CHIEF COMPLAINT: Abdominal pain, s/p [**Doctor First Name **]

PRESENT ILLNESS: This is an 81 year-old female with a history of CAD s/p MI with
stent placement 1 year ago, HTN, hypothyroidism, who presented
to an OSH with abdominal pain radiating to the back. CT scan
there showed multiple stones in a dilated CBD and gall bladder
with evidence of both intra and extrahepatic dilitation. She was
found to have elevated liver enzymes and was transferred to
[**Hospital1 18**] for further management.
.
Here, here labs were notable for a leukocytosis to 23, markedly
elevated liver and pancreatic enzymes, but she remained
hemodynamically stable and was afebrile. She was taken to [**Hospital1 **],
who placed a stent in her CBD and extracted multiple stones, the
largest of which was 1.4mm. She was given levo and flagyl.
.
She is transferred to the [**Hospital Unit Name 153**] post [**Hospital Unit Name **] before transfer back to
the floor in the care of general surgery for monitoring. She is
currently afebrile, BP 130/58, HR 90 satting 98% on 2L by nc.

MEDICAL HISTORY: HTN
CAD s/p MI in [**2160**] s/p stent placement on plavix
Hypothyroidism
Hyperlipidemia
GERD

MEDICATION ON ADMISSION: hctz
toprol XL 25mg
aspirin 81
synthroid 88mcg
plavix
crestor
lisinopril 40mg
norvasc
nexxium

ALLERGIES: Sulfa (Sulfonamides)

PHYSICAL EXAM: Vitals: T: 98.6 BP: 139/46 HR: 82 RR: 16 O2Sat: 96%2L
GEN: no acute distress
HEENT: EOMI, PERRL, sclerae slightly icteric, no epistaxis or
rhinorrhea, MM dry, OP Clear
NECK: JVP at 5cmH20, carotid pulses brisk, no bruits, no
cervical lymphadenopathy, trachea midline
COR: RRR, soft II/VI SM at LUSB non radiating, normal S1 S2,
radial pulses +2
PULM: Lungs CTAB, no W/R/R
ABD: Soft, mildly distended, +BS, no HSM, no masses. Mild
tenderness to deep palpation in RUQ, with no rebound or
guarding.
EXT: No C/C/E, no palpable cords
NEURO: alert, oriented to person, place, and time. CN II ?????? XII
grossly intact. Moves all 4 extremities. Plantar reflex
downgoing.
SKIN: No jaundice, cyanosis, or gross dermatitis. No ecchymoses.

FAMILY HISTORY: history of MI in father in his 40's.

SOCIAL HISTORY: no alcohol, tobacco, illicits. Lives with longtime family
friend, husband recently passed away.
Acute pancreatitis,Acute kidney failure, unspecified,Calculus of gallbladder and bile duct without cholecystitis, with obstruction,Cholangitis,Atrial fibrillation,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Old myocardial infarction,Dehydration,Esophageal reflux,Other and unspecified hyperlipidemia,Unspecified acquired hypothyroidism,Unspecified essential hypertension
Acute pancreatitis,Acute kidney failure NOS,Gall&bil cal w/o ch w ob,Cholangitis,Atrial fibrillation,Crnry athrscl natve vssl,Status-post ptca,Old myocardial infarct,Dehydration,Esophageal reflux,Hyperlipidemia NEC/NOS,Hypothyroidism NOS,Hypertension NOS
Admission Date:  [**2161-8-27**]              Discharge Date:   [**2161-9-1**]

Date of Birth:  [**2080-5-3**]             Sex:   F

Service: SURGERY

Allergies:
Sulfa (Sulfonamides)

Attending:[**Doctor First Name 5188**]
Chief Complaint:
Abdominal pain, s/p [**Doctor First Name **]

Major Surgical or Invasive Procedure:
[**Doctor First Name **]

History of Present Illness:
This is an 81 year-old female with a history of CAD s/p MI with
stent placement 1 year ago, HTN, hypothyroidism, who presented
to an OSH with abdominal pain radiating to the back. CT scan
there showed multiple stones in a dilated CBD and gall bladder
with evidence of both intra and extrahepatic dilitation. She was
found to have elevated liver enzymes and was transferred to
[**Hospital1 18**] for further management.
.
Here, here labs were notable for a leukocytosis to 23, markedly
elevated liver and pancreatic enzymes, but she remained
hemodynamically stable and was afebrile. She was taken to [**Hospital1 **],
who placed a stent in her CBD and extracted multiple stones, the
largest of which was 1.4mm. She was given levo and flagyl.
.
She is transferred to the [**Hospital Unit Name 153**] post [**Hospital Unit Name **] before transfer back to
the floor in the care of general surgery for monitoring. She is
currently afebrile, BP 130/58, HR 90 satting 98% on 2L by nc.


Past Medical History:
HTN
CAD s/p MI in [**2160**] s/p stent placement on plavix
Hypothyroidism
Hyperlipidemia
GERD


Social History:
no alcohol, tobacco, illicits. Lives with longtime family
friend, husband recently passed away.


Family History:
history of MI in father in his 40's.

Physical Exam:
Vitals: T: 98.6 BP: 139/46 HR: 82 RR: 16 O2Sat: 96%2L
GEN: no acute distress
HEENT: EOMI, PERRL, sclerae slightly icteric, no epistaxis or
rhinorrhea, MM dry, OP Clear
NECK: JVP at 5cmH20, carotid pulses brisk, no bruits, no
cervical lymphadenopathy, trachea midline
COR: RRR, soft II/VI SM at LUSB non radiating, normal S1 S2,
radial pulses +2
PULM: Lungs CTAB, no W/R/R
ABD: Soft, mildly distended, +BS, no HSM, no masses. Mild
tenderness to deep palpation in RUQ, with no rebound or
guarding.
EXT: No C/C/E, no palpable cords
NEURO: alert, oriented to person, place, and time. CN II ?????? XII
grossly intact. Moves all 4 extremities. Plantar reflex
downgoing.
SKIN: No jaundice, cyanosis, or gross dermatitis. No ecchymoses.

.
At Discharge:
Vitals:T-97.9, HR-140 bursts of AFIB, decreased to 69-70 sinus,
BP-140/59, RR-22, RA-98%
GEN: NAD, A/Ox3
CV:RRR, tachycardic w/ bursts of AFIB, no m/r/g
RESP: LCTAB
ABD: +BS, soft, NT/ND, RUQ decreased TTP
EXTREM: no c/c/e


Pertinent Results:
[**2161-8-27**] 11:35AM BLOOD ALT-199* AST-266* LD(LDH)-304*
AlkPhos-650* Amylase-2596* TotBili-2.5* DirBili-2.2* IndBili-0.3
[**2161-8-28**] 04:11AM BLOOD ALT-175* AST-181* LD(LDH)-189
AlkPhos-545* Amylase-895* TotBili-3.3*
[**2161-8-27**] 11:35AM BLOOD WBC-23.1* RBC-3.90* Hgb-11.8* Hct-35.8*
MCV-92 MCH-30.3 MCHC-33.1 RDW-13.3 Plt Ct-389
[**2161-8-28**] 04:11AM BLOOD WBC-18.4* RBC-3.47* Hgb-10.3* Hct-31.2*
MCV-90 MCH-29.8 MCHC-33.1 RDW-13.2 Plt Ct-324
[**2161-8-29**] 06:20AM BLOOD WBC-16.4* RBC-3.36* Hgb-10.2* Hct-30.6*
MCV-91 MCH-30.3 MCHC-33.3 RDW-13.3 Plt Ct-299
[**2161-8-30**] 06:15AM BLOOD WBC-13.8* RBC-3.43* Hgb-10.3* Hct-30.8*
MCV-90 MCH-30.2 MCHC-33.6 RDW-13.3 Plt Ct-319
[**2161-8-31**] 06:55AM BLOOD Glucose-104 UreaN-26* Creat-1.1 Na-142
K-3.6 Cl-108 HCO3-24 AnGap-14
[**2161-8-30**] 06:15AM BLOOD ALT-69* AST-30 AlkPhos-400* Amylase-102*
TotBili-0.8
[**2161-8-31**] 06:55AM BLOOD Amylase-97
.
Abdomen CT on [**2161-8-27**]:
IMPRESSION:
1. Cholelithiasis.
2. Intra- and extra-hepatic ductal dilation. By report, there is

choledocholithiasis on an outside study, however, that CT is not
available for comparison at this time. Consider MRCP if further
imaging is required.
Ductal dilatation in this pattern highly suggests
choledocholithiasis and
that diagnosis is not excluded even in lgiht of the US exam
results.
3. Abnormal morphology of the lower pole of the left kidney
without focal masslesion. This is not well visualized on this
study. Correlation with the outside CT is recommended, or if
this study is not available, then cross- sectional imaging (CT
or MRI) on a non-urgent basis is recommended.
.
[**Year (4 digits) **] [**8-27**]
Impression: Bulging of the major papilla.
Multiple etones at the CBD.
A sphincterotomy could not be performed as patient was on
Plavix.
A biliary stent was placed.
 (stent placement)


Brief Hospital Course:
[**8-27**] MICU Course:  Patient was admitted for monitoring after
[**Month/Day (4) **] for gallstone pancreatitis.   She was taken to [**Month/Day (4) **], who
placed a stent in her CBD and extracted multiple stones, the
largest of which was 1.4mm. No sphinceterotomy was performed due
to  home medications of ASA and plavix. Her blood pressure
remained stable and her amylase and lipase dramatically improved
and her liver enzymes also trended down after the procedure.
She had improvement in her leukocytosis.  She was started on
empiric levofloxacin and metronidazole post-procedure.  Due to
continued stability, she was transferred to general surgery
service for further monitoring.  Amlodipine, hydrochlorothiazide
and lisinopril were held initially, with plan to restart before
discharge.  Aspirin and clopidogrel were also held for recent
procedure, with plan to restart these also prior to discharge,
given history of coronary artery stent.
.
[**8-28**]: Patient transferred to the surgical floor.  Pt advanced to
clear liquids. PT went into afib.  Lopressor 5mg x 3 and one
dose of diltiazem was given with conversion to NSR.  PT
asymtomatic.  Cardiac enzymes negative x 2.
[**8-29**]: Pt advanced to regular diet.  Afib for 30 minutes Lopressor
5mg x 3, spontaneous conversion.
[**8-30**]: Patient on regular diet.  PT consulted.  In the P.M. pt
again went into afib rate to the 140s.  Lopressor 5mg x 3 and a
total of 20 mg of Diltiazem was administered without conversion
but with satisfactory rate control to the 80s -90s.  At midnight
patient spontaneously converted to NSR.
[**8-31**]: Pt again went into afib rate 90-110s.  5 mg lopressor given
for rate control.  Pt's cardiologist and pcp [**Name (NI) 79508**] no known
history of afib. Pt placed on all verified home cardiac
medications except ASA and plavix. PT also changed to PO
antibiotics. Tolerating & diet well medications well. Discussed
surgical options for gallbladder removal with Dr. [**Last Name (STitle) 5182**].
Agreed to have removal of gallbladder arranged at local
hospital. Patient will follow-up with PCP for referral.
[**9-1**]: Patient had another burst of AFIB overnight to 150's,
managed with 5mg IV Lopressor. COnverted to normal sinus. Blood
pressures stable. Lisinopril and Norvasc doses increased to home
doses confirmed per Cardiologist. Patient has a follow-up
appointment with Cardiologist Thursday [**2161-9-3**] for further
management of new onset Atrial Fibrillation. Visiting Nurse
services have been arranged for Blood pressure and heart rate
assessment tomorrow. S
.
Patient was advised to resume Aspirin 81mg daily, and HOLD
Plavix in setting of future gallbladder removal. If Plavix must
be resumed, this information must be relayed to the General
Surgeon to prevent post-operative bleeding complications. Both
the patient, and Cardiology office were informed.

Medications on Admission:
hctz
toprol XL 25mg
aspirin 81
synthroid 88mcg
plavix
crestor
lisinopril 40mg
norvasc
nexxium


Discharge Medications:
 1. Nexium 40 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO twice a day.
2. Hydrochlorothiazide 12.5 mg Capsule Sig: Two (2) Capsule PO
DAILY (Daily).
3. Levothyroxine 88 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
4. Rosuvastatin 5 mg Tablet Sig: Two (2) Tablet PO HS (at
bedtime).
5. Lisinopril 40 mg Tablet Sig: One (1) Tablet PO once a day.
6. Norvasc 10 mg Tablet Sig: One (1) Tablet PO once a day.
7. Metoprolol Succinate 25 mg Tablet Sustained Release 24 hr
Sig: One (1) Tablet Sustained Release 24 hr PO DAILY (Daily).
8. Metronidazole 500 mg Tablet Sig: One (1) Tablet PO TID (3
times a day) for 9 days: Take with food. Disp:*30 Tablet(s)*
Refills:*0*
9. Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q24H (every
24 hours) for 8 days: Take with food. Disp:*9 Tablet(s)*
Refills:*0*
10. Camphor-Menthol 0.5-0.5 % Lotion Sig: One (1) Appl Topical
QID (4 times a day) as needed. Disp:*qs * Refills:*0*
11. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO once a day.
12. Plavix 75 mg Tablet Sig: One (1) Tablet PO once a day: HOLD
for Gallbladder SURGERY.

1. Nexium 40 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO twice a day.
2. Hydrochlorothiazide 12.5 mg Capsule Sig: Two (2) Capsule PO
DAILY (Daily).
3. Levothyroxine 88 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
4. Rosuvastatin 5 mg Tablet Sig: Two (2) Tablet PO HS (at
bedtime).
5. Lisinopril 40 mg Tablet Sig: One (1) Tablet PO once a day.
6. Norvasc 10 mg Tablet Sig: One (1) Tablet PO once a day.
7. Metoprolol Succinate 25 mg Tablet Sustained Release 24 hr
Sig: One (1) Tablet Sustained Release 24 hr PO DAILY (Daily).
8. Metronidazole 500 mg Tablet Sig: One (1) Tablet PO TID (3
times a day) for 9 days: Take with food.
Disp:*30 Tablet(s)* Refills:*0*
9. Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q24H (every
24 hours) for 8 days: Take with food.
Disp:*9 Tablet(s)* Refills:*0*
10. Camphor-Menthol 0.5-0.5 % Lotion Sig: One (1) Appl Topical
QID (4 times a day) as needed.
Disp:*qs * Refills:*0*
11. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO once a day.
12. Plavix 75 mg Tablet Sig: One (1) Tablet PO once a day: HOLD
for Gallbladder SURGERY.

1. Nexium 40 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO twice a day.
2. Hydrochlorothiazide 12.5 mg Capsule Sig: Two (2) Capsule PO
DAILY (Daily).
3. Levothyroxine 88 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
4. Rosuvastatin 5 mg Tablet Sig: Two (2) Tablet PO HS (at
bedtime).
5. Lisinopril 40 mg Tablet Sig: One (1) Tablet PO once a day.
6. Norvasc 10 mg Tablet Sig: One (1) Tablet PO once a day.
7. Metoprolol Succinate 25 mg Tablet Sustained Release 24 hr
Sig: One (1) Tablet Sustained Release 24 hr PO DAILY (Daily).
8. Metronidazole 500 mg Tablet Sig: One (1) Tablet PO TID (3
times a day) for 9 days: Take with food.
Disp:*30 Tablet(s)* Refills:*0*
9. Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q24H (every
24 hours) for 8 days: Take with food.
Disp:*9 Tablet(s)* Refills:*0*
10. Camphor-Menthol 0.5-0.5 % Lotion Sig: One (1) Appl Topical
QID (4 times a day) as needed.
Disp:*qs * Refills:*0*
11. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO once a day.
12. Plavix 75 mg Tablet Sig: One (1) Tablet PO once a day: HOLD
for Gallbladder SURGERY.


Discharge Disposition:
Home With Service

Facility:
[**Hospital 2255**] [**Name (NI) 2256**]

Discharge Diagnosis:
Primary:HTN
Gallstone pancreatitis
Paroxysmal Atrial Fibrillation
.
Secondary:
HTN, CAD s/p MI, stent placement [**2160**], hypothyroidism, s/p
appendectomy


Discharge Condition:
Stable
Tolerating a regular diet
Adequate pain


Discharge Instructions:
Please call your doctor or return to the ER for any of the
following:
* You experience new chest pain, pressure, squeezing or
tightness.
* If you are vomiting and cannot keep in 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.
* Your pain is not improving within 8-12 hours or not gone
within 24 hours. Call or return immediately if your pain is
getting worse or is changing location or moving to your chest or

back.
* You have shaking chills, or a fever greater than 101.5 (F)
degrees or 38(C) degrees.
* Any serious change in your symptoms, or any new symptoms that
concern you.
* Please resume all regular home medications and take any new
meds
as ordered.
* Continue to ambulate several times per day.
.
Atrial Fibrillation:
-You have been newly diagnosed with an atrial fibrillation which
is an increased heart rate.
-Please follow-up with your Cardiologist on Thursday for further
management of this new diagnosis.
-Please continue with your Aspirin. HOLD the Plavix due to your
upcoming removal of your gallbladder.

Followup Instructions:
1. Please follow-up with your Cardiologist, Dr.[**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 174**] on
Thursday [**2161-9-3**] at 9am for further evaluation of your new
diagnosis of Atrial Fibrillation.
2. Please follow-up with [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] [**Telephone/Fax (1) 31010**] within 1
week to arrange for removal of your gallbladder at your local
hospital.
.
Previous Appointments:
1. Provider: [**Name Initial (NameIs) **] 2 (ST-4) GI ROOMS Date/Time:[**2161-10-1**] 10:00
2. Provider: [**Name10 (NameIs) 1948**] [**Last Name (NamePattern4) 1949**], MD Phone:[**Telephone/Fax (1) 463**]
Date/Time:[**2161-10-1**] 10:00


                             [**Name6 (MD) **] [**Last Name (NamePattern4) **] MD, [**MD Number(3) 5190**]

Completed by:[**2161-9-1**]
{'Acute pancreatitis,Acute kidney failure, unspecified,Calculus of gallbladder and bile duct without cholecystitis, with obstruction,Cholangitis,Atrial fibrillation,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Old myocardial infarction,Dehydration,Esophageal reflux,Other and unspecified hyperlipidemia,Unspecified acquired hypothyroidism,Unspecified essential hypertension'}


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, s/p [**Doctor First Name **]

PRESENT ILLNESS: This is an 81 year-old female with a history of CAD s/p MI with
stent placement 1 year ago, HTN, hypothyroidism, who presented
to an OSH with abdominal pain radiating to the back. CT scan
there showed multiple stones in a dilated CBD and gall bladder
with evidence of both intra and extrahepatic dilitation. She was
found to have elevated liver enzymes and was transferred to
[**Hospital1 18**] for further management.
.
Here, here labs were notable for a leukocytosis to 23, markedly
elevated liver and pancreatic enzymes, but she remained
hemodynamically stable and was afebrile. She was taken to [**Hospital1 **],
who placed a stent in her CBD and extracted multiple stones, the
largest of which was 1.4mm. She was given levo and flagyl.
.
She is transferred to the [**Hospital Unit Name 153**] post [**Hospital Unit Name **] before transfer back to
the floor in the care of general surgery for monitoring. She is
currently afebrile, BP 130/58, HR 90 satting 98% on 2L by nc.

MEDICAL HISTORY: HTN
CAD s/p MI in [**2160**] s/p stent placement on plavix
Hypothyroidism
Hyperlipidemia
GERD

MEDICATION ON ADMISSION: hctz
toprol XL 25mg
aspirin 81
synthroid 88mcg
plavix
crestor
lisinopril 40mg
norvasc
nexxium

ALLERGIES: Sulfa (Sulfonamides)

PHYSICAL EXAM: Vitals: T: 98.6 BP: 139/46 HR: 82 RR: 16 O2Sat: 96%2L
GEN: no acute distress
HEENT: EOMI, PERRL, sclerae slightly icteric, no epistaxis or
rhinorrhea, MM dry, OP Clear
NECK: JVP at 5cmH20, carotid pulses brisk, no bruits, no
cervical lymphadenopathy, trachea midline
COR: RRR, soft II/VI SM at LUSB non radiating, normal S1 S2,
radial pulses +2
PULM: Lungs CTAB, no W/R/R
ABD: Soft, mildly distended, +BS, no HSM, no masses. Mild
tenderness to deep palpation in RUQ, with no rebound or
guarding.
EXT: No C/C/E, no palpable cords
NEURO: alert, oriented to person, place, and time. CN II ?????? XII
grossly intact. Moves all 4 extremities. Plantar reflex
downgoing.
SKIN: No jaundice, cyanosis, or gross dermatitis. No ecchymoses.

FAMILY HISTORY: history of MI in father in his 40's.

SOCIAL HISTORY: no alcohol, tobacco, illicits. Lives with longtime family
friend, husband recently passed away. 

### Response:
{'Acute pancreatitis,Acute kidney failure, unspecified,Calculus of gallbladder and bile duct without cholecystitis, with obstruction,Cholangitis,Atrial fibrillation,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Old myocardial infarction,Dehydration,Esophageal reflux,Other and unspecified hyperlipidemia,Unspecified acquired hypothyroidism,Unspecified essential hypertension'}
