convulsions NEC,Encephalopathy NEC,Alcoh dep NEC/NOS-contin,Hypertension NOS,Pure hypercholesterolem,Hx-oral/pharynx malg NEC,Cor ath unsp vsl ntv/gft,Aortocoronary bypass,Special symptom NEC/NOS,Tobacco use disorder
Admission Date:  [**2154-1-13**]              Discharge Date:   [**2154-1-22**]

Date of Birth:  [**2096-12-20**]             Sex:   M

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 6346**]
Chief Complaint:
diverticulitis

Major Surgical or Invasive Procedure:
Central venous line placement


History of Present Illness:
57 yo M was transferred from [**Hospital3 7571**]Hospital with
sigmoid
diverticulitis and partial small bowel obstruction.  Wife
reports
that pt began experiencing abdominal pain and constipation on
Monday which progressed until pt admitted himself to the OSH on
Wednesday.  Pt underwent CT scan on [**1-9**] which demonstrated
sigmoid diverticulitis and partial SBO.  Pt left AMA on [**1-10**],
but
returned on [**1-11**] with bilious vomiting and diarrhea.  Pt was
made
NPO and antibiotics were started.  Cardiology was consulted and
performed an ECHO due to history of CAD with CABG.  Repeat CT on
[**1-13**] demonstrated increased small bowel thickening and possible
abscesses.  Due to concern over the patient's EtOH withdrawal in
the perioperative setting, the pt was transferred to [**Hospital1 18**] for
further care.

Past Medical History:
Alcoholism
CAD with 2-vessel CABG
Hypertension
Hypercholesterolemia
Oral cancer

Social History:
Chronic alcoholic, 5 large gin and tonic/day
Tobacco abuse
Married.


Family History:
Non-contributory

Physical Exam:
Upon Discharge:
VS: 98.9, 92, 102/60, 20, 95RA
NAD, AAO x 3
NCAT
RRR, S1S2
CTAB
Soft, ND, minimally tender to deep palpation. No rebound or
guarding
No C/C/E


Pertinent Results:
[**2154-1-13**] 05:16PM BLOOD WBC-11.9* RBC-3.20* Hgb-11.2* Hct-32.0*
MCV-100* MCH-35.1* MCHC-35.1* RDW-14.5 Plt Ct-290
[**2154-1-14**] 03:08AM BLOOD WBC-12.2* RBC-3.16* Hgb-10.8* Hct-31.5*
MCV-100* MCH-34.1* MCHC-34.2 RDW-14.7 Plt Ct-321
[**2154-1-16**] 01:59AM BLOOD WBC-22.1* RBC-3.44* Hgb-11.8* Hct-33.5*
MCV-98 MCH-34.2* MCHC-35.1* RDW-14.7 Plt Ct-478*
[**2154-1-17**] 05:55AM BLOOD WBC-20.6* RBC-3.47* Hgb-11.8* Hct-33.8*
MCV-97 MCH-34.1* MCHC-35.0 RDW-14.3 Plt Ct-505*
[**2154-1-17**] 04:44PM BLOOD WBC-18.2* RBC-3.79* Hgb-12.8* Hct-37.6*
MCV-99* MCH-33.8* MCHC-34.0 RDW-14.2 Plt Ct-717*
[**2154-1-18**] 06:16AM BLOOD WBC-14.5* RBC-3.30* Hgb-11.1* Hct-32.0*
MCV-97 MCH-33.7* MCHC-34.7 RDW-14.4 Plt Ct-557*
[**2154-1-19**] 02:53AM BLOOD WBC-14.4* RBC-3.22* Hgb-10.9* Hct-31.4*
MCV-97 MCH-33.7* MCHC-34.6 RDW-14.3 Plt Ct-555*
[**2154-1-20**] 06:00AM BLOOD WBC-14.3* RBC-3.33* Hgb-11.4* Hct-33.1*
MCV-99* MCH-34.2* MCHC-34.4 RDW-13.8 Plt Ct-632*
[**2154-1-21**] 08:40AM BLOOD WBC-11.8* RBC-3.39* Hgb-11.5* Hct-33.1*
MCV-98 MCH-33.8* MCHC-34.6 RDW-14.5 Plt Ct-636*
[**2154-1-13**] 05:16PM BLOOD PT-16.4* PTT-33.4 INR(PT)-1.5*
[**2154-1-13**] 05:16PM BLOOD Plt Ct-290
[**2154-1-16**] 01:59AM BLOOD PT-15.8* PTT-30.5 INR(PT)-1.4*
[**2154-1-13**] 05:16PM BLOOD Glucose-81 UreaN-11 Creat-0.7 Na-138
K-3.8 Cl-104 HCO3-24 AnGap-14
[**2154-1-14**] 03:08AM BLOOD Glucose-83 UreaN-8 Creat-0.6 Na-137 K-3.3
Cl-104 HCO3-24 AnGap-12
[**2154-1-14**] 03:00PM BLOOD Glucose-92 UreaN-5* Creat-0.6 Na-139
K-3.6 Cl-106 HCO3-24 AnGap-13
[**2154-1-15**] 04:22AM BLOOD Glucose-99 UreaN-3* Creat-0.6 Na-139
K-3.8 Cl-107 HCO3-24 AnGap-12
[**2154-1-16**] 01:59AM BLOOD Glucose-84 UreaN-4* Creat-0.6 Na-137
K-3.9 Cl-104 HCO3-25 AnGap-12
[**2154-1-17**] 05:55AM BLOOD Glucose-126* UreaN-8 Creat-0.6 Na-137
K-4.0 Cl-100 HCO3-26 AnGap-15
[**2154-1-17**] 04:44PM BLOOD Glucose-139* UreaN-8 Creat-0.8 Na-137
K-3.6 Cl-97 HCO3-20* AnGap-24*
[**2154-1-18**] 06:16AM BLOOD Glucose-133* UreaN-5* Creat-0.5 Na-136
K-3.8 Cl-102 HCO3-26 AnGap-12
[**2154-1-18**] 01:58PM BLOOD K-4.4
[**2154-1-19**] 02:53AM BLOOD Glucose-101 UreaN-4* Creat-0.6 Na-136
K-4.1 Cl-103 HCO3-25 AnGap-12
[**2154-1-19**] 02:37PM BLOOD K-3.8 HCO3-27
[**2154-1-20**] 06:00AM BLOOD Glucose-95 UreaN-4* Creat-0.7 Na-138
K-4.3 Cl-102 HCO3-24 AnGap-16
[**2154-1-21**] 08:40AM BLOOD Glucose-165* UreaN-7 Creat-0.8 Na-138
K-4.1 Cl-103 HCO3-25 AnGap-14
[**2154-1-13**] 05:16PM BLOOD ALT-5 AST-11 LD(LDH)-151 AlkPhos-58
TotBili-0.5
[**2154-1-14**] 03:08AM BLOOD ALT-3 AST-9 CK(CPK)-17* AlkPhos-56
TotBili-0.4
[**2154-1-14**] 11:09AM BLOOD CK(CPK)-34*
[**2154-1-15**] 04:37PM BLOOD ALT-4 AST-13 AlkPhos-60 TotBili-0.3
[**2154-1-17**] 05:55AM BLOOD ALT-6 AST-20 AlkPhos-69 TotBili-0.5
[**2154-1-17**] 09:56PM BLOOD CK(CPK)-36*
[**2154-1-18**] 06:16AM BLOOD CK(CPK)-23*
[**2154-1-18**] 01:58PM BLOOD CK(CPK)-35*
[**2154-1-14**] 03:08AM BLOOD CK-MB-2
[**2154-1-14**] 11:09AM BLOOD CK-MB-NotDone cTropnT-<0.01
[**2154-1-17**] 09:56PM BLOOD CK-MB-NotDone cTropnT-<0.01
[**2154-1-18**] 06:16AM BLOOD CK-MB-NotDone cTropnT-<0.01
[**2154-1-18**] 01:58PM BLOOD CK-MB-NotDone cTropnT-<0.01
[**2154-1-13**] 05:16PM BLOOD Albumin-2.6* Calcium-8.4 Phos-3.1 Mg-1.8
[**2154-1-14**] 03:08AM BLOOD Calcium-8.3* Phos-3.6 Mg-1.9
[**2154-1-14**] 03:00PM BLOOD Calcium-8.0* Phos-3.5 Mg-1.8
[**2154-1-15**] 04:22AM BLOOD Calcium-7.8* Phos-3.1 Mg-1.9
[**2154-1-16**] 01:59AM BLOOD Calcium-8.1* Phos-3.6 Mg-1.8
[**2154-1-17**] 05:55AM BLOOD Calcium-8.1* Phos-2.9 Mg-1.7
[**2154-1-17**] 04:44PM BLOOD Calcium-8.7 Phos-3.8 Mg-2.4
[**2154-1-18**] 06:16AM BLOOD Calcium-8.0* Phos-2.9 Mg-1.9
[**2154-1-18**] 01:58PM BLOOD Calcium-7.9* Phos-3.0 Mg-1.7
[**2154-1-19**] 02:53AM BLOOD Calcium-8.2* Phos-3.0 Mg-1.9
[**2154-1-19**] 02:37PM BLOOD Calcium-8.2* Phos-3.9 Mg-1.7
[**2154-1-20**] 06:00AM BLOOD Calcium-8.4 Phos-4.3 Mg-2.0
[**2154-1-21**] 08:40AM BLOOD Calcium-8.5 Phos-3.8 Mg-1.7
[**2154-1-13**] 05:37PM BLOOD Type-[**Last Name (un) **] pH-7.44
[**2154-1-13**] 08:38PM BLOOD Type-ART Temp-37.4 pO2-288* pCO2-37
pH-7.43 calTCO2-25 Base XS-1 Intubat-INTUBATED
[**2154-1-13**] 11:43PM BLOOD Type-ART pO2-184* pCO2-36 pH-7.45
calTCO2-26 Base XS-2
[**2154-1-14**] 03:31AM BLOOD Type-ART pO2-127* pCO2-36 pH-7.46*
calTCO2-26 Base XS-2
[**2154-1-15**] 04:34AM BLOOD Type-ART pO2-105 pCO2-34* pH-7.48*
calTCO2-26 Base XS-2
[**2154-1-15**] 01:51PM BLOOD Type-ART pO2-97 pCO2-39 pH-7.46*
calTCO2-29 Base XS-3
[**2154-1-15**] 03:12PM BLOOD Type-ART pO2-73* pCO2-33* pH-7.51*
calTCO2-27 Base XS-3
[**2154-1-13**] 05:37PM BLOOD freeCa-1.12
[**2154-1-15**] 03:12PM BLOOD freeCa-1.16

CXR [**1-14**]:
INDICATION: Nasogastric tube placement. No prior studies for
comparison.
Nasogastric tube terminates within the stomach, and an
endotracheal tube
terminates approximately 3.7 cm above the carina. Heart is
mildly enlarged, and interstitial pulmonary edema is present
within the lungs. No definite pleural effusion but left
costophrenic sulcus has been excluded, precluding assessment for
small effusion or peripheral left basilar abnormality.

CT abd/pelvis [**1-14**]:
IMPRESSION:
1. Sigmoid diverticulitis with a small contained performation.
2. Pelvic fluid collections associated with loops bowel, not
amenable to CT guided drainage.
3. Partial/early small bowel obstruction
4. Small bowel wall thickening, a non-specific finding in the
setting of
ascites and inflammation.

PORTABLE CHEST, [**2154-1-14**] WITH COMPARISON STUDY EARLIER THE SAME
DATE.
INDICATION: Line placement.
Left subclavian catheter terminates within the lower superior
vena cava, with no evidence of the pneumothorax. Interstitial
edema is improving, and discoid atelectasis at left lung base
has nearly resolved. Persistent right retrocardiac opacity, but
decrease in adjacent small right pleural effusion.

NON-CONTRAST HEAD CT [**1-17**]:
IMPRESSION: No acute intracranial pathology including no
hemorrhage. The study and the report were reviewed by the staff
radiologist.

CT Abd/Pelvis [**1-22**]:
Impression: Interval resolution of perihepatic ascites.
Previously described fluid collections are improved. No new
fluid collections are seen. Previoiusly seen dilated loops of
small bowel are no longer seen. Normal GB, kidneys, adrenals,
ureters, and spleen.


Brief Hospital Course:
Mr. [**Known lastname **] was transferred from [**Hospital3 7571**]Hospital with a
diagnosis of sigmoid
diverticulitis and partial small bowel obstruction. He was
initially placed in the SICU with the concern that he would need
an imminent operation. He was NPO with IVF and an NGT. He was
also started on broad spectrum ABX. He was intubated for
respiratory distress and agitation. Over a few days, he improved
clinically and his WBC count decreased and he was transferred to
the general floor.

On the floor he continued to improve and he was continued on
Cipro/Flagyl. On [**1-17**] he had a seizure, and went into
respiratory and cardiac arrest. A "Code Blue" was initiated and
he was resuscitated on the floor. IV Ativan was given, given his
history of EtOH abuse and signs of previous alcohol withdrawal.
He was transferred back to the SICU and stabilized on a CIWA
scale. Psychiatry and neurology consults were initiated. A CT of
his head was negative for organic process. After he was
stabilized on a regimen, he again returned to the general floor.

He continued to improve clinically and his WBC continued to
drop. A repeat CT of his abdomen/pelvis showed improvement of
his intra-abdominal fluid collections.

He was tolerating a regular diet prior to discharge. He was
cleared for home by PT. He was deemed not a good candidate for
inpatient [**Hospital **] rehab as he was screened by social work and case
management. His pain was well controlled. Psychiatrically and
neurologically, he was back to his baseline at discharge. He was
discharged home on [**2154-1-22**].

Medications on Admission:
Flagyl 500 mg IV q 8 hours
Levaquin 500 mg IV daily
Lisinopril 20 mg daily
ASA 325 mg daily
Wellbutrin 150 mg po BID
Folic acid 1 mg po daily
Protonix 40 mg IV dialy
Coreg 25 mg po BID
Lorazepam 3 mg po q 4 hours + CIWA
Nicotine patch 21 mg dilay
Magnesium oxide 400 mg [**Hospital1 **]
KCl 40 mEq po BID
Xopenex nebs 1.25 mg QID


Discharge Medications:
1. Lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

2. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
4. B Complex Vitamins     Capsule Sig: One (1) Cap PO DAILY
(Daily).
5. Albuterol Sulfate 90 mcg/Actuation HFA Aerosol Inhaler Sig:
Two (2) Puff Inhalation Q4H (every 4 hours) as needed for
wheezing.
6. Ipratropium Bromide 17 mcg/Actuation Aerosol Sig: Two (2)
Puff Inhalation QID (4 times a day).
7. Thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
8. Flagyl 500 mg Tablet Sig: One (1) Tablet PO three times a day
for 21 days.
Disp:*63 Tablet(s)* Refills:*0*
9. Ciprofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q12H
(every 12 hours) for 21 days.
Disp:*42 Tablet(s)* Refills:*0*
10. Bupropion 100 mg Tablet Sustained Release Sig: One (1)
Tablet Sustained Release PO DAILY (Daily).
11. Multivitamin     Tablet Sig: One (1) Tablet PO DAILY
(Daily).
12. Carvedilol 12.5 mg Tablet Sig: Two (2) Tablet PO BID (2
times a day).


Discharge Disposition:
Home

Discharge Diagnosis:
perforated diverticulitis
ETOH withdrawal


Discharge Condition:
Stable


Discharge Instructions:
Please call your doctor or return to the ER for any of the
following:
* You experience new chest pain, pressure, squeezing or
tightness.
* New or worsening cough or wheezing.
* If you are vomiting and cannot keep in fluids or your
medications.
* You are getting dehydrated due to continued vomiting,
diarrhea or other reasons. Signs of dehydration include dry
mouth, rapid heartbeat or feeling dizzy or faint when standing.
* You see blood or dark/black material when you vomit or have a
bowel movement.
* Your pain is not improving within 8-12 hours or not gone
within 24 hours. Call or return immediately if your pain is
getting worse or is changing location or moving to your chest or

back.
* You have shaking chills, or a fever greater than 101.5 (F)
degrees or 38(C) degrees.
* Any serious change in your symptoms, or any new symptoms that
concern you.
Other:
*Avoid lifting objects > 5lbs until your follow-up appointment
with the surgeon.
*Avoid driving or operating heavy machinery while taking pain
medications.
* Please resume all regular home medications and take any new
meds
as ordered.
* Continue to ambulate several times per day.

Followup Instructions:
Please follow up with Dr. [**First Name (STitle) 2819**] in 2 weeks. Call his office ASAP
to make an appointment. ([**Telephone/Fax (1) 6347**]. You do not need any new
imaging studies prior to your visit.



Completed by:[**2154-1-22**]
{'Diverticulitis of colon (without mention of hemorrhage),Cardiac arrest,Unspecified intestinal obstruction,Alcohol withdrawal delirium,Abscess of intestine,Other pulmonary insufficiency, not elsewhere classified,Other convulsions,Other encephalopathy,Other and unspecified alcohol dependence, continuous,Unspecified essential hypertension,Pure hypercholesterolemia,Personal history of malignant neoplasm of other and unspecified oral cavity and pharynx,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Other and unspecified special symptoms or syndromes, not elsewhere classified,Tobacco use disorder'}


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: diverticulitis

PRESENT ILLNESS: 57 yo M was transferred from [**Hospital3 7571**]Hospital with
sigmoid
diverticulitis and partial small bowel obstruction.  Wife
reports
that pt began experiencing abdominal pain and constipation on
Monday which progressed until pt admitted himself to the OSH on
Wednesday.  Pt underwent CT scan on [**1-9**] which demonstrated
sigmoid diverticulitis and partial SBO.  Pt left AMA on [**1-10**],
but
returned on [**1-11**] with bilious vomiting and diarrhea.  Pt was
made
NPO and antibiotics were started.  Cardiology was consulted and
performed an ECHO due to history of CAD with CABG.  Repeat CT on
[**1-13**] demonstrated increased small bowel thickening and possible
abscesses.  Due to concern over the patient's EtOH withdrawal in
the perioperative setting, the pt was transferred to [**Hospital1 18**] for
further care.

MEDICAL HISTORY: Alcoholism
CAD with 2-vessel CABG
Hypertension
Hypercholesterolemia
Oral cancer

MEDICATION ON ADMISSION: Flagyl 500 mg IV q 8 hours
Levaquin 500 mg IV daily
Lisinopril 20 mg daily
ASA 325 mg daily
Wellbutrin 150 mg po BID
Folic acid 1 mg po daily
Protonix 40 mg IV dialy
Coreg 25 mg po BID
Lorazepam 3 mg po q 4 hours + CIWA
Nicotine patch 21 mg dilay
Magnesium oxide 400 mg [**Hospital1 **]
KCl 40 mEq po BID
Xopenex nebs 1.25 mg QID

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Upon Discharge:
VS: 98.9, 92, 102/60, 20, 95RA
NAD, AAO x 3
NCAT
RRR, S1S2
CTAB
Soft, ND, minimally tender to deep palpation. No rebound or
guarding
No C/C/E

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Chronic alcoholic, 5 large gin and tonic/day
Tobacco abuse
Married. 

### Response:
{'Diverticulitis of colon (without mention of hemorrhage),Cardiac arrest,Unspecified intestinal obstruction,Alcohol withdrawal delirium,Abscess of intestine,Other pulmonary insufficiency, not elsewhere classified,Other convulsions,Other encephalopathy,Other and unspecified alcohol dependence, continuous,Unspecified essential hypertension,Pure hypercholesterolemia,Personal history of malignant neoplasm of other and unspecified oral cavity and pharynx,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Other and unspecified special symptoms or syndromes, not elsewhere classified,Tobacco use disorder'}
