CHIEF COMPLAINT: Transferred from Outside Hospital for GI Bleed and Cholecystitis

PRESENT ILLNESS: This was an 87 year-old man who approximately one week earlier
had entered an outside hospital with right upper quadrant pain
for 2 days and mild elevation of his liver function tests. An
ultrasound at that time showed a thickened gallbladder with
inflammatory changes consistent with cholecystitis. The common
bile duct was dilated to 9 mm. He was thought to have sludge and
possibly small stones in the distal common bile duct on the
ultrasound. At that time, he was placed on Unasyn. At 48 hours
of hospitalization, he suffered an acute upper
gastrointestinal hemorrhage. He ultimately received 6 units
of transfusion over the next 48 hours. He underwent 3
separate upper endoscopies during that time. He was found to
have a bleeding duodenal ulcer at one point which was
cauterized. He also was found to have several scattered
erosive lesions of the stomach which were thought possibly to
be consistent with arteriovenous malformations. These were
also cauterized at that time. Dr. [**Last Name (STitle) 519**] was called by a general
surgeon from the [**Hospital6 3872**], requesting
transfer to our hospital 4 days prior to the present
procedure. He had another episode of melena that morning.  The
patient was [**Hospital 25376**] transferred to [**Hospital1 18**] for higher level of
care.

MEDICAL HISTORY: Afib - started on coumadin [**8-8**]
CAD s/p CABGx2
CRI
Glaucoma
TIA/CVA
Prostate cancer s/p XRT
Hip replacement [**2101**]

MEDICATION ON ADMISSION: 

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Upon arrival by ambulance, the patient was afebrile with stable
vitals.

FAMILY HISTORY: 

SOCIAL HISTORY: Quit smoking 45 years ago, 1 drink/day, no drugs
Calculus of gallbladder with acute cholecystitis, without mention of obstruction,Accidental puncture or laceration during a procedure, not elsewhere classified,Atrial fibrillation,Chronic or unspecified duodenal ulcer with hemorrhage, without mention of obstruction,Angiodysplasia of stomach and duodenum with hemorrhage,Diseases of tricuspid valve,Chronic kidney disease, unspecified,Removal of other organ (partial) (total) causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Long-term (current) use of anticoagulants,Laparoscopic surgical procedure converted to open procedure,Personal history of malignant neoplasm of prostate,Aortocoronary bypass status
Cholelith w ac cholecyst,Accidental op laceration,Atrial fibrillation,Chr duoden ulcer w hem,Angio stm/dudn w hmrhg,Tricuspid valve disease,Chronic kidney dis NOS,Abn reac-organ rem NEC,Long-term use anticoagul,Lap surg convert to open,Hx-prostatic malignancy,Aortocoronary bypass
Name:  [**Known lastname 11443**],[**Known firstname 400**] H                 Unit No:   [**Numeric Identifier 11444**]

Admission Date:  [**2112-10-30**]              Discharge Date:   [**2112-11-8**]

Date of Birth:  [**2025-8-13**]             Sex:   M

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 5964**]
Addendum:
added on "follow-up appointments":   Please do not forget to
make an appointment ([**Telephone/Fax (1) 11445**]) with Dr. [**Name (NI) 11446**] for
a repeat EGD (esophageal-gastric-duodenal endoscopy) in [**3-9**]
weeks.


Discharge Disposition:
Extended Care

Facility:
[**Hospital1 2057**] - [**Location (un) 4887**]

                             [**First Name11 (Name Pattern1) 1080**] [**Last Name (NamePattern4) 3711**] MD, [**MD Number(3) 5966**]

Completed by:[**2112-11-8**]

Admission Date:  [**2112-10-30**]              Discharge Date:   [**2112-11-8**]


Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 3223**]
Chief Complaint:
Transferred from Outside Hospital for GI Bleed and Cholecystitis

Major Surgical or Invasive Procedure:
1. Laparoscopy.
2. Laparotomy.
3. Partial cholecystectomy with stone extraction and
fulguration of gallbladder.
4. Repair of iatrogenic colotomy

History of Present Illness:
This was an 87 year-old man who approximately one week earlier
had entered an outside hospital with right upper quadrant pain
for 2 days and mild elevation of his liver function tests. An
ultrasound at that time showed a thickened gallbladder with
inflammatory changes consistent with cholecystitis. The common
bile duct was dilated to 9 mm. He was thought to have sludge and
possibly small stones in the distal common bile duct on the
ultrasound. At that time, he was placed on Unasyn. At 48 hours
of hospitalization, he suffered an acute upper
gastrointestinal hemorrhage. He ultimately received 6 units
of transfusion over the next 48 hours. He underwent 3
separate upper endoscopies during that time. He was found to
have a bleeding duodenal ulcer at one point which was
cauterized. He also was found to have several scattered
erosive lesions of the stomach which were thought possibly to
be consistent with arteriovenous malformations. These were
also cauterized at that time. Dr. [**Last Name (STitle) 519**] was called by a general
surgeon from the [**Hospital6 3872**], requesting
transfer to our hospital 4 days prior to the present
procedure. He had another episode of melena that morning.  The
patient was [**Hospital 25376**] transferred to [**Hospital1 18**] for higher level of
care.


Past Medical History:
Afib - started on coumadin [**8-8**]
CAD s/p CABGx2
CRI
Glaucoma
TIA/CVA
Prostate cancer s/p XRT
Hip replacement [**2101**]


Social History:
Quit smoking 45 years ago, 1 drink/day, no drugs

Physical Exam:
Upon arrival by ambulance, the patient was afebrile with stable
vitals.

He was no in distressed.  He was alert and oriented, able to
carry out coherent conversations.

His heart was regularly irregular, with normal S1 and S2.
Lungs were clear to ascultation, bilaterally.

His abdomen was soft with RUQ tenderness without Muprhy's sign.
He had no rebound or guarding.

He did not have any clubbing, edema, or cyanosis on his
extremities.  He had good capillary refills.

Neurologically, he was alert and oriented x 3.  Cranial nerves
[**1-16**] were grossly intact.  Extraocular muscles intact.  Right
pulpil dilated from glaucoma medication. Strength was [**4-7**] in all
extremities.  His sensation was grossly intact.


Pertinent Results:
PATHOLOGY STILL PENDING

[**2112-11-7**] 06:55AM BLOOD WBC-7.7 RBC-3.41* Hgb-10.7* Hct-31.6*
MCV-93 MCH-31.5 MCHC-34.0 RDW-14.9 Plt Ct-220

[**2112-11-2**] 03:49AM BLOOD ALT-63* AST-49* LD(LDH)-159 AlkPhos-183*
Amylase-96 TotBili-1.1

[**2112-10-30**] 09:06PM BLOOD WBC-7.9 RBC-3.34* Hgb-10.4* Hct-28.6*
MCV-86 MCH-31.1 MCHC-36.3* RDW-15.0 Plt Ct-90*

[**2112-10-30**] 09:06PM   ALT(SGPT)-93* AST(SGOT)-82* CK(CPK)-48 ALK
PHOS-289* AMYLASE-59 TOT BILI-2.3*


Brief Hospital Course:
Upon arrival at [**Hospital1 18**], Mr. [**Known lastname 64907**] was immediately admitted to the
Intensive Care Unit for close monitoring.  He spent several days
in the ICU without needing a transfusion and was subsequently
transferred to the surgical floor.  Once his hematocrit was
stablized, he was taken to the operating room for a
cholecystectomy.  He tolerated the procedure well.
Post-operatively, he was deconditioned and needed physical
therapy.  He was slow to gain his appetite.  However, he
eventually came around to tolerate a regular diet.  Since his
surgery, he has been afebrile with stable vitals, producing
adequate urine.  His hematocrit has been stable.  He has been
working with a physical therapist to improve his strenght.  He
will be discharged [**2112-11-8**], in stable condition, to a
rehabilitation center to complete his full recovery.

Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
2. Percocet 5-325 mg Tablet Sig: 1-2 Tablets PO twice a day.
Disp:*30 Tablet(s)* Refills:*0*
3. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO once a day.
4. Insulin Regular Human 100 unit/mL Solution Sig: One (1)
Injection ASDIR (AS DIRECTED).
5. Acetaminophen 325 mg Tablet Sig: One (1) Tablet PO Q4-6H
(every 4 to 6 hours) as needed.
6. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed.
7. Morphine 2 mg/mL Syringe Sig: One (1)  Injection Q4H (every 4
hours) as needed.
8. Disopyramide 150 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
9. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO Q6HRS
().
10. Folic Acid  Oral
11. Tamsulosin 0.4 mg Capsule, Sust. Release 24HR Sig: One (1)
Capsule, Sust. Release 24HR PO DAILY (Daily).
12. Pantoprazole 20 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO BID (2 times a day).
13. Potassium Chloride 20 mEq Packet Sig: One (1)  PO DAILY
(Daily).
14. Metoprolol Tartrate 5 mg/5 mL Solution Sig: [**12-6**]  Intravenous
 Q 6 PRN () as needed.
15. Dolasetron 12.5 mg/0.625 mL Solution Sig: One (1)
Intravenous  Q8H (every 8 hours) as needed.


Discharge Disposition:
Extended Care

Facility:
[**Hospital1 **] - [**Location (un) 47**]

Discharge Diagnosis:
Cholecystitis


Discharge Condition:
Stable/Good


Discharge Instructions:
Please take medications as prescribed and read warning labels
carefully.  Please follow directions instructed by Dr. [**Last Name (STitle) 519**]
earlier.

Go to an Emergency Room if you experience new and continuing
nausea,
vomiting, fevers (>101.5 F), chills, or shortness of breath.
Also go to the ER if your wound becomes red, swollen, warm, or
produces pus.

If you experience clear drainage from your wounds, cover them
with a
clean dressing and stop showering until the drainage subsides
for at
least 2 days.

No heavy lifting or exertion for at least 6 weeks.

No driving while taking pain medications.

Narcotics can cause constipation.  Please take an over the
counter stool softener such as Colace or a gentle laxative such
as Milk of Magnesia if you experience constipation.

You may resume your regular diet as tolerated.

You may take showers (no baths) after your dressings have been
removed from your wounds.

Followup Instructions:
Please follow-up with Dr. [**Last Name (STitle) 519**] in [**12-6**] weeks.  Call [**Telephone/Fax (1) 6554**]
for an appointment.


                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 520**] MD, [**MD Number(3) 3226**]

Completed by:[**2112-11-8**]
{'Calculus of gallbladder with acute cholecystitis, without mention of obstruction,Accidental puncture or laceration during a procedure, not elsewhere classified,Atrial fibrillation,Chronic or unspecified duodenal ulcer with hemorrhage, without mention of obstruction,Angiodysplasia of stomach and duodenum with hemorrhage,Diseases of tricuspid valve,Chronic kidney disease, unspecified,Removal of other organ (partial) (total) causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Long-term (current) use of anticoagulants,Laparoscopic surgical procedure converted to open procedure,Personal history of malignant neoplasm of prostate,Aortocoronary bypass status'}


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: Transferred from Outside Hospital for GI Bleed and Cholecystitis

PRESENT ILLNESS: This was an 87 year-old man who approximately one week earlier
had entered an outside hospital with right upper quadrant pain
for 2 days and mild elevation of his liver function tests. An
ultrasound at that time showed a thickened gallbladder with
inflammatory changes consistent with cholecystitis. The common
bile duct was dilated to 9 mm. He was thought to have sludge and
possibly small stones in the distal common bile duct on the
ultrasound. At that time, he was placed on Unasyn. At 48 hours
of hospitalization, he suffered an acute upper
gastrointestinal hemorrhage. He ultimately received 6 units
of transfusion over the next 48 hours. He underwent 3
separate upper endoscopies during that time. He was found to
have a bleeding duodenal ulcer at one point which was
cauterized. He also was found to have several scattered
erosive lesions of the stomach which were thought possibly to
be consistent with arteriovenous malformations. These were
also cauterized at that time. Dr. [**Last Name (STitle) 519**] was called by a general
surgeon from the [**Hospital6 3872**], requesting
transfer to our hospital 4 days prior to the present
procedure. He had another episode of melena that morning.  The
patient was [**Hospital 25376**] transferred to [**Hospital1 18**] for higher level of
care.

MEDICAL HISTORY: Afib - started on coumadin [**8-8**]
CAD s/p CABGx2
CRI
Glaucoma
TIA/CVA
Prostate cancer s/p XRT
Hip replacement [**2101**]

MEDICATION ON ADMISSION: 

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Upon arrival by ambulance, the patient was afebrile with stable
vitals.

FAMILY HISTORY: 

SOCIAL HISTORY: Quit smoking 45 years ago, 1 drink/day, no drugs 

### Response:
{'Calculus of gallbladder with acute cholecystitis, without mention of obstruction,Accidental puncture or laceration during a procedure, not elsewhere classified,Atrial fibrillation,Chronic or unspecified duodenal ulcer with hemorrhage, without mention of obstruction,Angiodysplasia of stomach and duodenum with hemorrhage,Diseases of tricuspid valve,Chronic kidney disease, unspecified,Removal of other organ (partial) (total) causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Long-term (current) use of anticoagulants,Laparoscopic surgical procedure converted to open procedure,Personal history of malignant neoplasm of prostate,Aortocoronary bypass status'}
