CHIEF COMPLAINT: epigastric pain, increasing dyspnea on exertion

PRESENT ILLNESS: The patient is a 71 year old Chinese but English-speaking male
with a history of ?renal artery stenosis, chronic renal
insufficiency (Cr 4.8 at [**Hospital1 **]), HTN and DM2 with no known CAD
who presented to [**Hospital 5871**] hospital on [**5-4**] with epigastric pain x
1 week and increasing dyspnea on exertion x 3-4 days. The
patient denies any chest pain but notes that in the past [**2-25**]
days he has difficulty walking a few steps before he feels short
of breath. He lives upstairs and has difficulty walking up 3-4
steps at a time secondary to shortness of breath. He also admits
to increasing lower extremity edema. He uses 2 pillows at night
which has not increased recently.
.
Regarding his abdominal pain, the patient first noted this 1
week ago in the RUQ, epigastrium.  He says it only hurts with
palpation. He also noted pain after meals but denies
nausea/vomiting and states that he is tolerating PO.  He denies
diarrhea/constipation but states that his stool looks
"yellowish" and that his urine is dark. He denies
pruritus/jaundice.  He denies fevers but admits to chills. No
night sweats or weight loss.
.
At [**Hospital1 **], a RUQ U/S was performed which showed dilatation of
the intrahepatic biliary ducts and common bile duct which
measures 1.2 cm. The pancreatic duct was also dilated.  The
gallbladder had no stones.  The findings were suggestive of
distal CBD stone or mass.
An CXR showed increased lung markings in the right lung.
Furthermore, his labs showed elevated ALP of 186, bili WNL,
amylase 188, lipase 75, WBC 14.2, and BNP [**2055**]. Troponin 0.03,
CK 62.
.
The patient was then transferred to [**Hospital1 18**] for further
evaluation. He was found to be hypertensive to the 200-240 range
despite having taken his am meds.  He was given 10 mg IV
hydralazine x 2, lopressor 5 mg IV x 1, and clonidine 0.3 mg X
1.  His BP returned to 180.
.
ROS:  As above. Denies any cough. Chills but no fevers/night
sweats. No HA/blurry vision.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: Crestor 10 mg PO QD
Metoprolol 50 mg [**Hospital1 **]
Omeprazole 40 mg QD
Clonidine 0.3 mg PO BID
Norvasc 10 mg PO QD
Lisinopril 20 mg PO QD
Glipizide 10 mg PO QD
Aspirin 325 mg PO QD
Levothyroxine 150 mcg PO QD

ALLERGIES: Penicillins / Lipitor

PHYSICAL EXAM: Vitals: T   P 57  BP 200/54  RR 16  Sa 100% on RA
Gen: NAD, pleasant Chinese male, mild respiratory distress (pt
denies any shortness of breath), no accessory muscle use
HEENT: PERLA, dirty sclera, anicteric, PERLA, EOMI, bilateral
carotid bruits, no [**First Name4 (NamePattern1) **]
[**Last Name (NamePattern1) 3495**]: RRR, Grade I/VI soft, SEM at RUSB, RRR, S1, S2
Lungs: CTAB
Abdomen: Focal right-sided epigastric pain with palpation, no
rebound/guarding, hyperactive BS, negative [**Doctor Last Name **] sign, no HS
Rectal: Guaiac negative
Ext: +2 pitting edema to bilateral knees, +1 d. pedis
bilaterally
Skin: Mild, erythematous, nonblanching macules on abdomen (new),
nonpruritic
Neuro: CN II-XII grossly intact

FAMILY HISTORY: pt was adopted

SOCIAL HISTORY: 
Acute pancreatitis,Pneumonia, organism unspecified,Hemorrhage complicating a procedure,Acute posthemorrhagic anemia,Calculus of bile duct without mention of cholecystitis, with obstruction,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Chronic kidney disease, Stage V,Diastolic heart failure, unspecified,Unspecified procedure as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Other specified disorders of biliary tract,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Gout, unspecified,Other specified acquired hypothyroidism,Atherosclerosis of renal artery
Acute pancreatitis,Pneumonia, organism NOS,Hemorrhage complic proc,Ac posthemorrhag anemia,Choledochlith NOS w obst,Hyp kid NOS w cr kid V,Chron kidney dis stage V,Diastolc hrt failure NOS,Abn react-procedure NOS,Dis of biliary tract NEC,DMII wo cmp nt st uncntr,Gout NOS,Acquired hypothyroid NEC,Renal artery atheroscler
Admission Date:  [**2147-5-5**]              Discharge Date:   [**2147-5-14**]

Date of Birth:  [**2075-6-7**]             Sex:   M

Service: MEDICINE

Allergies:
Penicillins / Lipitor

Attending:[**First Name3 (LF) 613**]
Chief Complaint:
epigastric pain, increasing dyspnea on exertion

Major Surgical or Invasive Procedure:
ERCP s/p spincterotomy
EGD x 2
blood transfusion

History of Present Illness:
The patient is a 71 year old Chinese but English-speaking male
with a history of ?renal artery stenosis, chronic renal
insufficiency (Cr 4.8 at [**Hospital1 **]), HTN and DM2 with no known CAD
who presented to [**Hospital 5871**] hospital on [**5-4**] with epigastric pain x
1 week and increasing dyspnea on exertion x 3-4 days. The
patient denies any chest pain but notes that in the past [**2-25**]
days he has difficulty walking a few steps before he feels short
of breath. He lives upstairs and has difficulty walking up 3-4
steps at a time secondary to shortness of breath. He also admits
to increasing lower extremity edema. He uses 2 pillows at night
which has not increased recently.
.
Regarding his abdominal pain, the patient first noted this 1
week ago in the RUQ, epigastrium.  He says it only hurts with
palpation. He also noted pain after meals but denies
nausea/vomiting and states that he is tolerating PO.  He denies
diarrhea/constipation but states that his stool looks
"yellowish" and that his urine is dark. He denies
pruritus/jaundice.  He denies fevers but admits to chills. No
night sweats or weight loss.
.
At [**Hospital1 **], a RUQ U/S was performed which showed dilatation of
the intrahepatic biliary ducts and common bile duct which
measures 1.2 cm. The pancreatic duct was also dilated.  The
gallbladder had no stones.  The findings were suggestive of
distal CBD stone or mass.
An CXR showed increased lung markings in the right lung.
Furthermore, his labs showed elevated ALP of 186, bili WNL,
amylase 188, lipase 75, WBC 14.2, and BNP [**2055**]. Troponin 0.03,
CK 62.
.
The patient was then transferred to [**Hospital1 18**] for further
evaluation. He was found to be hypertensive to the 200-240 range
despite having taken his am meds.  He was given 10 mg IV
hydralazine x 2, lopressor 5 mg IV x 1, and clonidine 0.3 mg X
1.  His BP returned to 180.
.
ROS:  As above. Denies any cough. Chills but no fevers/night
sweats. No HA/blurry vision.


Family History:
pt was adopted

Physical Exam:
Vitals: T   P 57  BP 200/54  RR 16  Sa 100% on RA
Gen: NAD, pleasant Chinese male, mild respiratory distress (pt
denies any shortness of breath), no accessory muscle use
HEENT: PERLA, dirty sclera, anicteric, PERLA, EOMI, bilateral
carotid bruits, no [**First Name4 (NamePattern1) **]
[**Last Name (NamePattern1) 3495**]: RRR, Grade I/VI soft, SEM at RUSB, RRR, S1, S2
Lungs: CTAB
Abdomen: Focal right-sided epigastric pain with palpation, no
rebound/guarding, hyperactive BS, negative [**Doctor Last Name **] sign, no HS
Rectal: Guaiac negative
Ext: +2 pitting edema to bilateral knees, +1 d. pedis
bilaterally
Skin: Mild, erythematous, nonblanching macules on abdomen (new),
nonpruritic
Neuro: CN II-XII grossly intact

Pertinent Results:
Renal Angiogram [**2144**]: 50% R RAS, 14 mm Hg gradient
.
Colonoscopy [**4-14**]: Benign Polyp at 20 cm (polypectomy).  Mild
diverticulosis of R colon.  Small hemorrhoids
.
EGD [**4-14**]: Non-obstructing esophageal ring in lower esophagus.
Small hiatal hernia.  Gastritis (biopsy).  Duodenitis.
.
RUQ U/S @ OSH [**5-4**]: dilatation of the intrahepatic biliary ducts
and common bile duct which measures 1.2 cm.  The pancreatic duct
was also dilated. The gallbladder had no stones.
.
CXR [**5-5**]: Patchy opacities over lying the right lung concerning
for
pneumonia.  If there are no infectious symptoms, bronchoalveolar
carcinoma should be considered.
.
TTE [**5-5**]: 1. There is mild symmetric LVH with normal cavity
size. Regional left ventricular wall motion is normal. Left
ventricular systolic function is hyperdynamic (EF>75%).  2. The
aortic valve leaflets (3) are mildly thickened.  3. The mitral
valve leaflets are mildly thickened.  4. There is a small
pericardial effusion. There are no echocardiographic signs of
tamponade.
.
CT Abd/Pelvis [**5-5**]: Limited study secondary to lack of IV
contrast. Dilated common bile duct without evidence of ductal
stone. Possible prominence of the pancreatic head, but no
definite masses identified. MRCP could be helpful for further
evaluation. Multiple poorly defined patchy opacity seen at the
right lung base, incompletely characterized. Findings are
concerning for pneumonia, however, if there is a lack of
infectious symptoms, bronchoalveolar carcinoma could have a
similar appearance. Followup imaging recommended to document
resolution.
.
MRI Renal/MRCP [**5-5**]: 1. Intra- and extrahepatic biliary
dilatation, down to the level of the ampulla. No filling defects
or stones are identified. Vague area of enhancement is seen in
the expected location of the ampulla. Findings suggest ampullary
stenosis and further evaluation is recommended with an ERCP
examination. Underlying ampullary neoplasm cannot be excluded.
2. Evidence of chronic pancreatitis with moderate stenosis of
the pancreatic duct in the pancreatic head. No definite
pancreatic head mass is identified. This finding can also be
evaluated by ERCP.
3. Moderately distended gallbladder with wall edema. Given the
evidence of third spacing of fluid, this is a nonspecific
finding.
4. Bilateral renal artery stenosis, right side greater than
left.
.
ERCP [**5-8**]: 1. The papilla was extremely tight, consistent with
ampullary stenosis.
2. Limited pancreatogram showed a somewhat ectatic duct,
consistent with chronic pancreatitis. No obvious strictures or
filling defects were seen.
3. The common bile duct was somewhat dilated. There was a
suggestion of small filling defects in the distal duct upon
initial contrast injection, which were not seen when the duct
was more fully filled out. This is consistent with
microlithiasis/sludge. No strictures or evidence of obstruction
were seen.
4. A sphincterotomy was performed in the 12 o'clock position
using a sphincterotome over an existing guidewire. Upon
sphincterotomy, the ampulla appeared somewhat full and bulging.
This area was biopsied with cold forceps for histology to rule
out neoplasm.
5. Microlithiasis was extracted successfully using a 11 mm
balloon.
.
EGD [**5-9**]: 1. Ongoing bleeding at sphincterotomy site. Achieved
hemostasis with submucosal epinephrine injection.
.
EGD [**5-10**]: 1. The sphincterotomy site was again seen actively
bleeding.  Upon irrigating and suctioning, clear bile was seen
draining into the duodenum.  2. A 7 Fr gold probe electrocautery
device was applied for hemostasis successfully. The site was
irrigated with saline and no further bleeding was seen.
.
.
[**2147-5-5**] 01:45AM   WBC-11.6* RBC-3.52* HGB-10.0* HCT-29.8*
MCV-85 MCH-28.4 MCHC-33.7 RDW-17.1*
[**2147-5-5**] 01:45AM   PLT COUNT-281
[**2147-5-5**] 01:45AM   PT-12.6 PTT-29.8 INR(PT)-1.1
[**2147-5-5**] 01:45AM   NEUTS-78.5* LYMPHS-12.3* MONOS-5.0 EOS-3.7
BASOS-0.4
.
[**2147-5-5**] 01:45AM   ALBUMIN-2.9*
[**2147-5-5**] 01:45AM   CK-MB-NotDone
[**2147-5-5**] 01:45AM   cTropnT-0.03*
[**2147-5-5**] 01:45AM   ALT(SGPT)-27 AST(SGOT)-18 CK(CPK)-62 ALK
PHOS-183* AMYLASE-135* TOT BILI-0.3
[**2147-5-5**] 01:45AM   LIPASE-134*
.
[**2147-5-5**] 01:45AM   GLUCOSE-81 UREA N-67* CREAT-4.7* SODIUM-141
POTASSIUM-4.2 CHLORIDE-113* TOTAL CO2-16* ANION GAP-16
.
[**2147-5-5**] 02:20AM URINE  RBC-0-2 WBC-[**6-3**]* BACTERIA-FEW
YEAST-NONE EPI-0-2
[**2147-5-5**] 02:20AM URINE  COLOR-Straw APPEAR-Clear SP [**Last Name (un) 155**]-1.017
.
[**2147-5-5**] 07:55AM   CK-MB-NotDone
[**2147-5-5**] 07:55AM   cTropnT-0.02*
[**2147-5-5**] 07:55AM   CK(CPK)-53
.
[**2147-5-5**] 08:08AM   LACTATE-1.0
[**2147-5-5**] 02:58PM   TYPE-[**Known firstname **] PO2-90 PCO2-29* PH-7.36 TOTAL
CO2-17*
.
[**2147-5-5**] 10:00PM   CK-MB-3 cTropnT-0.03*
[**2147-5-5**] 10:00PM   CK(CPK)-49

Brief Hospital Course:
71M with h/o DM2, HTN, and CRI/RAS who presented with epigastric
pain and increasing DOE with pancreatitis and ? ampullary mass.
Hospital course addressed by problem below:
.
# Abdominal pain: CT abdomen without contrast concerning for CBD
dilation and multiple patchy RLL opacities.  He underwent MRCP
c/w ampullary stenosis but no visualized stones in CBD; also c/w
chronic pancreatitis with moderate stenosis in head of
pancreatic duct.  He underwent ERCP and sphincterotomy with
biopsy for ampullary stenosis and extraction of small
stones/sludge from CBD.  Post-ERCP the patient developed
BRBPR/maroon stools without HD instability.  He underwent EGD
showing bleeding at sphincterotomy site; epinephrine was
injected with resolution of bleeding.  On [**5-9**] pt noted to have
HCT 24, received 2 units and HCT unchanged. Underwent second EGD
showing continued bleeding at sphincterotomy site.
Electrocautery was used to stop bleeding with transfusion of 4 u
pRBCs.  He was sent to the [**Hospital Unit Name 153**] for montioring during
resuscitation given his multiple comorbidities.
Overnight in the [**Hospital Unit Name 153**], his Hct rose from 24->37 with 4u of PRBC.
 His respiratory status remained stable and he was afebrile.
His BRBPR ceased and he tolerated PO liquids without any
complaints.  His Hct remained stable on the floor.
.
# Shortness of breath: His exam was consistent with CHF on
admission with an elevated JVD and +2 pitting edema to his knees
bilaterally at admission. The most likely etiology for his CHF
was thought to be HTN urgency with his SBP in the 200-240s in
the ED.  TTE showed diastolic dysfunction.  CXR showed evidence
of RLL PNA. ABG showed good oxygenation, and no A-a gradient.
He was ruled out for MI with serial enzymes.  He had no tele
events; d/ced telemetry.  He completed a 7 dya course of
levoflox for PNA.  He was advised for an outpatient CT scan in 2
months to follow ? of bronchioalveolar carcinoma vs PNA seen in
RLL).
.
# DM2: His glipizide was held while NPO.  He was covered with
humalog SS and FS QID.
.
# HTN urgency: This was thought to be related to his bilateral
renal artery stenosis.  He was continued on his home meds of
Norvasc 10 mg PO QD and metoprolol 50 mg [**Hospital1 **].  His lisinopril
was stopped in the setting of RAS.  He was started on a
clonidine patch to provide better BP control.
.
# Chronic renal insufficiency: His baseline was unknown
baseline.  The Renal team was consulted re need for stenting his
renal artery stenosis.  He was started on calcitriol and
nephrocaps for PTH 138.  SPEP and UPEP wnl.  Outpatient
follow-up with Dr [**Last Name (STitle) 1366**] was arranged.
.
# Acute gout: The patient had an acute flare to his R ankle on
[**5-8**].  This quickly subsided with one dose of colchicine and
prednisone 40 mg.

Medications on Admission:
Crestor 10 mg PO QD
Metoprolol 50 mg [**Hospital1 **]
Omeprazole 40 mg QD
Clonidine 0.3 mg PO BID
Norvasc 10 mg PO QD
Lisinopril 20 mg PO QD
Glipizide 10 mg PO QD
Aspirin 325 mg PO QD
Levothyroxine 150 mcg PO QD

Discharge Medications:
1. You should stop taking your Clonidine pills.
2. You should stop taking your lisinopril.
3. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every
4 to 6 hours) as needed.
4. Rosuvastatin 5 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
5. Levothyroxine 150 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
6. Amlodipine 5 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).

7. Clonidine 0.3 mg/24 hr Patch Weekly Sig: One (1) Patch Weekly
Transdermal QSAT (every Saturday): Please place new patch
starting Saturday [**5-20**].
Disp:*4 Patch Weekly(s)* Refills:*2*
8. Calcitriol 0.25 mcg Capsule Sig: One (1) Capsule PO EVERY
OTHER DAY (Every Other Day).
Disp:*30 Capsule(s)* Refills:*2*
9. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
10. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
11. Glipizide 10 mg Tablet Sig: One (1) Tablet PO once a day.
12. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO once a day.
13. B Complex-Vitamin C-Folic Acid 1 mg Capsule Sig: One (1) Cap
PO DAILY (Daily).
Disp:*30 capsules* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
HTN
CRF
chronic pancreatitis
ampullary stenosis
post-ERCP bleeding
..
DM2
hypothyroidism


Discharge Condition:
stable, tolerating PO diet, ambulating well, BP controlled,
stable Hct.

Discharge Instructions:
Please return if you experience worsened abdominal pain,
shortness of breath, leg swelling, blood in your stool,
black-colored stools, fever >101.5, decreased urination, chest
pain, or any other worrisome symptoms.
.
Please take all medications as directed.  You have been started
on a patch form of your clonidine, which is to be worn on the
skin.  You should stop taking your clonidine pills.  You should
also stop taking your lisinopril.  For your kidneys you have
been started on calcitriol.  Finally, you should not take
aranesp until you see Dr [**Last Name (STitle) 1366**] in clinic.

Followup Instructions:
Please follow-up with Dr [**Last Name (STitle) **] within 1-2 weeks at
[**Telephone/Fax (1) **].  You should discuss the abnormal finding of a mass
in your right lung with Dr [**Last Name (STitle) **].  You will need a repeat CT
scan of your chest.
.
Please follow-up with Dr [**Last Name (STitle) 1366**] within 2 weeks at [**Telephone/Fax (1) **].
You should not take your Aranesp until you see him.
.
Provider: [**First Name11 (Name Pattern1) 354**] [**Last Name (NamePattern4) 3013**], M.D. Date/Time:[**2147-5-17**] 11:15

                             [**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) **] MD [**MD Number(2) 617**]
{'Acute pancreatitis,Pneumonia, organism unspecified,Hemorrhage complicating a procedure,Acute posthemorrhagic anemia,Calculus of bile duct without mention of cholecystitis, with obstruction,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Chronic kidney disease, Stage V,Diastolic heart failure, unspecified,Unspecified procedure as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Other specified disorders of biliary tract,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Gout, unspecified,Other specified acquired hypothyroidism,Atherosclerosis of renal artery'}


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: epigastric pain, increasing dyspnea on exertion

PRESENT ILLNESS: The patient is a 71 year old Chinese but English-speaking male
with a history of ?renal artery stenosis, chronic renal
insufficiency (Cr 4.8 at [**Hospital1 **]), HTN and DM2 with no known CAD
who presented to [**Hospital 5871**] hospital on [**5-4**] with epigastric pain x
1 week and increasing dyspnea on exertion x 3-4 days. The
patient denies any chest pain but notes that in the past [**2-25**]
days he has difficulty walking a few steps before he feels short
of breath. He lives upstairs and has difficulty walking up 3-4
steps at a time secondary to shortness of breath. He also admits
to increasing lower extremity edema. He uses 2 pillows at night
which has not increased recently.
.
Regarding his abdominal pain, the patient first noted this 1
week ago in the RUQ, epigastrium.  He says it only hurts with
palpation. He also noted pain after meals but denies
nausea/vomiting and states that he is tolerating PO.  He denies
diarrhea/constipation but states that his stool looks
"yellowish" and that his urine is dark. He denies
pruritus/jaundice.  He denies fevers but admits to chills. No
night sweats or weight loss.
.
At [**Hospital1 **], a RUQ U/S was performed which showed dilatation of
the intrahepatic biliary ducts and common bile duct which
measures 1.2 cm. The pancreatic duct was also dilated.  The
gallbladder had no stones.  The findings were suggestive of
distal CBD stone or mass.
An CXR showed increased lung markings in the right lung.
Furthermore, his labs showed elevated ALP of 186, bili WNL,
amylase 188, lipase 75, WBC 14.2, and BNP [**2055**]. Troponin 0.03,
CK 62.
.
The patient was then transferred to [**Hospital1 18**] for further
evaluation. He was found to be hypertensive to the 200-240 range
despite having taken his am meds.  He was given 10 mg IV
hydralazine x 2, lopressor 5 mg IV x 1, and clonidine 0.3 mg X
1.  His BP returned to 180.
.
ROS:  As above. Denies any cough. Chills but no fevers/night
sweats. No HA/blurry vision.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: Crestor 10 mg PO QD
Metoprolol 50 mg [**Hospital1 **]
Omeprazole 40 mg QD
Clonidine 0.3 mg PO BID
Norvasc 10 mg PO QD
Lisinopril 20 mg PO QD
Glipizide 10 mg PO QD
Aspirin 325 mg PO QD
Levothyroxine 150 mcg PO QD

ALLERGIES: Penicillins / Lipitor

PHYSICAL EXAM: Vitals: T   P 57  BP 200/54  RR 16  Sa 100% on RA
Gen: NAD, pleasant Chinese male, mild respiratory distress (pt
denies any shortness of breath), no accessory muscle use
HEENT: PERLA, dirty sclera, anicteric, PERLA, EOMI, bilateral
carotid bruits, no [**First Name4 (NamePattern1) **]
[**Last Name (NamePattern1) 3495**]: RRR, Grade I/VI soft, SEM at RUSB, RRR, S1, S2
Lungs: CTAB
Abdomen: Focal right-sided epigastric pain with palpation, no
rebound/guarding, hyperactive BS, negative [**Doctor Last Name **] sign, no HS
Rectal: Guaiac negative
Ext: +2 pitting edema to bilateral knees, +1 d. pedis
bilaterally
Skin: Mild, erythematous, nonblanching macules on abdomen (new),
nonpruritic
Neuro: CN II-XII grossly intact

FAMILY HISTORY: pt was adopted

SOCIAL HISTORY:  

### Response:
{'Acute pancreatitis,Pneumonia, organism unspecified,Hemorrhage complicating a procedure,Acute posthemorrhagic anemia,Calculus of bile duct without mention of cholecystitis, with obstruction,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Chronic kidney disease, Stage V,Diastolic heart failure, unspecified,Unspecified procedure as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Other specified disorders of biliary tract,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Gout, unspecified,Other specified acquired hypothyroidism,Atherosclerosis of renal artery'}
