CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a [**Age over 90 **] year old
young lady with a history of hypothyroid, previous
appendectomy and hysterectomy who presented to the Emergency
Department with a one day history of severe abdominal pain.
The patient endorses nausea without vomiting, sweating,
dysuria, chest pain, and shortness of breath.  The patient
did not have any prior episodes of this type of pain.  The
patient has no history of ulcers.  The patient's last bowel
movement was [**8-14**], it was normal.  The patient
tolerated breakfast by mouth today without any complications.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Chronic or unspecified gastric ulcer with perforation, without mention of obstruction,Atrial fibrillation,Unspecified protein-calorie malnutrition,Duodenitis, without mention of hemorrhage,Alzheimer's disease,Dementia in conditions classified elsewhere without behavioral disturbance,Unspecified essential hypertension
Chr stomach ulcer w perf,Atrial fibrillation,Protein-cal malnutr NOS,Duodenitis w/o hmrhg,Alzheimer's disease,Dementia w/o behav dist,Hypertension NOS
Admission Date:  [**2188-8-14**]       Discharge Date:  [**2188-8-23**]


Service:  General Surgery - Blue Team

HISTORY OF PRESENT ILLNESS:  The patient is a [**Age over 90 **] year old
young lady with a history of hypothyroid, previous
appendectomy and hysterectomy who presented to the Emergency
Department with a one day history of severe abdominal pain.
The patient endorses nausea without vomiting, sweating,
dysuria, chest pain, and shortness of breath.  The patient
did not have any prior episodes of this type of pain.  The
patient has no history of ulcers.  The patient's last bowel
movement was [**8-14**], it was normal.  The patient
tolerated breakfast by mouth today without any complications.

PHYSICAL EXAMINATION:  On physical examination the patient
was afebrile 100.0, heartrate 80, blood pressure 148/74,
respiratory 24, 99% on room air.  In general she was alert
and oriented times three.  Cardiac examination was irregular.
Chest examination with a fair amount of air entry.  Abdominal
examination, tenderness, guarding mainly in the right lower
quadrant.  Positive tympani.  Extremities were warm, no edema
or erythema.  Rectal examination, guaiac negative.

LABORATORY DATA:  Laboratory data on admission revealed white
count 13.7, hematocrit 42, platelets 397, sodium 139,
potassium 4.1, chloride 97, bicarbonate 34, BUN 19,
creatinine 1.0, glucose 127.  Liver function tests, ALT 16,
AST 28, alkaline phosphatase 78, total bilirubin 0.5, amylase
43.  Urinalysis, trace leukocytes, small blood, trace
ketones, red blood cells [**2-13**] and white blood cells [**2-13**].
Chest x-ray showed free air in his diaphragm on the right.
Abdominal x-rays, upright film showed free air with air in
the colon.  Stool absent all the way down through the colon.

HOSPITAL COURSE:  The patient was admitted and placed on
Ampicillin, Levofloxacin, and Flagyl.  Blood cultures were
sent.  On hospital day #1, [**2188-8-15**], the patient
underwent partial gastrectomy and gastrojejunostomy with
placement of feeding J-tube for a perforated gastric ulcer.
The patient tolerated the procedure well and there were no
complications during the surgery.  The patient was placed in
the Intensive Care Unit over night, intubated.  On [**2188-8-16**], postoperative day #1, the patient was weaned from
ventilator support and extubated without difficulty.  The
patient's renal function improved to producing over 30 cc/hr
and soft bowel sounds were appreciated.  On postoperative day
#3 the patient was transferred to the floor.  On the floor,
the patient was started on half-strength tube feeds.  Total
parenteral nutrition was continued and by [**8-21**],
postoperative day #6 the patient was tolerating sips.  On the
day of [**8-20**], the patient had one episode of atrial
fibrillation that was successfully controlled with
intravenous Lopressor.  By [**8-22**], the patient was
tolerating liquids without difficulty.  Total parenteral
nutrition had been stopped, antibiotics had been stopped and
rehabilitation planning had started.  Tube feeds were
increased to almost goal.  On [**8-23**], the patient was
tolerating full liquids without difficulty and was discharged
to rehabilitation.  The patient will be discharged to
[**Hospital **] Rehabilitation in good condition.  She is able to
ambulate with assistance, tolerate full liquids and has no
further need for antibiotics.

DISCHARGE DIAGNOSIS:
1.  Status post partial gastrectomy for perforation of gastric
ulcer, sepsis,
2.  Status post gastrojejunostomy
3.  Status post placement of
feeding J-tube
4.  Hypothyroid
5.  Status post appendectomy
6.  Status post hysterectomy
7. Coronary Artery Disease, Hypertension
8. Dementia
9. Malnutrition
10. Esophageal Motility Disorder

DISCHARGE MEDICATIONS:
1.  Acetaminophen 325 mg tablets, one to two tablets by mouth
q. 4-6 hours as needed
2.  Metoprolol 50 mg tablets [**12-15**] tablet by mouth twice a day
3.  Pantoprazole 40 mg tablets one tablet every 24 hours
4.  Prednisone 10 mg one tablet by mouth three times a day



                            [**Name6 (MD) 843**] [**Name8 (MD) 844**], M.D.  [**MD Number(1) 845**]

Dictated By:[**Name8 (MD) 846**]
MEDQUIST36

D:  [**2188-8-23**]  09:54
T:  [**2188-8-23**]  11:26
JOB#:  [**Job Number 847**]
{"Chronic or unspecified gastric ulcer with perforation, without mention of obstruction,Atrial fibrillation,Unspecified protein-calorie malnutrition,Duodenitis, without mention of hemorrhage,Alzheimer's disease,Dementia in conditions classified elsewhere without behavioral disturbance,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 [**Age over 90 **] year old
young lady with a history of hypothyroid, previous
appendectomy and hysterectomy who presented to the Emergency
Department with a one day history of severe abdominal pain.
The patient endorses nausea without vomiting, sweating,
dysuria, chest pain, and shortness of breath.  The patient
did not have any prior episodes of this type of pain.  The
patient has no history of ulcers.  The patient's last bowel
movement was [**8-14**], it was normal.  The patient
tolerated breakfast by mouth today without any complications.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{"Chronic or unspecified gastric ulcer with perforation, without mention of obstruction,Atrial fibrillation,Unspecified protein-calorie malnutrition,Duodenitis, without mention of hemorrhage,Alzheimer's disease,Dementia in conditions classified elsewhere without behavioral disturbance,Unspecified essential hypertension"}
