CHIEF COMPLAINT: 

PRESENT ILLNESS: This is an 81 year old female
originally admitted to [**Hospital1 69**]
[**Hospital3 628**] late on [**2157-8-15**], with sudden onset of
epigastric pain, nausea and vomiting, and found to have
elevated lipase, elevated liver function tests and elevated
total bilirubin.  Abdominal CT showed dilated common bile and
pancreatic duct.  The patient also complained of left sided
chest pain, arm and shoulder pain and was ruled out for
myocardial infarction with serial enzymes.  On the afternoon
of [**2157-8-16**], the patient spiked a fever to 102.2 degrees
Fahrenheit.  She became hypotensive to 90 systolic which
responded to intravenous fluid boluses up to 110 systolic.
She is being treated with intravenous fluids, Demerol and
Vistaril for pain control, Zofran for nausea.  She was also
given 10 mg of oral as well as 10 mg subcutaneous Vitamin K
to reverse her INR since she was taking Coumadin for her
atrial fibrillation.  This was done in anticipation of an
elective endoscopic retrograde cholangiopancreatography.
However, given her fever and low blood pressure, the patient
was transferred to the [**Hospital1 69**]
Intensive Care Unit.  The patient needed an emergent
endoscopic retrograde cholangiopancreatography.  The patient
got a total of two liters of normal saline as well as one
dose of Zosyn before transfer.

MEDICAL HISTORY: 1.  Chronic obstructive pulmonary disease, right lower lobe
lobectomy for mycobacterium xenopi infection.
2.  Atrial fibrillation, status post two failed
cardioversions.
3.  Hypertension.
4.  Hypercholesterolemia.
5.  Diverticulosis.
6.  Status post cholecystectomy.
7,  Status post total abdominal hysterectomy, bilateral
salpingo-oophorectomy.
8.  Arthritis.
9.  Gastroesophageal reflux disease.

MEDICATION ON ADMISSION: 1.  Cardizem CD 180 mg p.o. twice a day..
2,  Coumadin 5 mg p.o. q.h.s.
3.  Prozac.
4.  Hydrochlorothiazide 25 mg p.o. once daily.
5.  Flonase.
6.  Lipitor 10 mg p.o. once daily.

ALLERGIES: The patient is allergic to Codeine and Ultram.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient lives alone on [**Hospital3 **] and
visits her daughter who lives in [**Name (NI) 620**].  Former tobacco
use, quit thirty years ago.  No alcohol use.
Acute pancreatitis,Cholangitis,Chronic airway obstruction, not elsewhere classified,Atrial fibrillation,Cardiomegaly,Unspecified essential hypertension,Pure hypercholesterolemia,Diverticulosis of colon (without mention of hemorrhage),Arthropathy, unspecified, site unspecified
Acute pancreatitis,Cholangitis,Chr airway obstruct NEC,Atrial fibrillation,Cardiomegaly,Hypertension NOS,Pure hypercholesterolem,Dvrtclo colon w/o hmrhg,Arthropathy NOS-unspec
Admission Date:  [**2157-8-16**]     Discharge Date:  [**2157-8-19**]


Service:  ICU

HISTORY OF PRESENT ILLNESS:  This is an 81 year old female
originally admitted to [**Hospital1 69**]
[**Hospital3 628**] late on [**2157-8-15**], with sudden onset of
epigastric pain, nausea and vomiting, and found to have
elevated lipase, elevated liver function tests and elevated
total bilirubin.  Abdominal CT showed dilated common bile and
pancreatic duct.  The patient also complained of left sided
chest pain, arm and shoulder pain and was ruled out for
myocardial infarction with serial enzymes.  On the afternoon
of [**2157-8-16**], the patient spiked a fever to 102.2 degrees
Fahrenheit.  She became hypotensive to 90 systolic which
responded to intravenous fluid boluses up to 110 systolic.
She is being treated with intravenous fluids, Demerol and
Vistaril for pain control, Zofran for nausea.  She was also
given 10 mg of oral as well as 10 mg subcutaneous Vitamin K
to reverse her INR since she was taking Coumadin for her
atrial fibrillation.  This was done in anticipation of an
elective endoscopic retrograde cholangiopancreatography.
However, given her fever and low blood pressure, the patient
was transferred to the [**Hospital1 69**]
Intensive Care Unit.  The patient needed an emergent
endoscopic retrograde cholangiopancreatography.  The patient
got a total of two liters of normal saline as well as one
dose of Zosyn before transfer.

PAST MEDICAL HISTORY:
1.  Chronic obstructive pulmonary disease, right lower lobe
lobectomy for mycobacterium xenopi infection.
2.  Atrial fibrillation, status post two failed
cardioversions.
3.  Hypertension.
4.  Hypercholesterolemia.
5.  Diverticulosis.
6.  Status post cholecystectomy.
7,  Status post total abdominal hysterectomy, bilateral
salpingo-oophorectomy.
8.  Arthritis.
9.  Gastroesophageal reflux disease.

ALLERGIES:  The patient is allergic to Codeine and Ultram.

MEDICATIONS ON ADMISSION:
1.  Cardizem CD 180 mg p.o. twice a day..
2,  Coumadin 5 mg p.o. q.h.s.
3.  Prozac.
4.  Hydrochlorothiazide 25 mg p.o. once daily.
5.  Flonase.
6.  Lipitor 10 mg p.o. once daily.

MEDICATIONS ON TRANSFER:
1.  Zosyn 4.5 mg three times a day.
2.  Diltiazem 180 mg once daily.
3.  Prozac 20 mg once daily.
4.  Protonix 40 mg once daily.
5.  Maalox.
6.  Flovent.
7.  Sublingual Nitroglycerin p.r.n.
8.  Lipitor 10 mg once daily.
9.  Demerol 75 mg intravenously q3hours.

SOCIAL HISTORY:  The patient lives alone on [**Hospital3 **] and
visits her daughter who lives in [**Name (NI) 620**].  Former tobacco
use, quit thirty years ago.  No alcohol use.

PHYSICAL EXAMINATION:  On arrival, temperature was 101, heart
rate 91, atrial fibrillation, blood pressure 105/51,
respiratory rate 16, oxygen saturation 97% on two liters
nasal cannula.  In general, the patient was alert, oriented
times three in mild distress secondary to abdominal pain.
Head, eyes, ears, nose and throat examination - Her
oropharynx was dry.  The pupils are equal, round, and
reactive to light and accommodation.  Extraocular movements
are intact.  Cardiovascular is irregularly irregular, no
murmurs.  The lungs are clear to auscultation bilaterally.
The abdomen was soft with moderate distention, diffuse pain
to palpation, however, worse pain over her epigastrium with
voluntary guarding, but no rebound, hypoactive bowel sounds.
Extremities with no edema.

LABORATORY DATA:  Elevated white blood cell count at 16.9.
INR 2.4.  ALT 1702, AST 475, LDH 268, alkaline phosphatase
167, amylase and lipase normal, total bilirubin 4.4.  CK was
normal.  Arterial blood gases [**Location (un) **] 7.36/43/97 on two liters
nasal cannula.

Chest x-ray was negative.  KUB was negative.

HOSPITAL COURSE:
1.  Ascending cholangitis - The patient was started on
Ampicillin, Levofloxacin and Flagyl and overnight was kept
NPO and went for endoscopic retrograde
cholangiopancreatography the following morning.  She
underwent sphincterotomy with release of bile sludge without
complications.  The patient's diet was advanced and she was
switched to oral antibiotics, Augmentin and Levofloxacin.
She was to complete a total two week course of these
antibiotics through [**2157-8-30**].

2.  Infectious disease - fever and elevated white blood cell
count from cholangitis - The patient's blood and urine
cultures remained negative through her hospital stay.  The
patient was having loose stools which were close to the
patient's baseline upon discharge.  She also did spike a
temperature in the evening prior to discharge.  The patient
was unable to give a stool sample to check for Clostridium
difficile before leaving the hospital.

3.  Atrial fibrillation on Coumadin - The patient was given
Vitamin K at the outside hospital as well as four units of
fresh frozen plasma prior to her procedure to reverse her INR
for the endoscopic retrograde cholangiopancreatography.  The
patient'a anticoagulation was started two days later on the
date of discharge with 5 mg of Coumadin once daily. The
patient is to follow-up with her primary care physician, [**Last Name (NamePattern4) **].
[**Last Name (STitle) 14887**], on [**Location (un) **] for INR checks.

4.  Hypotension likely secondary to cholangitis.  The
patient's blood pressure remained stable after intravenous
fluid hydration.

5.  Atrial fibrillation - The patient was restarted on her
outpatient Diltiazem for rate control.

6.  Chronic obstructive pulmonary disease - The patient
received Albuterol and Atrovent nebulizers while in the
hospital.

The patient had a right atrial line placed for closer blood
pressure monitoring as well as an endoscopic retrograde
cholangiopancreatography.

FOLLOW-UP:  The patient is to continue two weeks of
antibiotics as described above.   The patient is to follow-up
her INR with primary care physician, [**Last Name (NamePattern4) **]. [**Last Name (STitle) 14887**].  The patient
is also to follow-up with her cardiologist, Dr. [**First Name (STitle) **], to
reschedule cardioversion now she has been off
anticoagulation.

The patient was seen by physical therapy and cleared to be
safe to go home.

DISCHARGE DIAGNOSES:
1.  Ascending cholangitis.
2.  Status post endoscopic retrograde
cholangiopancreatography with sphincterotomy.
3.  Atrial fibrillation.
4.  Hypertension.
5.  Chronic obstructive pulmonary disease.
6.  Status post reversal of anticoagulation.

MEDICATIONS ON DISCHARGE:
1.  Levofloxacin 500 mg p.o. once daily until [**2157-8-30**].
2.  Augmentin 500 mg p.o. three times a day until [**2157-8-28**].
3.  Coumadin 5 mg p.o. q.h.s. to be adjusted by her primary
care physician.
4.  Lipitor 10 mg p.o. once daily.
5.  Diltiazem 100 mg p.o. once daily.
6.  Flonase.
7.  Hydrochlorothiazide 25 mg p.o. once daily.
8.  Prozac.




                          [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] [**Name8 (MD) **], M.D.  [**MD Number(1) 292**]

Dictated By:[**Name8 (MD) 7112**]

MEDQUIST36

D:  [**2157-8-19**]  16:20
T:  [**2157-8-27**]  11:12
JOB#:  [**Job Number 100832**]
{'Acute pancreatitis,Cholangitis,Chronic airway obstruction, not elsewhere classified,Atrial fibrillation,Cardiomegaly,Unspecified essential hypertension,Pure hypercholesterolemia,Diverticulosis of colon (without mention of hemorrhage),Arthropathy, unspecified, site unspecified'}


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 an 81 year old female
originally admitted to [**Hospital1 69**]
[**Hospital3 628**] late on [**2157-8-15**], with sudden onset of
epigastric pain, nausea and vomiting, and found to have
elevated lipase, elevated liver function tests and elevated
total bilirubin.  Abdominal CT showed dilated common bile and
pancreatic duct.  The patient also complained of left sided
chest pain, arm and shoulder pain and was ruled out for
myocardial infarction with serial enzymes.  On the afternoon
of [**2157-8-16**], the patient spiked a fever to 102.2 degrees
Fahrenheit.  She became hypotensive to 90 systolic which
responded to intravenous fluid boluses up to 110 systolic.
She is being treated with intravenous fluids, Demerol and
Vistaril for pain control, Zofran for nausea.  She was also
given 10 mg of oral as well as 10 mg subcutaneous Vitamin K
to reverse her INR since she was taking Coumadin for her
atrial fibrillation.  This was done in anticipation of an
elective endoscopic retrograde cholangiopancreatography.
However, given her fever and low blood pressure, the patient
was transferred to the [**Hospital1 69**]
Intensive Care Unit.  The patient needed an emergent
endoscopic retrograde cholangiopancreatography.  The patient
got a total of two liters of normal saline as well as one
dose of Zosyn before transfer.

MEDICAL HISTORY: 1.  Chronic obstructive pulmonary disease, right lower lobe
lobectomy for mycobacterium xenopi infection.
2.  Atrial fibrillation, status post two failed
cardioversions.
3.  Hypertension.
4.  Hypercholesterolemia.
5.  Diverticulosis.
6.  Status post cholecystectomy.
7,  Status post total abdominal hysterectomy, bilateral
salpingo-oophorectomy.
8.  Arthritis.
9.  Gastroesophageal reflux disease.

MEDICATION ON ADMISSION: 1.  Cardizem CD 180 mg p.o. twice a day..
2,  Coumadin 5 mg p.o. q.h.s.
3.  Prozac.
4.  Hydrochlorothiazide 25 mg p.o. once daily.
5.  Flonase.
6.  Lipitor 10 mg p.o. once daily.

ALLERGIES: The patient is allergic to Codeine and Ultram.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient lives alone on [**Hospital3 **] and
visits her daughter who lives in [**Name (NI) 620**].  Former tobacco
use, quit thirty years ago.  No alcohol use. 

### Response:
{'Acute pancreatitis,Cholangitis,Chronic airway obstruction, not elsewhere classified,Atrial fibrillation,Cardiomegaly,Unspecified essential hypertension,Pure hypercholesterolemia,Diverticulosis of colon (without mention of hemorrhage),Arthropathy, unspecified, site unspecified'}
