CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 35-year-old
male referred for evaluation of gastric restrictive surgery for
morbid obesity. He presents electively for a gastric bypass
procedure.

MEDICAL HISTORY: 2.  Degenerative joint disease.
3.  Dyslipidemia.
4.  Hypoglycemia.

MEDICATION ON ADMISSION: His medication regimen included
Soma for back pain and glucosamine for joints.

ALLERGIES: He has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient does not smoke or use
recreational drugs.  He uses alcohol only socially.
Morbid obesity,Other postoperative infection
Morbid obesity,Other postop infection
Admission Date:  [**2173-10-8**]     Discharge Date:  [**2173-10-21**]

Date of Birth:   [**2138-7-9**]     Sex:  M

Service:  Surgery, Purple Team
HISTORY OF PRESENT ILLNESS:  The patient is a 35-year-old
male referred for evaluation of gastric restrictive surgery for
morbid obesity. He presents electively for a gastric bypass
procedure.

pounds, a height of 70.25 inches, and a body mass index
of 42.5.  Previous weight loss efforts included Neutra
System, Slim-Fast, and three months of [**Doctor Last Name 1729**] diet which had
limited effectiveness.  He has also tried medication therapy
without significant results.

PAST MEDICAL HISTORY:
2.  Degenerative joint disease.
3.  Dyslipidemia.
4.  Hypoglycemia.

PAST SURGICAL HISTORY: Arthroscopy of the right knee in [**2159**].

MEDICATIONS ON ADMISSION:  His medication regimen included
Soma for back pain and glucosamine for joints.

ALLERGIES:  He has no known drug allergies.

SOCIAL HISTORY:  The patient does not smoke or use
recreational drugs.  He uses alcohol only socially.

PHYSICAL EXAMINATION ON PRESENTATION:  On examination, the
patient was afebrile with a blood pressure of 122/76 and
pulse was 95.  Head, eyes, ears, nose, and throat examination
was within normal limits.  There was no cervical adenopathy,
thyromegaly, or carotid bruits.  Lungs were clear to
auscultation bilaterally.  The patient had a regular rate and
rhythm without any murmurs or rubs on cardiovascular
examination.  The abdomen was obese but soft and nontender.
The extremities were without cyanosis, clubbing, edema,
venous insufficiency, or evidence of joint swelling or
inflammation.  The patient was neurologically intact.

HOSPITAL COURSE:   The patient was admitted on [**2173-10-8**] for a planned open gastric bypass.

The patient's postoperative course was complicated by poor
urine output requiring multiple boluses of fluid as well as
poor pain control.

He was advanced up to a stage II diet on postoperative day
two.  On postoperative day three, out of concern for
potential leakage due to the patient's continued fluid
requirement and pain, a swallow study was obtained to
evaluate the jejunostomy anastomosis.  The swallow
study was read as normal with no evidence of spillage of
contrast, and the contrast flowed normally in the jejunal loops.

On [**2173-10-11**], which was postoperative day three,
because of continued fluid requirements and increasing pain,
the patient was taken for another upper gastrointestinal
study indicating air contrast levels and dilated loops of
small bowel; suggestive of postoperative ileus with an
unusual contour of contrast in the low-mid abdomen and large
free spillage of contrast in the abdomen at the level of the
proximal gastrojejunal anastomosis.

The patient was made nothing by mouth after discovering these
results.  The patient was taken back to the operating room on
[**2173-10-11**] for exploratory laparotomy, [**Location (un) 1661**]-[**Location (un) 1662**]
drain placement, revision of his gastrojejunostomy, and
gastrostomy tube placement.  Please see the Operative Note;
per Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] for details of this operation.

The patient's postoperative course was complicated by
difficulty with extubation.  He was maintained in the
Postanesthesia Care Unit on ventilation and extubated in the
morning after surgery (on [**2173-10-12**].) On [**2173-10-13**],
the patient was transferred to the floor.

A methylene blue study was done on [**2173-10-15**] to check
for evidence of continued leak.  This study was negative.  He
was advanced to a stage II diet on [**2173-10-16**] due to
the negative study with the methylene blue.

On [**2173-10-17**], he was advanced to a stage III diet.
On [**2173-10-18**], a methylene blue study was again
undertaken.  This result indicated that in fact there was
still a persistent leak at the gastrojejunostomy.  The
patient was made nothing by mouth.  He was taken for a CT to
evaluate his gastric remnant with the intention being to
utilize his gastrostomy tube for feeds.  The CT results
indicated a patent gastric remnant without any evidence of
extravasation or obstruction. There was a large collection in the
left upper quadrant that was tapped and appeared to be
consistent with old hematoma. As the collection was solid
clot, the drain was not left as it would not remain patent or
drain the collection. The patient was started on
gastrostomy tube feeds then; receiving the normal four
ounces three times per day of a Carnation Instant Breakfast
that he would be receiving with his stage III gastric bypass
diet.  He was also given fluid boluses for a total fluid
intake of around 1600 cc per day.

On [**2173-10-21**], the patient was discharged home on tube
feeds.  He was also to continue Levaquin and Flagyl times 14
days.  The patient had had continued spiking temperatures;
however, it was felt by the surgical team to be most likely
due to an abscess discovered by CT in his left upper
quadrant; probably secondary to extravasation of gastric
contents.  This abscess was draining through the
[**Location (un) 1661**]-[**Location (un) 1662**] drain present at his gastrojejunostomy.  The
patient was comfortable both with performing his
gastrostomy tube feeds as well as administrating his
medications per gastrostomy tube, as well as emptying
and recording the volumes on his [**Location (un) 1661**]-[**Location (un) 1662**] drain.

CONDITION AT DISCHARGE:  Condition on discharge was stable.

DISCHARGE STATUS:  Discharge status was to home with [**Hospital6 3429**] services.

DISCHARGE DIAGNOSES:   Open gastric bypass; complicated by
gastrojejunostomy leak, complicated by intra-abdominal
abscess formation.

MEDICATIONS ON DISCHARGE:
1.  Roxicet 5 cc to 10 cc per gastrojejunostomy tube q.4-6h.
as needed.
2.  Levaquin 500 mg per gastrojejunostomy tube q.d. (times 14
days).
3.  Flagyl 250 mg per gastrojejunostomy tube t.i.d. (times 14
days).
4.  Zantac elixir 150 mg per gastrojejunostomy tube b.i.d.
5.  Vitamin B12 1000 mg per gastrojejunostomy tube q.d.
6.  Actigall 300 mg per gastrojejunostomy tube b.i.d.

DISCHARGE INSTRUCTIONS:
1.  The patient was instructed to crush all pills prior to
attempting to administer them through his G-tube.
2.  He was placed on tube feeds which consisted of 120 cc of
Carnation Instant Breakfast mix given at breakfast, lunch,
and dinner.
3.  He was also instructed to bolus with 200 cc of water six
times per day and to take additional boluses with additional
water as his thirst indicated.
4.  [**Hospital6 407**] was scheduled once daily to
assist with drain maintenance, to record output, to assist
with g-tube medication delivery, to continue patient training on
g-tube maintenance as well as [**Location (un) 1661**]-[**Location (un) 1662**] drain maintenance; in
addition to forming every day dressing changes.
5.  The patient was to continue being nothing by mouth until
indicated by Dr. [**Last Name (STitle) **] that it was appropriate to initiate
oral feeds once again.

DISCHARGE FOLLOWUP:  Follow-up plans were to see Dr. [**Last Name (STitle) **]
in four days.





                          [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 13186**], M.D.  [**MD Number(1) 13187**]

Dictated By:[**Last Name (NamePattern1) 1752**]

MEDQUIST36

D:  [**2173-10-21**]  19:29
T:  [**2173-10-22**]  09:39
JOB#:  [**Job Number 43318**]
{'Morbid obesity,Other postoperative infection'}


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: The patient is a 35-year-old
male referred for evaluation of gastric restrictive surgery for
morbid obesity. He presents electively for a gastric bypass
procedure.

MEDICAL HISTORY: 2.  Degenerative joint disease.
3.  Dyslipidemia.
4.  Hypoglycemia.

MEDICATION ON ADMISSION: His medication regimen included
Soma for back pain and glucosamine for joints.

ALLERGIES: He has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient does not smoke or use
recreational drugs.  He uses alcohol only socially. 

### Response:
{'Morbid obesity,Other postoperative infection'}
