CHIEF COMPLAINT: (L)LQ abdominal pain and diarrhea

PRESENT ILLNESS: Pt is a 65M admitted to Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] on [**3-12**] with
ischemic colitis which was managed non-operatively.  This was
after an admission [**0-0-**] for a thrombosis of his
aorto-bifem graft and for which he underwent thrombectomy on
[**2148-11-24**].  That post-op course was complicated by a
retro-peritoneal bleed requiring re-exploration, pelvic fluid
collection requiring IR drainage, and question of ischemic
colitis for which he underwent sigmoidoscopy on [**11-25**] and which
showed patchy ischemia and edema. The colitis was managed with
antibiotics and hydration.  He then returned from rehab
hyponatremic and nauseated with persistent diarrhea and was
admitted to the general surgery service.

MEDICAL HISTORY: HTN, hypercholesterolemia, CAD s/p 4-vessel CABG [**2129**] (Echo
[**11-25**] showed no wall motion abnormalities, EF>55% and +pulm
HTN), PE/DVT on Coumadin, reactive thrombocytosis, PVD s/p
aortobifem [**2119**]'s (s/p thrombectomy R limb & placement
interposition graft [**2148-11-25**]) & L AKA [**2119**], s/p L CEA

MEDICATION ON ADMISSION: 1. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO TID
(3 times a day).
Disp:*90 Tablet(s)* Refills:*2*
2. Fluticasone 110 mcg/Actuation Aerosol Sig: Two (2) Puff
Inhalation [**Hospital1 **] (2 times a day).
3. Albuterol 90 mcg/Actuation Aerosol Sig: Two (2) Puff
Inhalation Q6H (every 6 hours) as needed.
4. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO once a day.
5. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
6. Hydrochlorothiazide 12.5 mg Capsule Sig: One (1) Capsule PO
daily qam.
7. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q6H (every 6 hours) as needed for pain.
8. Levofloxacin 750 mg Tablet Sig: One (1) Tablet PO once a day:

ALLERGIES: Percocet

PHYSICAL EXAM: On day of admission:
.
99.2 102 95/54 16 97%2L
NAD, lying comfortably in bed. AOx3. Appears chronically ill.
No jaundice or icterus
CTA B/L
RRR
Abd: healed lower midline scar. sl distended. soft. diffusely
TTP, worst in LLQ with localized rebound. No guarding.
Guaiac +. Incontinent of thin brown stool
L AKA warm, well perfused
RLE warm, well perfused. Dop PT/DP
.
At Discharge:
.
VS: T:98.8, BP:142/90, P:69, RR:18, SaO2:96% RA
GEN: Deconditioned gentleman lying comfortably in bed in NAD.
HEENT: Sclerae anicteric. O-P moist, intact.
NECK: Supple. No lymphadenopathy.
LUNGS: CTA(B)
CARDIAC: RRR
ABD: Ostomy stoma pink, intact; bag in place. Midline wounds 6cm
x 4cm and 4cm x 3cm granulating, clean w/o significant exudate.
Wet-to-dry dressing placed for transfer. Normoactive BS x4.
Soft/NT/ND.
EXTREM: (L) AKA stump well perfused, warm, intact. (R) LE well
perfused, warm; no c/c/e. Pedal pulses 2+/4+.
SKIN: As above, otherwise intact.
NEURO: A+Ox3. NF/grossly intact.

FAMILY HISTORY: -vascular disease
-sister -- "lost a foot" in her 40's b/c no blood flow
-brother -- arm amputated after down on floor for 3 days
-father passed from [**Name (NI) 4278**] disease and walking PNA
-mother w/ hernia

SOCIAL HISTORY: -prior to surgery was living w/ wife, daughter, son-in-law,
teenage grandson, mother in law, after surgery has been at
Country [**Hospital 731**] Rehab
-quit smoking 6 yrs ago, prior to that [**11-29**] PPD since age of 13
-no EtOH use for 27 yrs, but previously "almost alcoholic,"
drinking Whiskey, banana liquor, CC&coke, Canadian Mist
Acute vascular insufficiency of intestine,Perforation of intestine,Peritoneal abscess,Peripheral vascular disease, unspecified,Long-term (current) use of anticoagulants,Above knee amputation status,Personal history of venous thrombosis and embolism,Pure hypercholesterolemia,Unspecified essential hypertension,Aortocoronary bypass status
Ac vasc insuff intestine,Perforation of intestine,Peritoneal abscess,Periph vascular dis NOS,Long-term use anticoagul,Status amput above knee,Hx-ven thrombosis/embols,Pure hypercholesterolem,Hypertension NOS,Aortocoronary bypass
Admission Date:  [**2149-1-14**]              Discharge Date:   [**2149-2-7**]

Date of Birth:  [**2083-3-6**]             Sex:   M

Service: SURGERY

Allergies:
Percocet

Attending:[**First Name3 (LF) 2836**]
Chief Complaint:
(L)LQ abdominal pain and diarrhea

Major Surgical or Invasive Procedure:
[**2149-1-20**]:
1. Sigmoid colectomy, Hartmann's procedure
2. Partial small bowel resection


History of Present Illness:
 Pt is a 65M admitted to Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] on [**3-12**] with
ischemic colitis which was managed non-operatively.  This was
after an admission [**0-0-**] for a thrombosis of his
aorto-bifem graft and for which he underwent thrombectomy on
[**2148-11-24**].  That post-op course was complicated by a
retro-peritoneal bleed requiring re-exploration, pelvic fluid
collection requiring IR drainage, and question of ischemic
colitis for which he underwent sigmoidoscopy on [**11-25**] and which
showed patchy ischemia and edema. The colitis was managed with
antibiotics and hydration.  He then returned from rehab
hyponatremic and nauseated with persistent diarrhea and was
admitted to the general surgery service.

Last night he was transferred from Rehab to [**Hospital3 26615**] Hospital
with severe LLQ abdominal pain.  Patient reports pain jumped
from 0 to
"11".  Then has gone back down.  Also nausea, vomiting. Fever to
101.7
per the patient.  No chills.  Reports persistent diarrhea since
leaving the hospital.  No CP.  Has SOB with activity.  Reports
his RLE is not painful at this time.


Past Medical History:
HTN, hypercholesterolemia, CAD s/p 4-vessel CABG [**2129**] (Echo
[**11-25**] showed no wall motion abnormalities, EF>55% and +pulm
HTN), PE/DVT on Coumadin, reactive thrombocytosis, PVD s/p
aortobifem [**2119**]'s (s/p thrombectomy R limb & placement
interposition graft [**2148-11-25**]) & L AKA [**2119**], s/p L CEA


Social History:
-prior to surgery was living w/ wife, daughter, son-in-law,
teenage grandson, mother in law, after surgery has been at
Country [**Hospital 731**] Rehab
-quit smoking 6 yrs ago, prior to that [**11-29**] PPD since age of 13
-no EtOH use for 27 yrs, but previously "almost alcoholic,"
drinking Whiskey, banana liquor, CC&coke, Canadian Mist


Family History:
-vascular disease
-sister -- "lost a foot" in her 40's b/c no blood flow
-brother -- arm amputated after down on floor for 3 days
-father passed from [**Name (NI) 4278**] disease and walking PNA
-mother w/ hernia


Physical Exam:
On day of admission:
.
99.2 102 95/54 16 97%2L
NAD, lying comfortably in bed. AOx3. Appears chronically ill.
No jaundice or icterus
CTA B/L
RRR
Abd: healed lower midline scar. sl distended. soft. diffusely
TTP, worst in LLQ with localized rebound. No guarding.
Guaiac +. Incontinent of thin brown stool
L AKA warm, well perfused
RLE warm, well perfused. Dop PT/DP
.
At Discharge:
.
VS: T:98.8, BP:142/90, P:69, RR:18, SaO2:96% RA
GEN: Deconditioned gentleman lying comfortably in bed in NAD.
HEENT: Sclerae anicteric. O-P moist, intact.
NECK: Supple. No lymphadenopathy.
LUNGS: CTA(B)
CARDIAC: RRR
ABD: Ostomy stoma pink, intact; bag in place. Midline wounds 6cm
x 4cm and 4cm x 3cm granulating, clean w/o significant exudate.
Wet-to-dry dressing placed for transfer. Normoactive BS x4.
Soft/NT/ND.
EXTREM: (L) AKA stump well perfused, warm, intact. (R) LE well
perfused, warm; no c/c/e. Pedal pulses 2+/4+.
SKIN: As above, otherwise intact.
NEURO: A+Ox3. NF/grossly intact.


Pertinent Results:
[**2149-1-14**] 05:37AM   LACTATE-1.2
[**2149-1-14**] 05:30AM   GLUCOSE-109* UREA N-6 CREAT-0.6 SODIUM-132*
POTASSIUM-3.8 CHLORIDE-97 TOTAL CO2-27 ANION GAP-12
[**2149-1-14**] 05:30AM   WBC-15.3* RBC-4.08* HGB-11.4* HCT-34.0*
MCV-83 MCH-28.0 MCHC-33.6 RDW-17.6*
[**2149-1-14**] 05:30AM   NEUTS-54.8 LYMPHS-35.4 MONOS-8.3 EOS-0.9
BASOS-0.6
[**2149-1-14**] 05:30AM   PLT COUNT-967*
[**2149-1-14**] 05:30AM   PT-37.1* PTT-49.0* INR(PT)-4.0*
.
[**2149-1-27**] Abd/Pelvic CT:
1. Rim-enhancing collection in the pelvis just superior to the
bladder
represents abscess. This is amenable to percutaneous drainage.
2. Contrast reaches the enteroenteric anastomosis with minimal
contrast
extending to the cecum. While there is no evidence of complete
obstruction, a caliber change proximal to the anastamosis raises
suspicion for stenosis that is partially or intermittently
obstructive.
3. Diffuse anasarca and ascites.
4. Nodular appeareaing spleen is smaller since [**2148-12-27**], likely
representing the sequelae of embolic phenomenon.
.
[**2149-1-28**] IR procedure:
IMPRESSION: Successful CT-guided fluid aspiration from the right
lateral
midabdomen/upper pelvis. Samples were sent for Gram stain,
culture and
sensitivity. As there was no clear evidence of infection or
mature loculated area to drain, no drainage catheter was placed
at this time.
.
[**2149-1-28**] 10:00 am ABSCESS Culture:
GRAM STAIN (Final [**2149-1-28**]):
      4+   (>10 per 1000X FIELD):   POLYMORPHONUCLEAR
LEUKOCYTES.
      NO MICROORGANISMS SEEN.
      This is a concentrated smear made by cytospin method,
please refer to
      hematology for a quantitative white blood cell count..
WOUND CULTURE (Final [**2149-1-31**]):    NO GROWTH.
ANAEROBIC CULTURE (Final [**2149-2-3**]):    NO GROWTH


Brief Hospital Course:
The patient was admitted to the hospital on [**1-14**].  He was
started on cipro/flagyl; foley catheter placed, NPO, IVF
started.

[**1-15**] started on TPN, diet advanced to clears
[**1-16**] given 2.5mg Vit K for elevated INR, continued TPN, abx
[**1-17**] NPO due to distention, PICC line placed, flexiseal placed,
NG tube placed, heparin drip started
[**1-18**] - [**1-19**] - continued heparin drip, antibiotics
[**1-20**] - taken to the operating room for a sigmoid colectomy.
While in the operating room, it was noted that there was dense
adhesion to the adjacent small bowel and a partial small bowel
resection was performed.  He tolerated the procedure and was
transferred to the ICU intubated overnight for respiratory
issues. Heparin drip at 500 started.
[**1-21**] - extubated in the morning, NGT in place, foley catheter in
place, remained on IVF, Heparin drip 500, TPN.
[**1-22**] - NG tube removed, diet advanced to sips, continued [**Hospital 19176**]
transferred to the floor, heparin drip increased to goal PTT
60-80. TPN
[**1-23**]- Warfarin restarted 5mg daily INR goal [**12-31**]. Continues on
Heparin drip. Received 2UPRBs for HCT 22. Out of bed with PT.
TPN
[**1-24**]- Clear diet with minimal nausea. Continues Heparin drip;
goal 60-80. PCA with good pain control. TPN
[**1-25**]- Pt. made NPO for diet again with IV abx. Lasix
administered.
[**1-26**]- Heparin gtt. Pt. OOB to chair. Lasix administered. TPN
[**1-27**]- CT abd/pelvis done; IR drainage on abscess performed. 20
ccs ascites looking fluid drained. Heparin gtt. Pt. OOB to
chair. Lasix administered. TPN.
[**1-28**]- Heparin gtt. Pt. OOB to chair. Lasix administered. TPN
[**1-29**]- Pt. begun on aspirin due to high platelet count. Lopressor
increased due to tachycardia. TPN. Lasix.
[**1-30**]- Pt. put on po meds and sips for diet. NGT discontinued.
TPN. Lasix. VAC w/ white sponge placed.
[**1-31**]- Heparin gtt discontinued. Lasix.
[**2-1**]- Lasix. TPN. No events.
[**2-2**]- Diet advanced to clear liquids. Pt. put on po meds,
including antibiotics. TPN. CVL discontinued. PICC placed.
[**2-3**]- Diet advanced to regular. VAC replaced. Pt. started on
Zinc. Coumadin reduced to 3 mg. TPN. PT on board.
[**2-4**]- Pt. placed on calorie counts. TPN reduced to half bag
overnight. Ensure supplements begun. Foley removed and standing
Lasix reduced to qday. Transfused.
[**2-5**]- Tolerating regular diet with supplements without N/V. TPN
continued to augment nutrtion until patient able to meet total
daily caloric goal of approximately 1800. Warfarin dose
decreased to 1mg in evening for INR 3.2. Remained
hemodynamically stable; no bleeding.
[**2-6**]- Continued to tolerate diet well. TPN continued as
prescribed. Abdominal wounds healing well with VAC dressing.
Continues hemodynamically stable.
[**2-7**]- Tolerating diet. TPN continues as prescibed. Continues
hemodynamically stable. Discharged to rehabilitation.


Medications on Admission:
1. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO TID
(3 times a day).
Disp:*90 Tablet(s)* Refills:*2*
2. Fluticasone 110 mcg/Actuation Aerosol Sig: Two (2) Puff
Inhalation [**Hospital1 **] (2 times a day).
3. Albuterol 90 mcg/Actuation Aerosol Sig: Two (2) Puff
Inhalation Q6H (every 6 hours) as needed.
4. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO once a day.
5. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
6. Hydrochlorothiazide 12.5 mg Capsule Sig: One (1) Capsule PO
daily qam.
7. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q6H (every 6 hours) as needed for pain.
8. Levofloxacin 750 mg Tablet Sig: One (1) Tablet PO once a day:

Please take until follow-up appt with Dr. [**First Name (STitle) **].
9. Flagyl 500 mg Tablet Sig: One (1) Tablet PO three times a
day: Please take until follow-up appt with Dr. [**First Name (STitle) **].
10. Acetaminophen 325 mg Tablet Sig: One (1) Tablet PO every [**3-3**]

hours as needed for fever, pain: Do not exceed 4gm acetaminophen

intake daily  .
11. Warfarin 2 mg Tablet Sig: Seven (7) mg PO daily in the
evening.


Discharge Medications:
1. Fluticasone 110 mcg/Actuation Aerosol Sig: Two (2) Puff
Inhalation [**Hospital1 **] (2 times a day).
2. Albuterol 90 mcg/Actuation Aerosol Sig: 1-2 Puffs Inhalation
Q4H (every 4 hours) as needed.
3. Nystatin 100,000 unit/mL Suspension Sig: Five (5) ML PO QID
(4 times a day) as needed.
4. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
5. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

6. Hydrochlorothiazide 12.5 mg Capsule Sig: One (1) Capsule PO
DAILY (Daily).
7. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
8. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO TID
(3 times a day).
9. Dilaudid 2 mg Tablet Sig: 1-2 Tablets PO every 4-6 hours.
10. Zinc Sulfate 220 mg Capsule Sig: One (1) Capsule PO DAILY
(Daily).
11. Ciprofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q12H
(every 12 hours) for 5 days. Tablet(s)
12. Insulin Regular Human 100 unit/mL Solution Sig: One (1)
Injection ASDIR (AS DIRECTED): As directed per regular insulin
sliding scale.
13. Heparin Flush (10 units/ml) 2 mL IV PRN line flush
PICC, heparin dependent: Flush with 10mL Normal Saline followed
by Heparin as above daily and PRN per lumen.
14. Flagyl 500 mg Tablet Sig: One (1) Tablet PO every eight (8)
hours for 5 days.
15. Hydrocodone-Acetaminophen 5-500 mg Tablet Sig: One (1)
Tablet PO Q6H (every 6 hours) as needed.
16. Warfarin 2.5 mg Tablet Sig: One (1) Tablet PO Once Daily at
4 PM.


Discharge Disposition:
Extended Care

Facility:
[**Hospital **] Medical Center - [**Hospital1 3597**]

Discharge Diagnosis:
Primary:
Ischemic Colitis s/p sigmoid colectomy, partial small bowel
obstruction


Discharge Condition:
Good


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.

*Avoid lifting objects > 10lbs until your follow-up appointment
with the surgeon.

*Avoid driving or operating heavy machinery while taking pain
medications.
* 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.
* Please resume all regular home medications and take any new
meds
as ordered.
* Continue to ambulate several times per day.
.
Incision Care:
-Your steri-strips will fall off on their own. Please remove any
remaining strips 7-10 days after surgery.
-You may shower, and wash surgical incisions.
-Avoid swimming and baths until your follow-up appointment.
-Please call the doctor if you have increased pain, swelling,
redness, or drainage from the incision sites.

Monitoring Ostomy output/Prevention of Dehydration:
-Keep well hydrated.
-Replace fluid loss from ostomy daily.
-Avoid only drinking plain water. Include Gatorade and/or other
vitamin drinks to replace fluid.
-Try to maintain ostomy output between 1000mL to 1500mL per day.

-If Ostomy output >1 liter, take 4mg of Imodium, repeat 2mg with
each episode of loose stool. Do not exceed 16mg/24 hours.

VAC Dressing:
*Black Granu-foam VAC Dressing set at 125mmHg
*Monitor for wound site redness, swelling, new pain, prurulent
drainage in collection container, loss of vacuum suction, or if
*Maintain VAC dressing settings as prescribed and battery
charge.


Followup Instructions:
Please call the office of Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] at [**Telephone/Fax (1) 2998**] to
arrange a follow up appointment in [**12-31**] weeks



Completed by:[**2149-2-7**]
{'Acute vascular insufficiency of intestine,Perforation of intestine,Peritoneal abscess,Peripheral vascular disease, unspecified,Long-term (current) use of anticoagulants,Above knee amputation status,Personal history of venous thrombosis and embolism,Pure hypercholesterolemia,Unspecified essential hypertension,Aortocoronary bypass status'}


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: (L)LQ abdominal pain and diarrhea

PRESENT ILLNESS: Pt is a 65M admitted to Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] on [**3-12**] with
ischemic colitis which was managed non-operatively.  This was
after an admission [**0-0-**] for a thrombosis of his
aorto-bifem graft and for which he underwent thrombectomy on
[**2148-11-24**].  That post-op course was complicated by a
retro-peritoneal bleed requiring re-exploration, pelvic fluid
collection requiring IR drainage, and question of ischemic
colitis for which he underwent sigmoidoscopy on [**11-25**] and which
showed patchy ischemia and edema. The colitis was managed with
antibiotics and hydration.  He then returned from rehab
hyponatremic and nauseated with persistent diarrhea and was
admitted to the general surgery service.

MEDICAL HISTORY: HTN, hypercholesterolemia, CAD s/p 4-vessel CABG [**2129**] (Echo
[**11-25**] showed no wall motion abnormalities, EF>55% and +pulm
HTN), PE/DVT on Coumadin, reactive thrombocytosis, PVD s/p
aortobifem [**2119**]'s (s/p thrombectomy R limb & placement
interposition graft [**2148-11-25**]) & L AKA [**2119**], s/p L CEA

MEDICATION ON ADMISSION: 1. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO TID
(3 times a day).
Disp:*90 Tablet(s)* Refills:*2*
2. Fluticasone 110 mcg/Actuation Aerosol Sig: Two (2) Puff
Inhalation [**Hospital1 **] (2 times a day).
3. Albuterol 90 mcg/Actuation Aerosol Sig: Two (2) Puff
Inhalation Q6H (every 6 hours) as needed.
4. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO once a day.
5. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
6. Hydrochlorothiazide 12.5 mg Capsule Sig: One (1) Capsule PO
daily qam.
7. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q6H (every 6 hours) as needed for pain.
8. Levofloxacin 750 mg Tablet Sig: One (1) Tablet PO once a day:

ALLERGIES: Percocet

PHYSICAL EXAM: On day of admission:
.
99.2 102 95/54 16 97%2L
NAD, lying comfortably in bed. AOx3. Appears chronically ill.
No jaundice or icterus
CTA B/L
RRR
Abd: healed lower midline scar. sl distended. soft. diffusely
TTP, worst in LLQ with localized rebound. No guarding.
Guaiac +. Incontinent of thin brown stool
L AKA warm, well perfused
RLE warm, well perfused. Dop PT/DP
.
At Discharge:
.
VS: T:98.8, BP:142/90, P:69, RR:18, SaO2:96% RA
GEN: Deconditioned gentleman lying comfortably in bed in NAD.
HEENT: Sclerae anicteric. O-P moist, intact.
NECK: Supple. No lymphadenopathy.
LUNGS: CTA(B)
CARDIAC: RRR
ABD: Ostomy stoma pink, intact; bag in place. Midline wounds 6cm
x 4cm and 4cm x 3cm granulating, clean w/o significant exudate.
Wet-to-dry dressing placed for transfer. Normoactive BS x4.
Soft/NT/ND.
EXTREM: (L) AKA stump well perfused, warm, intact. (R) LE well
perfused, warm; no c/c/e. Pedal pulses 2+/4+.
SKIN: As above, otherwise intact.
NEURO: A+Ox3. NF/grossly intact.

FAMILY HISTORY: -vascular disease
-sister -- "lost a foot" in her 40's b/c no blood flow
-brother -- arm amputated after down on floor for 3 days
-father passed from [**Name (NI) 4278**] disease and walking PNA
-mother w/ hernia

SOCIAL HISTORY: -prior to surgery was living w/ wife, daughter, son-in-law,
teenage grandson, mother in law, after surgery has been at
Country [**Hospital 731**] Rehab
-quit smoking 6 yrs ago, prior to that [**11-29**] PPD since age of 13
-no EtOH use for 27 yrs, but previously "almost alcoholic,"
drinking Whiskey, banana liquor, CC&coke, Canadian Mist 

### Response:
{'Acute vascular insufficiency of intestine,Perforation of intestine,Peritoneal abscess,Peripheral vascular disease, unspecified,Long-term (current) use of anticoagulants,Above knee amputation status,Personal history of venous thrombosis and embolism,Pure hypercholesterolemia,Unspecified essential hypertension,Aortocoronary bypass status'}
