CHIEF COMPLAINT: GERD and Recurrent hiatal hernia

PRESENT ILLNESS: This woman had a laparoscopic hiatal hernia repair and
fundoplication in the past for severe reflux with pulmonary
symptoms. She initially had a good response and now has
recurrent with her symptoms. A pH probe was positive.
There was a suggestion of a hiatal hernia on an upper GI series.
She has been counseled as to her options and really wishes to
have the repair because of increasing pulmonary symptoms
requiring steroids

MEDICAL HISTORY: hypertension, hypothyroidism, migraines, asthma,
hypercholesterolemia.

MEDICATION ON ADMISSION: Pred taper on 10mg
levoxyl 75
ASA 81
Diovan 120 mg
Protonix 40
celexa 40
lipitor 10
xanax .5 TID
albuterol
spiriva
advair
fosamax 35 qweek
zantac 300

ALLERGIES: Singulair / Percocet

PHYSICAL EXAM: General - Obese, pleasant woman in NAD
Neuro: Alert and Oriented
CV: RRR no M/R/G
Lungs: CTABL
GI: Midline incision with staples intact.  Appropriately tender.
Obese but nondistended.
EXT: No clubbing, cyanosis, or edema

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Lives alone; supportive daughter willing to assist as needed -
25 pack year h/o smoking, quit 24 yrs ago; rare EtOH
Diaphragmatic hernia with obstruction,Urinary complications, not elsewhere classified,Acute kidney failure, unspecified,Hyperpotassemia,Esophageal reflux,Gout, unspecified,Unspecified essential hypertension,Obstructive sleep apnea (adult)(pediatric),Asthma, unspecified type, unspecified,Long-term (current) use of steroids,Unspecified acquired hypothyroidism,Other and unspecified hyperlipidemia,Obesity, unspecified,Temporomandibular joint disorders, unspecified,Personal history of tobacco use
Diaphragm hernia w obstr,Surg compl-urinary tract,Acute kidney failure NOS,Hyperpotassemia,Esophageal reflux,Gout NOS,Hypertension NOS,Obstructive sleep apnea,Asthma NOS,Long-term use steroids,Hypothyroidism NOS,Hyperlipidemia NEC/NOS,Obesity NOS,TMJ disorders NOS,History of tobacco use
Admission Date:  [**2139-8-19**]              Discharge Date:   [**2139-8-23**]

Date of Birth:  [**2062-3-4**]             Sex:   F

Service: SURGERY

Allergies:
Singulair / Percocet

Attending:[**First Name3 (LF) 1481**]
Chief Complaint:
GERD and Recurrent hiatal hernia

Major Surgical or Invasive Procedure:
Open hiatal hernia repair
Revision Nissen fundoplication
Flexible Esophagoscopy


History of Present Illness:
This woman had a laparoscopic hiatal hernia repair and
fundoplication in the past for severe reflux with pulmonary
symptoms. She initially had a good response and now has
recurrent with her symptoms. A pH probe was positive.
There was a suggestion of a hiatal hernia on an upper GI series.
She has been counseled as to her options and really wishes to
have the repair because of increasing pulmonary symptoms
requiring steroids

Past Medical History:
hypertension, hypothyroidism, migraines, asthma,
hypercholesterolemia.


Social History:
Lives alone; supportive daughter willing to assist as needed -
25 pack year h/o smoking, quit 24 yrs ago; rare EtOH


Family History:
Non-contributory

Physical Exam:
General - Obese, pleasant woman in NAD
Neuro: Alert and Oriented
CV: RRR no M/R/G
Lungs: CTABL
GI: Midline incision with staples intact.  Appropriately tender.
Obese but nondistended.
EXT: No clubbing, cyanosis, or edema

Pertinent Results:
[**2139-8-19**] 10:23PM URINE  HOURS-RANDOM CREAT-263 SODIUM-34

[**2139-8-19**] 09:44PM   GLUCOSE-145* UREA N-17 CREAT-1.7* SODIUM-138
POTASSIUM-5.4* CHLORIDE-105 TOTAL CO2-23 ANION GAP-15

FeNa of .11 in the PACU

[**2139-8-19**] 09:44PM   CK-MB-8 cTropnT-<0.01


Brief Hospital Course:
Patient was taken to the operative suite and tolerated the
procedure well.  Post operatively she had low urine output and
after several boluses and decreases in her bupivicaine/dilaudid
epidural it was necessary to place a central line to assess her
volume status.  Subsequently she experience a bump in her Cr.
from a baseline of .7 to a peak of 1.9 and her potassium was
elevated to 6.2.  She was treated for the potassium with
bicarbonate, ca gluconate, insulin, and D5 NS.

At this point she was transfered to the ICU for close monitoring
and recovered very well over the next few days.  She was moved
to the floor without incidenct and on POD #4 tolerated a regular
diet and requested to go home after a PT consult.

Medications on Admission:
Pred taper on 10mg
levoxyl 75
ASA 81
Diovan 120 mg
Protonix 40
celexa 40
lipitor 10
xanax .5 TID
albuterol
spiriva
advair
fosamax 35 qweek
zantac 300

Discharge Medications:
1. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig:
One (1) inhalation Inhalation [**Hospital1 **] (2 times a day).
Disp:*60 inhalation* Refills:*2*
2. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours).
Disp:*60 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
3. Levothyroxine 75 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
4. Prednisone 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily)
for 2 days.
Disp:*2 Tablet(s)* Refills:*0*
5. Citalopram 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).
Disp:*60 Tablet(s)* Refills:*2*
6. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
7. Acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO Q8H (every
8 hours) as needed for pain.
8. Hydromorphone 2 mg Tablet Sig: One (1) Tablet PO Q4-6H (every
4 to 6 hours) as needed for pain.
Disp:*50 Tablet(s)* Refills:*0*
9. Valsartan 160 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
10. Alprazolam 0.25 mg Tablet Sig: One (1) Tablet PO TID (3
times a day) as needed.
Disp:*90 Tablet(s)* Refills:*0*
11. Colace 100 mg Capsule Sig: One (1) Capsule PO twice a day.
Disp:*60 Capsule(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Company 1519**]

Discharge Diagnosis:
Hiatal Hernia


Discharge Condition:
Good


Discharge Instructions:
Regular diet no bread or crackers and no to limited raw
vegetables.

Restart all home asthma medications.

Please call your surgeon if you develop chest pain, shortness of
breath, fever greater than 101.5, foul smelling or colorful
drainage from your incisions, redness or swelling, severe
abdominal pain or distention, persistent nausea or vomiting,
inability to eat or drink, or any other symptoms which are
concerning to you.

No tub baths or swimming. You may shower. If there is clear
drainage from your incisions, cover with a dry dressing. Staples
will be removed at appt with Dr. [**Last Name (STitle) **].

Activity: No heavy lifting of items [**11-23**] pounds until the
follow up
appointment with your doctor.

Medications: Resume your home medications. You should take a
stool softener, Colace 100 mg twice daily as needed for
constipation. You will be given pain medication which may make
you drowsy. No driving while taking pain medicine.


Followup Instructions:
Follow up with Dr. [**Last Name (STitle) **] in 10 days to two weeks.  Please
call ([**Telephone/Fax (1) 1483**] to set up an appointment.
{'Diaphragmatic hernia with obstruction,Urinary complications, not elsewhere classified,Acute kidney failure, unspecified,Hyperpotassemia,Esophageal reflux,Gout, unspecified,Unspecified essential hypertension,Obstructive sleep apnea (adult)(pediatric),Asthma, unspecified type, unspecified,Long-term (current) use of steroids,Unspecified acquired hypothyroidism,Other and unspecified hyperlipidemia,Obesity, unspecified,Temporomandibular joint disorders, unspecified,Personal history of tobacco use'}


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: GERD and Recurrent hiatal hernia

PRESENT ILLNESS: This woman had a laparoscopic hiatal hernia repair and
fundoplication in the past for severe reflux with pulmonary
symptoms. She initially had a good response and now has
recurrent with her symptoms. A pH probe was positive.
There was a suggestion of a hiatal hernia on an upper GI series.
She has been counseled as to her options and really wishes to
have the repair because of increasing pulmonary symptoms
requiring steroids

MEDICAL HISTORY: hypertension, hypothyroidism, migraines, asthma,
hypercholesterolemia.

MEDICATION ON ADMISSION: Pred taper on 10mg
levoxyl 75
ASA 81
Diovan 120 mg
Protonix 40
celexa 40
lipitor 10
xanax .5 TID
albuterol
spiriva
advair
fosamax 35 qweek
zantac 300

ALLERGIES: Singulair / Percocet

PHYSICAL EXAM: General - Obese, pleasant woman in NAD
Neuro: Alert and Oriented
CV: RRR no M/R/G
Lungs: CTABL
GI: Midline incision with staples intact.  Appropriately tender.
Obese but nondistended.
EXT: No clubbing, cyanosis, or edema

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Lives alone; supportive daughter willing to assist as needed -
25 pack year h/o smoking, quit 24 yrs ago; rare EtOH 

### Response:
{'Diaphragmatic hernia with obstruction,Urinary complications, not elsewhere classified,Acute kidney failure, unspecified,Hyperpotassemia,Esophageal reflux,Gout, unspecified,Unspecified essential hypertension,Obstructive sleep apnea (adult)(pediatric),Asthma, unspecified type, unspecified,Long-term (current) use of steroids,Unspecified acquired hypothyroidism,Other and unspecified hyperlipidemia,Obesity, unspecified,Temporomandibular joint disorders, unspecified,Personal history of tobacco use'}
