CHIEF COMPLAINT: abdominal pain

PRESENT ILLNESS: 79F hx/o HTN, HLD possible prior episode of pancreaitis who
initially presented to OSH on [**2172-4-6**] with sudden onset
abdominal pain radiation to the back associated with nausea &
vomiting.  The patient's pain originally started in her
epigastrium and radiated to her R back & shoulder.  She was
unable to tolerate PO intake secondary to symptoms.  There were
no factors that relieved her pain.
The patient also endorsed some diarrhea.  Review of systems
otherwise negative at OSH.

MEDICAL HISTORY: - HTN
- HLD
- Remote history of ? pancreatitis vs ulcers

MEDICATION ON ADMISSION: - Metoprolol 50 mg QD
- Lisinopril 20 mg QD
- Pravastatin 40 mg QD
- Amlodipine 5 mg QD
- Aspirin 81mg daily
- MVI

ALLERGIES: lisinopril

PHYSICAL EXAM: ADMISSION EXAM:
GEN: Well-appearing female resting in bed in NAD
HEENT: Small 0.5 cm in diameter excoriation on upper lip. Poor
dentition.
NECK: JVD at 9 cm.
COR: +S1S2, possible S3. No m/g/r.
PULM: Markedly diminished BS at bases. No c/w/[**Initials (NamePattern4) **]
[**Last Name (NamePattern4) **]: +NABS in 4Q. Soft, tender to deep palpation in epigastrium
& RUQ. Negative [**Doctor Last Name 515**].
EXT: Trace LE edema.
NEURO: Awake, alert.

FAMILY HISTORY: Aunt: problems with gallbladder
Father: stomach cancer, neck cancer

SOCIAL HISTORY: Lives with daughter. Denies smoking, alcohol, or illicit drug
use
Acute pancreatitis,Acute edema of lung, unspecified,Unspecified pleural effusion,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Hypoxemia
Acute pancreatitis,Acute lung edema NOS,Pleural effusion NOS,Hypertension NOS,Hyperlipidemia NEC/NOS,Hypoxemia
Admission Date:  [**2172-4-8**]              Discharge Date:   [**2172-4-14**]

Date of Birth:  [**2093-1-30**]             Sex:   F

Service: MEDICINE

Allergies:
lisinopril

Attending:[**First Name3 (LF) 1943**]
Chief Complaint:
abdominal pain

Major Surgical or Invasive Procedure:
NONE

History of Present Illness:
79F hx/o HTN, HLD possible prior episode of pancreaitis who
initially presented to OSH on [**2172-4-6**] with sudden onset
abdominal pain radiation to the back associated with nausea &
vomiting.  The patient's pain originally started in her
epigastrium and radiated to her R back & shoulder.  She was
unable to tolerate PO intake secondary to symptoms.  There were
no factors that relieved her pain.
The patient also endorsed some diarrhea.  Review of systems
otherwise negative at OSH.

On initial pressentation, 98  66  133/77  16  100% RA.  Her exam
was significant for poor dentition, mild tenderness to palpation
in epigastrium with radiation to L flank.

OSH labs revealed WBC 17.7, hemoglobin 13.6, amylase 3498,
lipase [**Numeric Identifier **], creatinine 1.04, AST 86.

At OSH, the patient was treated with IVF and IV morphine for
pain control.  Triglycerides noted to be 33 on [**2172-4-7**]. Imaging
studies were obtained including a RUQ U/S which was read as
being moderately distended without definitive wall thickening or
stones.  A CT abdomen on [**2172-4-7**] showed "extensive fluid around
the pancrease compatible with acute pancreatitis.  GB appears
mildly distended some apparent wall thickening and
pericholcystic fluid. GB findings may be related to adjacent
pancreatitis.  Acute cholcecystitis not excluded with
certaintly.  There is no obvious dilatation of the common duct."
 Finally, a HIDA scan was performed on [**2172-4-7**] which was
"negative for cystic duct obstruction or active cholecystisis"
it was, however abnormal for "moderaltely delayed bile transit
time from BG and liver into small intestines" concerning for
distal CBD obstruction or Sphincter of Oddi spasm (possibly
related to morphine).

At some point during her hospitalization at OSH she as startred
on levothyroxine and flagyl.  She was also on a morphine PCA.

Today, lipase 724.  She was noted to have an increasing oxygen
requirement. Given the patient's ongoing pain and risk for ARDS,
her family requested transfer to [**Location (un) 86**] for evaluation by a
GI/pancreas team.

On arrival to the ICU, VSS WNL.  Reports improved pain compared
to prior.

REVIEW OF SYSTEMS:
(+): Abdominal pain
(-): HA, chest pain, SOB, diarrhea, nausea, vomiting, focal
numbness or weakness, cough.

Past Medical History:
- HTN
- HLD
- Remote history of ? pancreatitis vs ulcers

Social History:
Lives with daughter. Denies smoking, alcohol, or illicit drug
use

Family History:
Aunt: problems with gallbladder
Father: stomach cancer, neck cancer

Physical Exam:
ADMISSION EXAM:
GEN: Well-appearing female resting in bed in NAD
HEENT: Small 0.5 cm in diameter excoriation on upper lip. Poor
dentition.
NECK: JVD at 9 cm.
COR: +S1S2, possible S3. No m/g/r.
PULM: Markedly diminished BS at bases. No c/w/[**Initials (NamePattern4) **]
[**Last Name (NamePattern4) **]: +NABS in 4Q. Soft, tender to deep palpation in epigastrium
& RUQ. Negative [**Doctor Last Name 515**].
EXT: Trace LE edema.
NEURO: Awake, alert.

DISCHARGE EXAM:
Vitals:  98.3  98.1   120/40  90   18  94  RA
GEN: Well-appearing female resting in bed in NAD
HEENT: Small 0.5 cm in diameter excoriation on upper lip. Poor
dentition.
CV: PMI non-displaced, RRR, nl S1-S2, no MRG
PULM: Diminished BS at bases. No c/w/r.
[**Last Name (un) **]: soft, mildly diffusely tender, mildly distended, no
rebound/guarding
EXT: WWP, trace LE edema.
NEURO: awake, A&Ox3, CNs II-XII grossly intact

Pertinent Results:
ADMISSION LABS:

[**2172-4-8**] 01:50AM BLOOD WBC-15.4* RBC-4.23 Hgb-12.8 Hct-40.3
MCV-95 MCH-30.3 MCHC-31.8 RDW-12.6 Plt Ct-218
[**2172-4-8**] 01:50AM BLOOD Neuts-88.4* Lymphs-5.1* Monos-6.4 Eos-0
Baso-0.1
[**2172-4-8**] 01:50AM BLOOD PT-13.9* PTT-31.9 INR(PT)-1.3*
[**2172-4-8**] 01:50AM BLOOD Glucose-113* UreaN-17 Creat-0.7 Na-139
K-4.3 Cl-107 HCO3-24 AnGap-12
[**2172-4-8**] 01:50AM BLOOD ALT-25 AST-28 LD(LDH)-187 AlkPhos-53
Amylase-436* TotBili-0.9
[**2172-4-8**] 01:50AM BLOOD Lipase-595*
[**2172-4-8**] 01:50AM BLOOD Calcium-8.3* Phos-2.4* Mg-2.1
[**2172-4-8**] 01:50AM BLOOD Triglyc-63
[**2172-4-8**] 02:48AM BLOOD Type-[**Last Name (un) **] pO2-29* pCO2-42 pH-7.39
calTCO2-26 Base XS--1
[**2172-4-8**] 02:48AM BLOOD Lactate-1.3

MICROBIOLOGY:
[**4-8**] Urine culture

LIVER OR GALLBLADDER US (SINGLE ORGAN) Study Date of [**2172-4-9**]
8:44 AM

FINDINGS:
The hepatic echotexture is unremarkable. No concerning liver
lesion is
identified. No biliary dilatation is seen in the common duct
measures 0.5 cm.
The portal vein is patent with hepatopetal flow.

There is sludge seen within the lumen of the gallbladder. No
gallstones are
identified. No gallbladder wall edema or pericholecystic fluid
is seen.

The pancreas and midline structures including the aorta are
obscured from view
by overlying bowel gas. The spleen is unremarkable, measuring
7.0 cm. No
hydronephrosis is seen on limited views of the kidneys. A trace
of ascites is
seen in the left upper quadrant, however, no ascites is seen in
the lower
quadrants. There is a small right pleural effusion.

IMPRESSION:

-> No gallstones identified. There is sludge within the lumen of
the
gallbladder. No signs of cholecystitis.

-> The pancreas could not be visualized.

-> Trace of ascites and small right pleural effusion.

CTA CHEST W&W/O C&RECONS, NON-CORONARY Study Date of [**2172-4-11**]
10:25 PM
IMPRESSION:
1. No evidence of pulmonary embolism or acute aortic injury.
2. Bilateral moderate pleural effusions with adjacent airspace
atelectasis,
left greater than right.
3. Sequela of pancreatitis are again noted in the limited
visualized portions of the upper abdomen.

[**2172-4-14**] 08:00AM BLOOD WBC-11.0 RBC-3.50* Hgb-10.5* Hct-33.2*
MCV-95 MCH-30.0 MCHC-31.7 RDW-12.9 Plt Ct-345
[**2172-4-8**] 01:50AM BLOOD Neuts-88.4* Lymphs-5.1* Monos-6.4 Eos-0
Baso-0.1
[**2172-4-14**] 08:00AM BLOOD PT-13.5* PTT-37.5* INR(PT)-1.3*
[**2172-4-14**] 08:00AM BLOOD Glucose-102* UreaN-10 Creat-0.6 Na-137
K-3.9 Cl-101 HCO3-28 AnGap-12
[**2172-4-13**] 09:00AM BLOOD Glucose-97 UreaN-11 Creat-0.5 Na-138
K-3.4 Cl-99 HCO3-30 AnGap-12
[**2172-4-9**] 07:25AM BLOOD ALT-14 AST-21 TotBili-0.8
[**2172-4-8**] 01:50AM BLOOD Lipase-595*
[**2172-4-14**] 08:00AM BLOOD Mg-2.1
[**2172-4-13**] 09:00AM BLOOD Calcium-8.0* Phos-3.0 Mg-1.8
[**2172-4-12**] 07:35AM BLOOD Calcium-7.8* Phos-3.0 Mg-1.9
[**2172-4-8**] 01:50AM BLOOD Triglyc-63

Brief Hospital Course:
79 F with HTN, [**Hospital 33210**] transferred from OSH with acute pancreatitis
with possible remote history of pancreatitis in the past.

# Acute Pancreatitis: Lipase [**Numeric Identifier 961**]+ on admission to OSH;
trending down prior to transfer.  Etiology unclear in the
absence of alcohol use or evidence of obstruction on OSH
imaging.  Biliary sludging vs Sphincter of Oddi spasm on the
differential, although would not expect these to cause such
profound pancreatitis (by lab analysis).  Likely that patient
has cholelithiasis, with stone not imaged on OSH scans.  Her
history of post-prandial intermittent RUQ pain would be c/w this
diagnosis.  Overnight, she was continued on IVF with NS @
120cc/hr.  This was increased to 150cc/hr the following morning.
 Pain was controlled with dilaudid prn pain.  GI consulted
recommended repeat RUQ U/S which showed some "No gallstones
identified. There is sludge within the lumen of the gallbladder.
No signs of cholecystitis." The etiology was never clear of why
she had this epsidoe, but supportive care was done with bowel
rest, pain control, IVF and ursodiol was started because of
sludge. Lisinopril was stopped because of possible etiology
contribution. She was diuresed secondary to pulmonary edema and
was discharged tolerated a regular diet, pain controlled,
ambulating on room air.

# Hypoxia [**1-30**] Pulmonary edema and Pulmonary effusion: Pt was 96%
on 2L of oxygen by NC at OSH.  On arrival to ICU, sat 93% on RA,
no complaints of SOB.  No crackles or JVD to suggest volume
overload. Unclear how much volume resucitation took place at
OSH.  Bibasilar dullness suspicious for effusions vs atelectasis
vs. habitus (although no crackles). Overnight, patient was
started on 2L supplemental oxygen. During the course of her stay
on the floor, she was volume resuscitated and developed acute
pulmonary edema and pulmonary effusion. This improved with lasix
and autodiuresis.

# Leukocytosis: Admitted with WBC 17 at OSH, subsequently
trended down to 10.  Possibly hemoconcentration vs. stress
response in setting of acute pancreatitis.

# HTN:  lisinopril held. Toprol XL continued.

# Hyperlipidemia: Continued statin.

Transitions of care:
-followup with gastroenterology regarding possible need for
cholecystectomy.

Medications on Admission:
- Metoprolol 50 mg QD
- Lisinopril 20 mg QD
- Pravastatin 40 mg QD
- Amlodipine 5 mg QD
- Aspirin 81mg daily
- MVI

Discharge Medications:
1. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
2. pravastatin 40 mg Tablet Sig: One (1) Tablet PO once a day.
3. multivitamin     Tablet Sig: One (1) Tablet PO DAILY (Daily).

4. ursodiol 300 mg Capsule Sig: One (1) Capsule PO BID (2 times
a day).
Disp:*60 Capsule(s)* Refills:*0*
5. acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO Q8H (every
8 hours) as needed for pain.
6. ondansetron 4 mg Tablet, Rapid Dissolve Sig: One (1) Tablet,
Rapid Dissolve PO three times a day as needed for nausea.
Disp:*15 Tablet, Rapid Dissolve(s)* Refills:*0*
7. metoprolol succinate 50 mg Tablet Extended Release 24 hr Sig:
One (1) Tablet Extended Release 24 hr PO once a day.
8. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day): hold for diarrhea.
Disp:*60 Capsule(s)* Refills:*0*
9. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day): hold for diarrhea.
Disp:*60 Tablet(s)* Refills:*0*
10. bisacodyl 5 mg Tablet Sig: [**12-30**] Tablet, Delayed Release
(E.C.)s PO DAILY (Daily) as needed for constipation: hold for
diarrhea.
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*0*
11. ibuprofen 400 mg Tablet Sig: One (1) Tablet PO twice a day
as needed for pain.

Discharge Disposition:
Home

Discharge Diagnosis:
Primary:
pancreatitis
pleural effusions

Secondary:
hypertension

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

Discharge Instructions:
It was a pleasure participating in your care at [**Hospital1 18**]. You were
admitted to the hospital for abdominal pain and found to have
pancreatitis. The cause of this was still not entirely clear.
You were treated with bowel rest, intravenous fluids and pain
medicine and improved to the point where you could be discharged
home.

REGARDING YOUR MEDICATIONS...
Medications STARTED that you should continue:
ursodiol, colace, senna, bisacodyl, ibuprofen, tylenol

Medications STOPPED this admission:
lisinopril (may have caused the pancreatitis), amlodipine.

Otherwise, it is very important that you take all of your usual
home medications as directed in your discharge paperwork.

Followup Instructions:
Name: [**Doctor Last Name **],SAYEEDA
Location: [**Hospital 46644**] MEDICAL ASSOCIATES
Address: [**Street Address(2) **], [**Location **],[**Numeric Identifier 21771**]
Phone: [**Telephone/Fax (1) 82227**]
When: Tuesday, [**2171-4-21**]:15 AM

Department: DIV. OF GASTROENTEROLOGY
When: WEDNESDAY [**2172-4-22**] at 2:30 PM
With: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 22337**], MD [**Telephone/Fax (1) 463**]
Building: Ra [**Hospital Unit Name 1825**] ([**Hospital Ward Name 1826**]/[**Hospital Ward Name 1827**] Complex) [**Location (un) **]
Campus: EAST     Best Parking: Main Garage


Completed by:[**2172-4-14**]
{'Acute pancreatitis,Acute edema of lung, unspecified,Unspecified pleural effusion,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Hypoxemia'}


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: abdominal pain

PRESENT ILLNESS: 79F hx/o HTN, HLD possible prior episode of pancreaitis who
initially presented to OSH on [**2172-4-6**] with sudden onset
abdominal pain radiation to the back associated with nausea &
vomiting.  The patient's pain originally started in her
epigastrium and radiated to her R back & shoulder.  She was
unable to tolerate PO intake secondary to symptoms.  There were
no factors that relieved her pain.
The patient also endorsed some diarrhea.  Review of systems
otherwise negative at OSH.

MEDICAL HISTORY: - HTN
- HLD
- Remote history of ? pancreatitis vs ulcers

MEDICATION ON ADMISSION: - Metoprolol 50 mg QD
- Lisinopril 20 mg QD
- Pravastatin 40 mg QD
- Amlodipine 5 mg QD
- Aspirin 81mg daily
- MVI

ALLERGIES: lisinopril

PHYSICAL EXAM: ADMISSION EXAM:
GEN: Well-appearing female resting in bed in NAD
HEENT: Small 0.5 cm in diameter excoriation on upper lip. Poor
dentition.
NECK: JVD at 9 cm.
COR: +S1S2, possible S3. No m/g/r.
PULM: Markedly diminished BS at bases. No c/w/[**Initials (NamePattern4) **]
[**Last Name (NamePattern4) **]: +NABS in 4Q. Soft, tender to deep palpation in epigastrium
& RUQ. Negative [**Doctor Last Name 515**].
EXT: Trace LE edema.
NEURO: Awake, alert.

FAMILY HISTORY: Aunt: problems with gallbladder
Father: stomach cancer, neck cancer

SOCIAL HISTORY: Lives with daughter. Denies smoking, alcohol, or illicit drug
use 

### Response:
{'Acute pancreatitis,Acute edema of lung, unspecified,Unspecified pleural effusion,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Hypoxemia'}
