CHIEF COMPLAINT: abdominal pain

PRESENT ILLNESS: HPI: 53F with 2 weeks of jaundice, presenting with nausea,
vomiting and RUQ/epigastric pain since last night. Patient had
not seen any doctor for her 2 weeks of jaundice. Developed
nausea
last night and had 5 episodes of vomiting overnight. Also felt
some chills, but no objective fevers. Pain started early this
morning, constant in nature and progressively worse. Pt went to
to [**Hospital3 10310**], had a WBC of 18.5 (17% bands), Tbili 10.7,
lipase 1131. An U/S showed a CBD 15 mm, gallstones, no
gallbladder wall thickenning or pericholecystic fluid. In the ED
patient was slightly confused and BP down to 80/60s, improved
with 1L bolus of NS.

MEDICAL HISTORY: Past Surgical History: laparoscopic exploration

MEDICATION ON ADMISSION: Medications: calcium with vit. D 500 mg daily, dulcolax 5 mg
bedtime, lopid 600 mg twice daily, zantac 150 mg daily, senakot
2 tabs twice daily, tylenol 650 mg as needed for h/a, body
aches, clozaril 200 mg bedtime

ALLERGIES: Penicillins

PHYSICAL EXAM: Physical Exam: upon admission:

FAMILY HISTORY: NC

SOCIAL HISTORY: Social History: Lives alone, denies tobacco, EtOH, drugs
Calculus of gallbladder and bile duct without cholecystitis, with obstruction,Acute pancreatitis,Cholangitis,Myalgia and myositis, unspecified,Chronic fatigue syndrome
Gall&bil cal w/o ch w ob,Acute pancreatitis,Cholangitis,Myalgia and myositis NOS,Chronic fatigue syndrome
Admission Date:  [**2134-3-10**]              Discharge Date:   [**2134-3-18**]

Date of Birth:  [**2080-6-21**]             Sex:   F

Service: SURGERY

Allergies:
Penicillins

Attending:[**First Name3 (LF) 598**]
Chief Complaint:
abdominal pain

Major Surgical or Invasive Procedure:
[**2134-3-10**]:  ERCP, spincterotomy


History of Present Illness:
HPI: 53F with 2 weeks of jaundice, presenting with nausea,
vomiting and RUQ/epigastric pain since last night. Patient had
not seen any doctor for her 2 weeks of jaundice. Developed
nausea
last night and had 5 episodes of vomiting overnight. Also felt
some chills, but no objective fevers. Pain started early this
morning, constant in nature and progressively worse. Pt went to
to [**Hospital3 10310**], had a WBC of 18.5 (17% bands), Tbili 10.7,
lipase 1131. An U/S showed a CBD 15 mm, gallstones, no
gallbladder wall thickenning or pericholecystic fluid. In the ED
patient was slightly confused and BP down to 80/60s, improved
with 1L bolus of NS.


Past Medical History:
Past Surgical History: laparoscopic exploration


Social History:
Social History: Lives alone, denies tobacco, EtOH, drugs


Family History:
NC

Physical Exam:
Physical Exam: upon admission:

Vitals: T 97.2 HR 97 BP 124/70 RR 18 SO2 95% ra
GEN: A&O, NAD
HEENT: No scleral icterus, mucus membranes moist
CV: RRR, No M/G/R
PULM: Clear to auscultation b/l, No W/R/R
ABD: Obese, soft, nondistended, tender to palpation in
epigastrium/RUQ, no rebound or guarding, normoactive bowel
sounds, no palpable masses
Ext: No LE edema, LE warm and well perfused


Pertinent Results:
[**2134-3-18**] 04:45AM BLOOD WBC-16.6* RBC-3.92* Hgb-12.2 Hct-36.4
MCV-93 MCH-31.2 MCHC-33.6 RDW-16.2* Plt Ct-455*
[**2134-3-17**] 05:07AM BLOOD WBC-18.3* RBC-3.71* Hgb-11.8* Hct-34.9*
MCV-94 MCH-31.8 MCHC-33.7 RDW-16.0* Plt Ct-452*
[**2134-3-16**] 06:30AM BLOOD WBC-20.1* RBC-3.79* Hgb-11.8* Hct-35.7*
MCV-94 MCH-31.1 MCHC-33.0 RDW-15.7* Plt Ct-424
[**2134-3-15**] 05:10AM BLOOD WBC-19.6* RBC-3.85* Hgb-11.9* Hct-36.5
MCV-95 MCH-31.0 MCHC-32.7 RDW-15.7* Plt Ct-341
[**2134-3-12**] 04:37AM BLOOD WBC-20.1*# RBC-3.97* Hgb-12.5 Hct-38.5
MCV-97 MCH-31.3 MCHC-32.4 RDW-15.7* Plt Ct-240
[**2134-3-11**] 02:07AM BLOOD WBC-12.5* RBC-4.43 Hgb-13.9 Hct-43.7
MCV-99* MCH-31.4 MCHC-31.9 RDW-15.8* Plt Ct-276
[**2134-3-10**] 06:40PM BLOOD WBC-14.0* RBC-4.26 Hgb-13.4 Hct-41.7
MCV-98 MCH-31.4 MCHC-32.1 RDW-15.6* Plt Ct-286
[**2134-3-18**] 04:45AM BLOOD Neuts-78.2* Lymphs-15.5* Monos-2.1
Eos-3.2 Baso-0.9
[**2134-3-18**] 04:45AM BLOOD Plt Ct-455*
[**2134-3-18**] 04:45AM BLOOD PT-18.1* INR(PT)-1.6*
[**2134-3-17**] 05:07AM BLOOD Plt Ct-452*
[**2134-3-17**] 05:07AM BLOOD PT-27.3* PTT-31.5 INR(PT)-2.7*
[**2134-3-18**] 04:45AM BLOOD Glucose-110* UreaN-6 Creat-0.6 Na-141
K-3.7 Cl-102 HCO3-31 AnGap-12
[**2134-3-17**] 05:07AM BLOOD Glucose-107* UreaN-4* Creat-0.5 Na-140
K-3.6 Cl-99 HCO3-33* AnGap-12
[**2134-3-16**] 06:30AM BLOOD Glucose-83 UreaN-4* Creat-0.5 Na-144
K-3.3 Cl-101 HCO3-34* AnGap-12

[**2134-3-10**]:  EKG:

Sinus rhythm. Prominent inferior lead Q waves are
non-diagnostic. Low
precordial lead QRS voltage. Modest diffuse ST-T wave changes.
Findings are non-specific. Clinical correlation is suggested. No
previous tracing
available for comparison

[**2134-3-18**] 04:45AM BLOOD ALT-24 AST-26 AlkPhos-129* TotBili-1.6*
[**2134-3-17**] 05:07AM BLOOD ALT-29 AST-30 AlkPhos-132* TotBili-1.6*
[**2134-3-16**] 06:30AM BLOOD ALT-37 AST-29 LD(LDH)-243 AlkPhos-144*
Amylase-22 TotBili-1.9*
[**2134-3-11**] 02:07AM BLOOD ALT-209* AST-119* LD(LDH)-218
AlkPhos-356* Amylase-523* TotBili-6.9*
[**2134-3-10**] 06:40PM BLOOD ALT-216* AST-135* AlkPhos-360*
TotBili-9.5*
[**2134-3-16**] 06:30AM BLOOD Lipase-34
[**2134-3-15**] 05:10AM BLOOD Lipase-41
[**2134-3-12**] 02:13AM BLOOD Lipase-267*
[**2134-3-11**] 02:07AM BLOOD Lipase-1529*
[**2134-3-10**] 06:40PM BLOOD Lipase-3148*
[**2134-3-18**] 04:45AM BLOOD Calcium-8.2* Phos-3.5 Mg-2.2
[**2134-3-17**] 05:07AM BLOOD Calcium-8.3* Phos-3.4 Mg-2.3
[**2134-3-13**] 05:15AM BLOOD calTIBC-217* TRF-167*
[**2134-3-15**] 09:30PM BLOOD Lactate-0.9
[**2134-3-15**] 01:24PM BLOOD Lactate-1.1
[**2134-3-10**] 06:44PM BLOOD Lactate-2.5* K-4.3
[**2134-3-15**] 09:30PM BLOOD Hgb-11.9* calcHCT-36

[**2134-3-10**]: EKG:

Sinus rhythm. Prominent inferior lead Q waves are
non-diagnostic. Low
precordial lead QRS voltage. Modest diffuse ST-T wave changes.
Findings are non-specific. Clinical correlation is suggested. No
previous tracing
available for comparison.

[**2134-3-11**]: chest x-ray:

 FINDINGS: The lung volumes are low. There are bilateral areas
of
atelectasis, left more than right, with multiple air
bronchograms. Presence of a minimal left pleural effusion cannot
be excluded. No evidence of pulmonary edema. Borderline size of
the cardiac silhouette. No evidence of pneumonia or pneumothorax


[**2134-3-12**]:  Chest x-ray:

There is no change in cardiomegaly, left lower lobe
consolidation and
interstitial pulmonary edema. Bilateral atelectasis and pleural
effusion are most likely present, unchanged.

[**2134-3-15**]: chest x-ray:

 FINDINGS: As compared to the previous radiograph, the lung
volumes have
increased, potentially reflecting improved ventilation. However,
there is
still evidence of moderate cardiomegaly with a mild-to-moderate
left pleural effusion and subsequent left retrocardiac
atelectasis. At the bases of the right lung, a plate-like
atelectasis is seen. No newly occurred focal parenchymal opacity
suggesting pneumonia. No evidence of pneumothorax.

[**2134-3-16**]: cat scan abdomen and pelvis:

 IMPRESSION:
1. No pulmonary embolism. Bibasilar atelectasis with small
bilateral pleural effusions.
2. Extensive peripancreatic fat stranding with a
small-to-moderate degree of mesenteric and para-renal fluid, but
no well-defined fluid collections. No pancreatic necrosis,
pseudocyst, or vascular compromise.
3. Biliary stent without biliary ductal dilatation. Nondistended
gallbladder may contain sludge or stones.
4. Fatty liver.



Brief Hospital Course:
53 year old female admitted to the Acute care service with
abdominal pain, jaundice, nausea and vomitting.  Upon admission
to the emergency room,  she was hypotensive, and confused
requiring intravenous fluids.  She was admitted to the intensive
care unit for intravenous hydration and monitoring.  The GI
service was consulted and based on her physical examination and
blood work an ERCP was recommended.  She underwent an ERCP on
HOD #1.  She was reported to have an impacted stone in the bile
duct and underwent removal of the stone with placment of a
stent.  Overnight, she was monitored in the intensive care unit
requiring additional intravenous fluids for decreased urine
output.  She was also maintained on ciprofloxacin and flagyl.
Her liver function tests slowly improved and the intensity of
her pain diminished.

She was transferred to the regular floor on HD#3.  Her foley
catheter was discontinued at this time and she was voiding
without difficulty.  During this time, she did have bouts of
confusion which were thought to be related to the narcotics for
analgesic management.  Nutrition service evaluated the patient
and made recommendations about her nutritional status. She did
have a mild elevation of her INR to 2.7 during her
hospitalization, but his decreased to 1.6 over the last few
days.  On HD #7, she had an episode of decreased oxygenation.
Despite a nebulizer treatment, she did receive a dose of lasix
with improvment of her oxygenation.  She continued to have bouts
of oxygen desaturation and was taken for a chest cat scan after
placment of a PICC line for intravenous access.  The cat scan
was negative for a pulmonary embolism but did show bibasilar
atelectasis and small bilater pleural effusions.  She has
maintained her oxygen saturation at 96-98% on room air at rest,
but continues to desaturate to 88-95% on room air while
ambulating.

Her vital signs have been stable and she is afebrile.  She is
tolerating a regular diet and voiding without difficulty.  She
has ambulated in the [**Doctor Last Name **] and has been encouraged to use the
incentive spirometer.  She is requiring minimal analgesia for
management of her abdominal pain. Her antibiotics were
discontinued on HD#9.

She is planning for dicharge home with VNA services to assess
her cardio-pulmonary status.   She has been intstructed to
follow up with the Acute care service in 2 weeks for discussion
about elective cholecystectomy.  She will need to follow-up with
ERCP 1 month for stent removal.



Medications on Admission:
Medications: calcium with vit. D 500 mg daily, dulcolax 5 mg
bedtime, lopid 600 mg twice daily, zantac 150 mg daily, senakot
2 tabs twice daily, tylenol 650 mg as needed for h/a, body
aches, clozaril 200 mg bedtime

Discharge Medications:
1. Lopid 600 mg Tablet Sig: One (1) Tablet PO twice a day.
2. Zantac 150 mg Tablet Sig: One (1) Tablet PO once a day.
3. senakot  Sig: Two (2) tablets  twice a day: hold for
diarrhea.
4. acetaminophen 650 mg Tablet Sig: One (1) Tablet PO every six
(6) hours: as needed for headache, body ache.
5. Clozaril 100 mg Tablet Sig: Two (2) Tablet PO at bedtime.
6. bisacodyl 5 mg Tablet Sig: One (1) Tablet PO at bedtime: hold
for diarrhea.
7. calcium with vitamin D
500 mg every morning


Discharge Disposition:
Home With Service

Facility:
Able Nursing

Discharge Diagnosis:
 Cholangitis
 Cholelithiasis
 Gallstone pancreatitis



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


Discharge Instructions:
You were admitted to the hospital with right upper quadrant
pain.  You had an ultrasound done which showed gallstones. You
underwent ERCP which showed a large stone in the common bile
duct.  The stone was removed and you had a stent placed in the
bile duct.  Your pain has decreased and your liver enzymes have
improved.  You are now preparing for discharge home with
follow-up for gallbladder removal.  Your discharge instructions
are outlined:

Please call your doctor or nurse practitioner or return to the
Emergency Department for any of the following:

*You experience new chest pain, pressure, squeezing or
tightness.

*New or worsening cough, shortness of breath, or wheeze.

*If you are vomiting and cannot keep down 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.

*You experience burning when you urinate, have blood in your
urine, or experience a discharge.

*You have shaking chills, or fever greater than 101.5 degrees
Fahrenheit or 38 degrees Celsius.

*Any change in your symptoms, or any new symptoms that concern
you.

Please resume all regular home medications , unless specifically
advised not to take a particular medication. Also, please take
any new medications as prescribed.


Followup Instructions:
Please folow up with the Acute care service in 2 weeks.  You can
schedule your appointment by calling # [**Telephone/Fax (1) 600**]

You will also need to follow up with ERCP in 1 month for stent
removal.  They will contact you about this.


                             [**First Name8 (NamePattern2) **] [**Name8 (MD) **] MD [**MD Number(2) 601**]

Completed by:[**2134-3-18**]
{'Calculus of gallbladder and bile duct without cholecystitis, with obstruction,Acute pancreatitis,Cholangitis,Myalgia and myositis, unspecified,Chronic fatigue syndrome'}


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: HPI: 53F with 2 weeks of jaundice, presenting with nausea,
vomiting and RUQ/epigastric pain since last night. Patient had
not seen any doctor for her 2 weeks of jaundice. Developed
nausea
last night and had 5 episodes of vomiting overnight. Also felt
some chills, but no objective fevers. Pain started early this
morning, constant in nature and progressively worse. Pt went to
to [**Hospital3 10310**], had a WBC of 18.5 (17% bands), Tbili 10.7,
lipase 1131. An U/S showed a CBD 15 mm, gallstones, no
gallbladder wall thickenning or pericholecystic fluid. In the ED
patient was slightly confused and BP down to 80/60s, improved
with 1L bolus of NS.

MEDICAL HISTORY: Past Surgical History: laparoscopic exploration

MEDICATION ON ADMISSION: Medications: calcium with vit. D 500 mg daily, dulcolax 5 mg
bedtime, lopid 600 mg twice daily, zantac 150 mg daily, senakot
2 tabs twice daily, tylenol 650 mg as needed for h/a, body
aches, clozaril 200 mg bedtime

ALLERGIES: Penicillins

PHYSICAL EXAM: Physical Exam: upon admission:

FAMILY HISTORY: NC

SOCIAL HISTORY: Social History: Lives alone, denies tobacco, EtOH, drugs 

### Response:
{'Calculus of gallbladder and bile duct without cholecystitis, with obstruction,Acute pancreatitis,Cholangitis,Myalgia and myositis, unspecified,Chronic fatigue syndrome'}
