CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a 79-year-old male with
a previous medical history of hypertension, valvular heart
disease, atrial fibrillation, prostate cancer, status post
abdominal aortic aneurysm repair who presented to the [**Hospital1 1444**] Emergency Department with a
history of abdominal pain, nausea, vomiting of approximately
three days duration.  The patient described the pain as
crampy, diffused, worse in the right lower quadrant.  No
radiation.  No fever.  No chills.  No sweats.  The patient's
last bowel movement was immediately following a CAT scan done
on [**9-11**], hence three days prior.  Since that time
the patient has had no flatus and no bowel movements.  The
patient denies hematuria, cough, shortness of breath, chest
pain, palpitations, arthralgias, myalgias.  The patient did
report a decreased in appetite and increase in abdominal
distention.

MEDICAL HISTORY: 1.  Hypertension.
2.  Valvular heart disease.
3.  Atrial fibrillation.
4.  Prostate cancer.
5.  Status post abdominal aortic aneurysm repair.

MEDICATION ON ADMISSION: 1.  Coumadin 5 mg q.o.d.
2.  Lasix 40 mg daily.
3.  Lisinopril 5 mg once daily.
4.  Ativan 1 mg q.h.s. p.r.n.
5.  Metoprolol 50 mg twice a day.

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Hernia of other specified sites, with obstruction,Atrial fibrillation,Congestive heart failure, unspecified,Long-term (current) use of anticoagulants,Unspecified essential hypertension,Personal history of malignant neoplasm of prostate
Hernia, site NEC w obstr,Atrial fibrillation,CHF NOS,Long-term use anticoagul,Hypertension NOS,Hx-prostatic malignancy
Admission Date:  [**2200-9-15**]     Discharge Date:  [**2200-9-26**]


Service:  Surgery

HISTORY OF PRESENT ILLNESS:  This is a 79-year-old male with
a previous medical history of hypertension, valvular heart
disease, atrial fibrillation, prostate cancer, status post
abdominal aortic aneurysm repair who presented to the [**Hospital1 1444**] Emergency Department with a
history of abdominal pain, nausea, vomiting of approximately
three days duration.  The patient described the pain as
crampy, diffused, worse in the right lower quadrant.  No
radiation.  No fever.  No chills.  No sweats.  The patient's
last bowel movement was immediately following a CAT scan done
on [**9-11**], hence three days prior.  Since that time
the patient has had no flatus and no bowel movements.  The
patient denies hematuria, cough, shortness of breath, chest
pain, palpitations, arthralgias, myalgias.  The patient did
report a decreased in appetite and increase in abdominal
distention.

PAST MEDICAL HISTORY:
1.  Hypertension.
2.  Valvular heart disease.
3.  Atrial fibrillation.
4.  Prostate cancer.
5.  Status post abdominal aortic aneurysm repair.

MEDICATIONS ON ADMISSION:
1.  Coumadin 5 mg q.o.d.
2.  Lasix 40 mg daily.
3.  Lisinopril 5 mg once daily.
4.  Ativan 1 mg q.h.s. p.r.n.
5.  Metoprolol 50 mg twice a day.

LABS ON ADMISSION:  White blood cell count 10.7, hematocrit
48.5, platelet count 211.  PT 23.3, PTT 32.9.  INR 3.6.
Sodium 140, potassium 4.6, chloride 99, bicarbonate 27, BUN
40, creatinine 1.7, glucose 137, total bilirubin 1.7, ALT 25,
AST 35, alkaline phosphatase 74, amylase 72, lipase 38,
albumin 4.2.  Abdominal film done in the emergency department
showing a positive dilated loops of small bowel with no free
air, positive air fluid levels and positive retention of
barium from the CAT scan that was done on [**2200-9-11**].

HOSPITAL COURSE:  The gentleman was admitted with a diagnosis
of small bowel obstruction, placed on NPO and intravenous
fluids.  Hospital day number one the patient stated that he
was feeling much better.  Denied any nausea or vomiting and
decreased abdominal pain.  The patient remained afebrile 96.5
was temperature max.  The patient was placed on a three day
course of Levaquin when he complained of a slight burning on
urination.  On hospital day number three the patient
continued to have increasing improvement in his clinical exam
denying any abdominal pain and any complaints over night.
The patient also stated that he was not having any flatus or
bowel movements during the same period.  The patient
continued to atrial fibrillation as noted on the heart
monitor's.  This was a chronic underlying condition for the
patient.  On hospital day number four the patient underwent
an abdominal CAT scan to evaluate small bowel obstruction.
The CAT scan revealed a persistence of a small bowel
obstruction with a questionable transition point in the
jejunum.  It was then decided to take the patient to surgery
for an exploratory laparotomy and a question lysis of
adhesion and evaluation of small bowel obstruction.  The
patient underwent an exploratory laparotomy, lysis of
adhesion, reduction of internal hernia and repair of small
bowel on [**2200-9-18**].  The patient tolerated this
procedure well was extubated in the operating room and
transferred to the recovery room without incident.
Postoperatively the patient was returned to the floor and it
was noted that the patient remained in atrial fibrillation
with his heart rate between 110 and 120.  The patient had one
episode of agitation, confusion and delirium during which he
pulled out his nasogastric tube.  The patient's O2
saturations dropped to 90 percent while on three liters and
the patient started having expiratory wheezes.  The patient
was given 10 mg intravenous Lasix and greater than 400 cc of
urine was excreted.  The patient's inspiratory status did not
improve dramatically and there was questionable probable
volume overload.  At this point the patient was transferred
to the CSRU for respiratory distress.  An atrial line was
placed.  The patient during this time was ruled out for
ischemia.  The patient continued on intravenous Lasix to
diurese the excessive fluid.  By postoperative day number two
the patient was transferred back to the floor.  While on the
floor the patient continues to do well, starting to pass
flatus and the pain was well controlled.  By postoperative
day number five the patient was on the low fat diet
tolerating this without difficulty.  The patient was taken
off TPN and evaluation for home services.  The patient was
also restarted on his Coumadin for his chronic atrial
fibrillation.  By postoperative day number six the patient
was tolerating low fat diet without difficulty.  He was
started on beta-blocker Metoprolol 25 mg twice a day and
continuation with Diltiazem-LD 120 twice a day and his
Coumadin was started.  The patient remained in rapid atrial
fibrillation as was his baseline cardiac condition.  On
postoperative day number eight the patient continued to do
well and was discharged to home.

CONDITION ON DISCHARGE:  Good, afebrile, pain well controlled
on oral pain medications, tolerating p.o. food without
difficulty, ambulating without assistance.

DISCHARGE DIAGNOSIS:
1.  Status post exploratory laparotomy for small bowel
obstruction.
2.  Lysis of adhesions.
3.  Reduction of internal hernia.
4.  Repair of small bowel.
5.  Hypertension.
6.  Valvular heart disease.
7.  Chronic atrial fibrillation.
8.  Prostate cancer.
9.  Status post abdominal aortic aneurysm repair.

DISCHARGE MEDICATIONS:
1.  Percocet one to two tablets p.o. q.4-6h. p.r.n. for pain.
2.  Coumadin 5 mg q. every other day.
3.  Lasix 40 mg q. daily.
4.  Lisinopril 5 mg daily.
5.  Ativan 1 mg q.h.s. p.r.n.
6.  Metoprolol 50 mg twice a day.

DISPOSITION:  The patient was discharged to home to follow-up
with Dr. [**Last Name (STitle) **] in two to three weeks.






                          [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 2213**], M.D.  [**MD Number(1) 2214**]

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

MEDQUIST36

D:  [**2200-11-12**]  15:03
T:  [**2200-11-13**]  13:33
JOB#:  [**Job Number 94743**]

cc:[**Last Name (NamePattern1) 44177**]
{'Hernia of other specified sites, with obstruction,Atrial fibrillation,Congestive heart failure, unspecified,Long-term (current) use of anticoagulants,Unspecified essential hypertension,Personal history of malignant neoplasm of prostate'}


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: This is a 79-year-old male with
a previous medical history of hypertension, valvular heart
disease, atrial fibrillation, prostate cancer, status post
abdominal aortic aneurysm repair who presented to the [**Hospital1 1444**] Emergency Department with a
history of abdominal pain, nausea, vomiting of approximately
three days duration.  The patient described the pain as
crampy, diffused, worse in the right lower quadrant.  No
radiation.  No fever.  No chills.  No sweats.  The patient's
last bowel movement was immediately following a CAT scan done
on [**9-11**], hence three days prior.  Since that time
the patient has had no flatus and no bowel movements.  The
patient denies hematuria, cough, shortness of breath, chest
pain, palpitations, arthralgias, myalgias.  The patient did
report a decreased in appetite and increase in abdominal
distention.

MEDICAL HISTORY: 1.  Hypertension.
2.  Valvular heart disease.
3.  Atrial fibrillation.
4.  Prostate cancer.
5.  Status post abdominal aortic aneurysm repair.

MEDICATION ON ADMISSION: 1.  Coumadin 5 mg q.o.d.
2.  Lasix 40 mg daily.
3.  Lisinopril 5 mg once daily.
4.  Ativan 1 mg q.h.s. p.r.n.
5.  Metoprolol 50 mg twice a day.

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Hernia of other specified sites, with obstruction,Atrial fibrillation,Congestive heart failure, unspecified,Long-term (current) use of anticoagulants,Unspecified essential hypertension,Personal history of malignant neoplasm of prostate'}
