CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 69 year old
male with a complicated past medical history.  He initially
presented to [**Hospital1 69**] in
[**Month (only) **], complaining of constipation and vague abdominal
pain, associated with nausea and vomiting. The patient also
reported a ten pound weight loss at that admission.  The
patient underwent CT of the abdomen, which showed a markedly
abnormal pancreas with an ectatic duct and possible filling
defect. The patient was suspected to have IPMT disease;
however, MRCP of the pancreas was more consistent with a
calculus disease of the pancreas with an additional finding
of acute cholecystitis.  During that admission, the patient
successfully underwent endoscopic retrograde
cholangiopancreatography with sphincterotomy, resulting in
removal of multiple gallstones and drainage of pus from the
biliary system.  After discharge from the hospital, the
patient was followed up with the hepatobiliary surgical
office and was seen by Dr. [**First Name (STitle) **] Vomer, who had initially
been consulted during the prior admission.  With the
successful resolution of the calculous disease of the
pancreas, the patient agreed to undergo elective laparoscopic
cholecystectomy and presented to the operating room on
[**2105-12-2**].

MEDICAL HISTORY: Significant for diabetes mellitus;
coronary artery disease; chronic renal insufficiency with
baseline creatinine level of 2.6; hypertension and paroxysmal
atrial fibrillation, documented during the last admission.
(It is not clear whether this was an acute onset or a chronic
onset that was recently detected). Benign prostatic
hypertrophy.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY: 
Calculus of gallbladder with other cholecystitis, without mention of obstruction,Hemorrhage complicating a procedure,Congestive heart failure, unspecified,Laparoscopic surgical procedure converted to open procedure,Atrial fibrillation,Anemia in chronic kidney disease,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified disorder of kidney and ureter,Unspecified essential hypertension
Cholelith w cholecys NEC,Hemorrhage complic proc,CHF NOS,Lap surg convert to open,Atrial fibrillation,Anemia in chr kidney dis,DMII wo cmp nt st uncntr,Renal & ureteral dis NOS,Hypertension NOS
Admission Date:  [**2105-12-2**]       Discharge Date:  [**2105-12-11**]

Date of Birth:   [**2036-8-7**]       Sex:  M

Service:

HISTORY OF PRESENT ILLNESS:  The patient is a 69 year old
male with a complicated past medical history.  He initially
presented to [**Hospital1 69**] in
[**Month (only) **], complaining of constipation and vague abdominal
pain, associated with nausea and vomiting. The patient also
reported a ten pound weight loss at that admission.  The
patient underwent CT of the abdomen, which showed a markedly
abnormal pancreas with an ectatic duct and possible filling
defect. The patient was suspected to have IPMT disease;
however, MRCP of the pancreas was more consistent with a
calculus disease of the pancreas with an additional finding
of acute cholecystitis.  During that admission, the patient
successfully underwent endoscopic retrograde
cholangiopancreatography with sphincterotomy, resulting in
removal of multiple gallstones and drainage of pus from the
biliary system.  After discharge from the hospital, the
patient was followed up with the hepatobiliary surgical
office and was seen by Dr. [**First Name (STitle) **] Vomer, who had initially
been consulted during the prior admission.  With the
successful resolution of the calculous disease of the
pancreas, the patient agreed to undergo elective laparoscopic
cholecystectomy and presented to the operating room on
[**2105-12-2**].

PAST MEDICAL HISTORY:  Significant for diabetes mellitus;
coronary artery disease; chronic renal insufficiency with
baseline creatinine level of 2.6; hypertension and paroxysmal
atrial fibrillation, documented during the last admission.
(It is not clear whether this was an acute onset or a chronic
onset that was recently detected). Benign prostatic
hypertrophy.

PAST SURGICAL HISTORY:  Status post coronary artery bypass
graft in [**2102**]; status post left carotid endarterectomy in
[**2099**] and status post prostate surgery in [**2086**].

REVIEW OF SYSTEMS:  Anemia secondary to chronic renal
insufficiency, otherwise all other medical history was
reported previously and review of systems was otherwise
noncontributory.

FAMILY HISTORY:  Noncontributory.

MEDICATIONS AT HOME:
1.  Cardura 6 mg p.o. q. a.m. and 4 mg p.o. q. p.m.
2.  Lopressor 100 mg p.o. twice a day.
3.  Cozaar 100 mg p.o. q. day.
4.  Aspirin p.o. q. day.
5.  Lasix 40 mg p.o. q. day.
6.  Rocaltrol 0.25 mg p.o. q. day.
7.  Procrit 4000 units q. four days.
8.  Lipitor 10 mg p.o. q. day.
9.  NPH 42 units in the a.m. and 12 units q h.s. with Humalog
    sliding scale.
10. Cardizem CD 240 mg p.o. q. day.
11. Multi-vitamins.
12. Folate.
13. Nasonex and Clarinex.

PHYSICAL EXAMINATION:  The patient was afebrile; temperature
96.8; heart rate of 67; blood pressure 179/78; saturating 97%
on room air.  Fingerstick was 199.  The patient was alert and
oriented times three without jaundice or icteric sclera; not
in apparent distress.  HEAD, EYES, EARS, NOSE AND THROAT
examination was otherwise normal.  Cardiovascular
examination:  Regular rate and rhythm with S1 and S2, no
murmurs were appreciated.  Respiratory examination:  Clear to
auscultation bilaterally.  Abdominal examination:  Bowel
sounds present; obese, soft, nontender, nondistended.

HOSPITAL COURSE:  The patient underwent laparoscopic
cholecystectomy but at the very end of the procedure, the
patient had intraoperative hemorrhage from the liver bed,
upon separation of the gallbladder from the liver.  Because
of the profuse bleeding, the procedure was converted to open
cholecystectomy for management of the hemorrhage.  The
estimated blood loss was 800 cc.  The patient received 5.5
liters of Crystalloid and 2 units of packed red blood cells
and was transferred to the Intensive Care Unit at the end of
the case for postoperative management.  The patient was
followed with serial hematocrit levels, which remained
stable, above the level of 30 and there was no further
evidence of bleeding postoperatively.  During his Intensive
Care Unit admission, the patient was found to have atrial
fibrillation postoperatively.  Cardiology consult was
obtained, given the patient's history of cardiac disease and
that his cardiologist was a [**Hospital1 188**] cardiologist. With cardiology consult, the patient was
started on Amiodarone bolus and was continued on Amiodarone
drip.  The patient spontaneously came out of atrial
fibrillation, only to return again and the patient was
continued on Amiodarone as per cardiology consult.

The patient left the Intensive Care Unit on postoperative day
number four, only to return promptly again with rapid atrial
fibrillation.  The patient was continued to be treated with
Lopressor and Amiodarone with conversion of his cardiac
rhythm.  After conversion of the cardiac rhythm to sinus
rhythm, the patient was transferred to the floor and his
cardiac rhythm was monitored by telemetry.  He was found to
have several episodes of paroxysmal atrial fibrillation.
Again, cardiology consult was obtained and the patient was
restarted on his home regimen as noted above.  The patient
had several episodes of nausea and vomiting and with
appropriate medication, the patient's nausea improved and the
patient was slowly advanced on his diet, which he tolerated
without difficulty.  Nausea and vomiting had been resolved
within a time period of 24 hours and after further
consultation with cardiology, the patient was discharged on
[**2105-12-11**] on postoperative day number nine, having
passed flatus and having had bowel movement.

DISCHARGE CONDITION:  Stable.

DISCHARGE STATUS:
Discharged to home.

DISCHARGE DIAGNOSES:
1.  History of calculus disease of the pancreas.
2.  Acute cholecystitis.
3.  Coronary artery disease status post coronary artery
    bypass graft.
4.  Diabetes mellitus.
5.  Chronic renal insufficiency.
6.  Atrial fibrillation.
7.  Hypertension.
8.  Benign prostatic hypertrophy.
9.  Liver hemangioma.

DISCHARGE MEDICATIONS:
1.  Patient is to continue on all his preadmission
    medications and is to add the following:
2.  Amiodarone 200 mg p.o. q. day.
3.  Coumadin 4 mg p.o. q h.s.
4.  Tylenol with codeine 30/300 mg one to two tablets p.o.
    every four hours prn for pain.
5.  Colace 400 mg p.o. twice a day.

FOLLOW-UP:  The patient is to follow-up with Dr. [**Last Name (STitle) **] in
his office one week from discharge.  The patient is to see
his cardiologist, Dr. [**First Name8 (NamePattern2) 487**] [**Last Name (NamePattern1) **], and is to follow-up on
his arrhythmia which will be monitored at home with [**Doctor Last Name **] of
Hearts monitoring.  The patient is to see his primary care
physician and [**Name9 (PRE) 702**] with him to check the INR with a goal
of 2 to 3.







                            [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], M.D.  [**MD Number(1) 8275**]

Dictated By:[**Last Name (NamePattern1) 30603**]
MEDQUIST36

D:  [**2105-12-24**]  07:42
T:  [**2105-12-24**]  19:43
JOB#:  [**Job Number 30604**]
{'Calculus of gallbladder with other cholecystitis, without mention of obstruction,Hemorrhage complicating a procedure,Congestive heart failure, unspecified,Laparoscopic surgical procedure converted to open procedure,Atrial fibrillation,Anemia in chronic kidney disease,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified disorder of kidney and ureter,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: 

PRESENT ILLNESS: The patient is a 69 year old
male with a complicated past medical history.  He initially
presented to [**Hospital1 69**] in
[**Month (only) **], complaining of constipation and vague abdominal
pain, associated with nausea and vomiting. The patient also
reported a ten pound weight loss at that admission.  The
patient underwent CT of the abdomen, which showed a markedly
abnormal pancreas with an ectatic duct and possible filling
defect. The patient was suspected to have IPMT disease;
however, MRCP of the pancreas was more consistent with a
calculus disease of the pancreas with an additional finding
of acute cholecystitis.  During that admission, the patient
successfully underwent endoscopic retrograde
cholangiopancreatography with sphincterotomy, resulting in
removal of multiple gallstones and drainage of pus from the
biliary system.  After discharge from the hospital, the
patient was followed up with the hepatobiliary surgical
office and was seen by Dr. [**First Name (STitle) **] Vomer, who had initially
been consulted during the prior admission.  With the
successful resolution of the calculous disease of the
pancreas, the patient agreed to undergo elective laparoscopic
cholecystectomy and presented to the operating room on
[**2105-12-2**].

MEDICAL HISTORY: Significant for diabetes mellitus;
coronary artery disease; chronic renal insufficiency with
baseline creatinine level of 2.6; hypertension and paroxysmal
atrial fibrillation, documented during the last admission.
(It is not clear whether this was an acute onset or a chronic
onset that was recently detected). Benign prostatic
hypertrophy.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY:  

### Response:
{'Calculus of gallbladder with other cholecystitis, without mention of obstruction,Hemorrhage complicating a procedure,Congestive heart failure, unspecified,Laparoscopic surgical procedure converted to open procedure,Atrial fibrillation,Anemia in chronic kidney disease,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified disorder of kidney and ureter,Unspecified essential hypertension'}
