CHIEF COMPLAINT: Common hepatic artery aneurysm

PRESENT ILLNESS: This is a 74-year-old male with a
history of chronic weight loss of unknown etiology, who,
while undergoing a workup, was found to have a 2- to 3-cm
common hepatic artery aneurysm.  He was consented for
resection of the aneurysm.

MEDICAL HISTORY: HTN
DJD
hepatic artery aneurism
migraines

MEDICATION ON ADMISSION: Atenolol 50 mg orally once a day, lisinopril 10 mg
orally once a day, trazodone 150 mg at night, a multivitamin,
vitamin B12, and vitamin C supplements.

ALLERGIES: Penicillins / Fluarix

PHYSICAL EXAM: vss afebrile
Gen: thin male in nad
Neck: supple, no jvd, trach midline
Card: RRR
Lungs: CTA bilat
Abd: soft +bs, no m/t/o; incision c/d/i
Extremities: fem/dp/pt pulses palpable bilat

FAMILY HISTORY: non contributory

SOCIAL HISTORY: current tobacco use - 7 cigarettes/day
no EtOH use
Aneurysm of other visceral artery,Nutritional marasmus,Urinary tract infection, site not specified,Body Mass Index less than 19, adult,Unspecified essential hypertension,Migraine, unspecified, without mention of intractable migraine without mention of status migrainosus,Loss of weight,Retention of urine, unspecified,Tobacco use disorder
Visceral aneurysm NEC,Nutritional marasmus,Urin tract infection NOS,BMI less than 19,adult,Hypertension NOS,Migrne unsp wo ntrc mgrn,Abnormal loss of weight,Retention urine NOS,Tobacco use disorder
Name:  [**Known lastname 11753**],[**Known firstname 7104**] J               Unit No:   [**Numeric Identifier 11754**]

Admission Date:  [**2146-6-16**]              Discharge Date:   [**2146-6-21**]

Date of Birth:  [**2072-1-25**]             Sex:   M

Service: SURGERY

Allergies:
Penicillins / Fluarix

Attending:[**First Name3 (LF) 5118**]
Addendum:
Patient was found to have a positive UA and was started on a 7
day course of Cipro 250mg [**Hospital1 **] for treament. His foley will be
removed on Friday [**6-24**] by his PCP

Discharge Disposition:
Home

                             [**Name6 (MD) 116**] [**Last Name (NamePattern4) 2878**] MD [**MD Number(2) 5119**]

Completed by:[**2146-6-21**]

Name:  [**Known lastname 11753**],[**Known firstname 7104**] J               Unit No:   [**Numeric Identifier 11754**]

Admission Date:  [**2146-6-16**]              Discharge Date:   [**2146-6-21**]

Date of Birth:  [**2072-1-25**]             Sex:   M

Service: SURGERY

Allergies:
Penicillins / Fluarix

Attending:[**First Name3 (LF) 5118**]
Addendum:
Please note:

During his hospitalization Mr. [**Known lastname **] suffered from severe
malnutrition based on [**Hospital 8**] hospital criteria of albumin of 3.0,
BMI of 18.0 and a cachetic appearance.

Discharge Disposition:
Home

                             [**Name6 (MD) 116**] [**Last Name (NamePattern4) 2878**] MD [**MD Number(2) 5119**]

Completed by:[**2146-8-1**]

Admission Date:  [**2146-6-16**]              Discharge Date:   [**2146-6-21**]

Date of Birth:  [**2072-1-25**]             Sex:   M

Service: SURGERY

Allergies:
Penicillins / Fluarix

Attending:[**First Name3 (LF) 6088**]
Chief Complaint:
Common hepatic artery aneurysm

Major Surgical or Invasive Procedure:
[**2146-6-16**]

Resection of common hepatic artery aneurysm, with
right greater saphenous vein interposition graft.


History of Present Illness:
This is a 74-year-old male with a
history of chronic weight loss of unknown etiology, who,
while undergoing a workup, was found to have a 2- to 3-cm
common hepatic artery aneurysm.  He was consented for
resection of the aneurysm.


Past Medical History:
HTN
DJD
hepatic artery aneurism
migraines

PSH:
status post cholecystectomy
bilateral carpal tunnel releases
recent biateral laparoscopic inguinal hernia repairs
C3-C4 posterior discectomy.

Social History:
current tobacco use - 7 cigarettes/day
no EtOH use


Family History:
non contributory

Physical Exam:
vss afebrile
Gen: thin male in nad
Neck: supple, no jvd, trach midline
Card: RRR
Lungs: CTA bilat
Abd: soft +bs, no m/t/o; incision c/d/i
Extremities: fem/dp/pt pulses palpable bilat

Pertinent Results:
[**2146-6-21**] 06:55AM BLOOD WBC-4.6 RBC-3.71* Hgb-11.7* Hct-33.2*
MCV-90 MCH-31.7 MCHC-35.4* RDW-14.2 Plt Ct-208
[**2146-6-20**] 08:10AM BLOOD WBC-4.9 RBC-3.69* Hgb-11.3* Hct-32.8*
MCV-89 MCH-30.6 MCHC-34.4 RDW-14.3 Plt Ct-218#
[**2146-6-18**] 03:45AM BLOOD WBC-6.1 RBC-3.32* Hgb-10.6* Hct-30.8*
MCV-93 MCH-32.0 MCHC-34.4 RDW-14.7 Plt Ct-137*
[**2146-6-17**] 04:26AM BLOOD WBC-6.4 RBC-3.45* Hgb-10.8* Hct-31.4*
MCV-91 MCH-31.3 MCHC-34.3 RDW-14.9 Plt Ct-204
[**2146-6-16**] 02:21PM BLOOD WBC-9.2 RBC-3.75* Hgb-12.0* Hct-35.2*
MCV-94 MCH-31.9 MCHC-34.0 RDW-14.9 Plt Ct-255
[**2146-6-21**] 06:55AM BLOOD Glucose-107* UreaN-10 Creat-0.8 Na-138
K-4.0 Cl-98 HCO3-35* AnGap-9
[**2146-6-20**] 08:10AM BLOOD Glucose-96 UreaN-9 Creat-0.7 Na-133 K-3.8
Cl-94* HCO3-31 AnGap-12
[**2146-6-19**] 03:30AM BLOOD Glucose-152* UreaN-7 Creat-0.5 Na-133
K-3.8 Cl-97 HCO3-30 AnGap-10
[**2146-6-18**] 03:45AM BLOOD Glucose-113* UreaN-10 Creat-0.6 Na-134
K-3.7 Cl-100 HCO3-30 AnGap-8
[**2146-6-17**] 04:26AM BLOOD Glucose-115* UreaN-9 Creat-0.6 Na-137
K-4.0 Cl-104 HCO3-27 AnGap-10
[**2146-6-16**] 02:21PM BLOOD Glucose-138* UreaN-13 Creat-0.9 Na-140
K-4.6 Cl-111* HCO3-23 AnGap-11
[**2146-6-21**] 06:55AM BLOOD ALT-229* AST-44* AlkPhos-71 Amylase-77
TotBili-0.5
[**2146-6-20**] 08:10AM BLOOD ALT-333* AST-91* AlkPhos-72 Amylase-64
TotBili-0.5
[**2146-6-19**] 03:30AM BLOOD ALT-507* AST-355* AlkPhos-66 Amylase-66
TotBili-0.4
[**2146-6-18**] 03:45AM BLOOD ALT-555* AST-592* AlkPhos-63 Amylase-65
TotBili-0.3
[**2146-6-17**] 04:26AM BLOOD ALT-325* AST-336* AlkPhos-67 Amylase-88
TotBili-0.4
[**2146-6-16**] 02:21PM BLOOD ALT-316* AST-333* AlkPhos-71 Amylase-81
TotBili-0.3
[**2146-6-19**] 03:30AM BLOOD Lipase-30
[**2146-6-18**] 03:45AM BLOOD Lipase-30
[**2146-6-17**] 04:26AM BLOOD Lipase-42
[**2146-6-16**] 02:21PM BLOOD Lipase-88*
[**2146-6-21**] 06:55AM BLOOD Calcium-8.3* Phos-3.3 Mg-2.0
[**2146-6-20**] 08:10AM BLOOD Calcium-8.1* Phos-3.6# Mg-1.9
[**2146-6-19**] 03:30AM BLOOD Albumin-3.0* Calcium-8.0* Phos-1.8*
Mg-1.4* Iron-20*
[**2146-6-18**] 03:45AM BLOOD Calcium-8.1* Phos-2.8 Mg-1.9
[**2146-6-17**] 04:11PM BLOOD Calcium-8.0* Phos-3.2 Mg-1.7
[**2146-6-17**] 04:26AM BLOOD Calcium-8.4 Phos-4.3 Mg-2.0
[**2146-6-16**] 11:47PM BLOOD Calcium-8.1* Mg-2.4
[**2146-6-16**] 02:21PM BLOOD Calcium-8.2* Phos-4.7* Mg-1.6

[**2146-6-16**] 2:20 pm MRSA SCREEN      Source: Nasal swab.

                            **FINAL REPORT [**2146-6-19**]**

   MRSA SCREEN (Final [**2146-6-19**]):    No MRSA isolated.


Brief Hospital Course:
Mr. [**Known lastname 68553**] was admitted and underwent hepatic artery aneurysm
repair under general anesthesia with a tohoracic epidural on
[**2146-6-16**]. He tolerated the procedure well, was extubated and was
transfered to the CVICU postoperativey. He was hemodynamically
stable but did have some brief episodes of bradycardia which
resolved on their own. On POD 1 he was noted to have some
elevated LFTs, as expected. He was quite stable and was
transfered to the VICU for further recovery. In the vicu he
remained hemodynamically stable with good pain control. On POD 2
he tolerated a clear liquid diet and was OOB with assistance. A
nutrition consult was obtained given his recent weight loss and
preoperative status of having poor nutrition. He was advanced to
a regular diet on POD 3 with ensure supplements which he
tolerated well. He was transfered to the floor on POD 3 as well.
On POD 4 his epidural was removed. He tolerated PO pain meds
quite well. Later that day his foley was removed, and he voided
a small amount, however, by the evening he had not voided in
several hours and a bladder scan showed over 800cc of residual,
hence a foley was re placed. He was also started on flomax . His
jp drain was also removed on POD 4 without difficulty. He was
hemodynamically stable and able to ambulate without assistance.
On POD 5 he was tolerating his diet well and felt comfortable
with his foley and leg bag. He was evaluated by PT and found
stable to go home. He will follow up with his PCP on friday for
foley removal.

Medications on Admission:
Atenolol 50 mg orally once a day, lisinopril 10 mg
orally once a day, trazodone 150 mg at night, a multivitamin,
vitamin B12, and vitamin C supplements.


Discharge Medications:
1. Atenolol 50 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
2. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

3. Tamsulosin 0.4 mg Capsule, Sust. Release 24 hr Sig: One (1)
Capsule, Sust. Release 24 hr PO HS (at bedtime).
Disp:*30 Capsule, Sust. Release 24 hr(s)* Refills:*0*
4. Trazodone 150 mg Tablet Sig: One (1) Tablet PO at bedtime.
5. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
6. Hydromorphone 2 mg Tablet Sig: One (1) Tablet PO Q4H (every 4
hours) as needed for pain.
Disp:*20 Tablet(s)* Refills:*0*
7. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
8. Diphenhydramine HCl 25 mg Tablet Sig: One (1) Tablet PO Q6H
(every 6 hours) as needed for Itching.
9. Resume
OTC vitamins and minerals


Discharge Disposition:
Home

Discharge Diagnosis:
Common hepatic artery aneurysm.


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
Division of Vascular and Endovascular Surgery
Discharge Instructions

What to expect when you go home:
1. It is normal to feel weak and tired, this will last for [**5-31**]
weeks
??????	You should get up out of bed every day and gradually increase
your activity each day
??????	You may walk and you may go up and down stairs
??????	Increase your activities as you can tolerate- do not do too
much right away!

2. It is normal to have incisional and leg swelling:
??????	Wear loose fitting pants/clothing (this will be less
irritating to incision)
??????	Elevate your legs above the level of your heart (use [**1-26**]
pillows or a recliner) every 2-3 hours throughout the day and at
night
??????	Avoid prolonged periods of standing or sitting without your
legs elevated

3. It is normal to have a decreased appetite, your appetite will
return with time
??????	You will probably lose your taste for food and lose some
weight
??????	Eat small frequent meals
??????	It is important to eat nutritious food options (high fiber,
lean meats, vegetables/fruits, low fat, low cholesterol) to
maintain your strength and assist in wound healing
??????	To avoid constipation: eat a high fiber diet and use stool
softener while taking pain medication

What activities you can and cannot do:
??????	No driving until post-op visit and you are no longer taking
pain medications
??????	You should get up every day, get dressed and walk, gradually
increasing your activity
??????	You may up and down stairs, go outside and/or ride in a car
??????	Increase your activities as you can tolerate- do not do too
much right away!
??????	No heavy lifting, pushing or pulling (greater than 5 pounds)
until your post op visit
??????	You may shower (let the soapy water run over incision, rinse
and pat dry)
??????	Your incision may be left uncovered, unless you have small
amounts of drainage from the wound, then place a dry dressing
over the area that is draining, as needed
??????	Take all the medications you were taking before surgery,
unless otherwise directed
??????	Take one full strength (325mg) enteric coated aspirin daily,
unless otherwise directed
??????	Call and schedule an appointment to be seen in 2 weeks for
staple/suture removal

What to report to office:
??????	Redness that extends away from your incision
??????	A sudden increase in pain that is not controlled with pain
medication
??????	A sudden change in the ability to move or use your leg or the
ability to feel your leg
??????	Temperature greater than 101.5F for 24 hours
??????	Bleeding from incision
??????	New or increased drainage from incision or white, yellow or
green drainage from incisions

You had urinary retention and had your foley catheter replaced.
You will go home with a leg bag and catheter in place. Follow up
with your primary care doctor [**First Name (Titles) **] [**Last Name (Titles) **] in [**2-25**] days for
removal of the catheter.


Followup Instructions:
Provider: [**Name10 (NameIs) 251**] [**Last Name (NamePattern4) 1490**], MD Phone:[**Telephone/Fax (1) 1237**]
Date/Time:[**2146-7-6**] 9:45

Dr. [**Last Name (STitle) 11302**] [**Name (STitle) **] 1115 am
- follow up and foley removal



Completed by:[**2146-6-21**]
{'Aneurysm of other visceral artery,Nutritional marasmus,Urinary tract infection, site not specified,Body Mass Index less than 19, adult,Unspecified essential hypertension,Migraine, unspecified, without mention of intractable migraine without mention of status migrainosus,Loss of weight,Retention of urine, unspecified,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: Common hepatic artery aneurysm

PRESENT ILLNESS: This is a 74-year-old male with a
history of chronic weight loss of unknown etiology, who,
while undergoing a workup, was found to have a 2- to 3-cm
common hepatic artery aneurysm.  He was consented for
resection of the aneurysm.

MEDICAL HISTORY: HTN
DJD
hepatic artery aneurism
migraines

MEDICATION ON ADMISSION: Atenolol 50 mg orally once a day, lisinopril 10 mg
orally once a day, trazodone 150 mg at night, a multivitamin,
vitamin B12, and vitamin C supplements.

ALLERGIES: Penicillins / Fluarix

PHYSICAL EXAM: vss afebrile
Gen: thin male in nad
Neck: supple, no jvd, trach midline
Card: RRR
Lungs: CTA bilat
Abd: soft +bs, no m/t/o; incision c/d/i
Extremities: fem/dp/pt pulses palpable bilat

FAMILY HISTORY: non contributory

SOCIAL HISTORY: current tobacco use - 7 cigarettes/day
no EtOH use 

### Response:
{'Aneurysm of other visceral artery,Nutritional marasmus,Urinary tract infection, site not specified,Body Mass Index less than 19, adult,Unspecified essential hypertension,Migraine, unspecified, without mention of intractable migraine without mention of status migrainosus,Loss of weight,Retention of urine, unspecified,Tobacco use disorder'}
