CHIEF COMPLAINT: Transfered from OSH s/p cholecystectomy with bile leak followed
by ex lap with drainage of bilious fluid, and pneumothorax s/p
CVL placement being transferred for [**First Name3 (LF) **] to correct continue
leak

PRESENT ILLNESS: 61 yo female with h/o DM2, COPD on home O2, h/o DVT/[**Hospital **]
transferred from [**Hospital3 4107**].  She underwent cholecystectomy
on [**2-1**] then represented to [**Hospital3 4107**] for abdominal pain.
She was found to have significant ileus and ascites, and
underwent exploratory laparotomy which showed a 2cm hole in the
base of the systic duct with 1 Liter bilious ascites.  There was
ischemic bowel with massive ileus and distention due to bile
peritonitis.  Her hospitalization was also complicated by a CVL
placement with subsequent pneumothorax. A left sided chest tube
was place, and also a right femoral line was placed. She is
being transferred here for [**Hospital3 **] in AM to fix the continued bile
leakage.  Of note, she has been treated with vancomycin,
metronidazole, and levofloxacin at [**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) **] for
peritonitis.
.
Currently, she states she is having severe pain in her abdomen.
She denies CP.  Her breathing is slightly labored, but she
thinks that's secondary to her large abdomen.  She otherwise
denies fevers, chills, headache, or any other symptoms.  She
request pain medications.  She was on a dilaudid PCA at the OSH.

MEDICAL HISTORY: 1. Diabetes
2. Chronoc obstructive pulmonary disease
3. T9-10 vertebral fractures.
4. h/o DVT/PE
5. Chronic back pain
6. Right knee osteonecrosis s/p right knee replacement [**Doctor First Name **]
7. Hyperthyroidism
8. Anxiety
9. Enterococcus bactermia

MEDICATION ON ADMISSION: MEDICATIONS ON TRANSFER:
1. Fortical 1 spray each nostril every 48 hrs
2. Vitamin B12 1000 mcg every 30 days
3. Dilaudid PCA (dose unclear)
4. Narcan PRN
5. Zofran 4 mg IV q6H PRN
6. Dilaudid 1 mg q4H PRN
7. tylenol 650 mg Q6H PRN
8. Lopressor 5 mg IV q2H PRN HR>120
9. Fentanyl Citrate 25 mcg q30 mins PRN
10. HISS
11. Solumedrol 20 mg IV x 3 days
12. Spiriva inhaler 1 puff daily
13. Advair 500/50 puff [**Hospital1 **]
14. Xopenex 1.25 mg q4H PRN
15. Coumadin 2 mg daily (currently held)
16. Protonix 40 mg IV daily
17. Levofloxacin 500 mg IV daily
18. Metronidazole 500 q8H
19. Vancomycin 1 gm q12h
20. TPN daily
.
ADMISSION MEDICATIONS:
1. KCL 40 meq 3 x daily
2. Spiriva 18 mcg INH daily
3. Fortical 1 spray alternating nostrils daily
4. Vitamin D 400 units daily
5. Prednisone 30 mg daily
6. Mag oxide 400 mg [**Hospital1 **]
7. MVI daily
8. Trazadone 50 mg qhs
9. Advair 1 puff [**Hospital1 **]
10. Amoxicillin 500 mg [**Hospital1 **]
11. Neurontin 300 mg TID
12. Oxycodone 50 mg q6H PRN
13. Singulair 10 mg daily
14. Cymbalta 60 mg daily
15. Lasix 40 mg daily
16. Protonix 40 mg [**Hospital1 **]
17. Synthroid 112 mcg daily
18. B12 1000 mcg IM monthly
19. Iron 325 mg daily
20. Oxycontin 20 mg [**Hospital1 **]
21. Xopenex 1 puf q4H PRN
22. Dilaudid 2 mg PO q4H PRN
23. Coumadin 2 mg daily
24. Ativan 0.5 mg [**Hospital1 **]
25. Albuterol INH q4h prn
26. Atroven neb q4H PRN

ALLERGIES: Celebrex / Zithromax / Sulfa (Sulfonamides)

PHYSICAL EXAM: vitals - T 98.8 P 120 ST BP 154/74 RR 17 89% O2 sat on 4L NC
gen - Alert awake,
heent - MMM, No icterus, no signs of conjunctivitis
cv - S1S2 RRR
pulm - Coarse breath sounds anteriorly, Decreased BS b/l, few
scattered rhonci.  left chest tube in place with no air leak
noted
abd - BS hypoactive; TTP diffusely but particulary in RLQ.
bandage in place with JP drain with bilious fluid.  + tympany to
percussion
ext - warm, no edema. Multiple echymosis.
neuro - alert and awake. No focal abnormalities.

FAMILY HISTORY: NC

SOCIAL HISTORY: Widowed. lives independently. Denies alcohol, smoking.
Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Chronic airway obstruction, not elsewhere classified,Personal history of venous thrombosis and embolism,Long-term (current) use of anticoagulants
Abn react-surg proc NEC,DMII wo cmp nt st uncntr,Chr airway obstruct NEC,Hx-ven thrombosis/embols,Long-term use anticoagul
Admission Date:  [**2119-2-9**]              Discharge Date:   [**2119-2-11**]

Date of Birth:  [**2055-11-29**]             Sex:   F

Service: MEDICINE

Allergies:
Celebrex / Zithromax / Sulfa (Sulfonamides)

Attending:[**First Name3 (LF) 2485**]
Chief Complaint:
Transfered from OSH s/p cholecystectomy with bile leak followed
by ex lap with drainage of bilious fluid, and pneumothorax s/p
CVL placement being transferred for [**First Name3 (LF) **] to correct continue
leak

Major Surgical or Invasive Procedure:
[**First Name3 (LF) **]
Intubation s/p extubation


History of Present Illness:
61 yo female with h/o DM2, COPD on home O2, h/o DVT/[**Hospital **]
transferred from [**Hospital3 4107**].  She underwent cholecystectomy
on [**2-1**] then represented to [**Hospital3 4107**] for abdominal pain.
She was found to have significant ileus and ascites, and
underwent exploratory laparotomy which showed a 2cm hole in the
base of the systic duct with 1 Liter bilious ascites.  There was
ischemic bowel with massive ileus and distention due to bile
peritonitis.  Her hospitalization was also complicated by a CVL
placement with subsequent pneumothorax. A left sided chest tube
was place, and also a right femoral line was placed. She is
being transferred here for [**Hospital3 **] in AM to fix the continued bile
leakage.  Of note, she has been treated with vancomycin,
metronidazole, and levofloxacin at [**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) **] for
peritonitis.
.
Currently, she states she is having severe pain in her abdomen.
She denies CP.  Her breathing is slightly labored, but she
thinks that's secondary to her large abdomen.  She otherwise
denies fevers, chills, headache, or any other symptoms.  She
request pain medications.  She was on a dilaudid PCA at the OSH.

.
Also on chroinc steroids for COPD.

Past Medical History:
1. Diabetes
2. Chronoc obstructive pulmonary disease
3. T9-10 vertebral fractures.
4. h/o DVT/PE
5. Chronic back pain
6. Right knee osteonecrosis s/p right knee replacement [**Doctor First Name **]
7. Hyperthyroidism
8. Anxiety
9. Enterococcus bactermia


Social History:
Widowed. lives independently. Denies alcohol, smoking.


Family History:
NC

Physical Exam:
vitals - T 98.8 P 120 ST BP 154/74 RR 17 89% O2 sat on 4L NC
gen - Alert awake,
heent - MMM, No icterus, no signs of conjunctivitis
cv - S1S2 RRR
pulm - Coarse breath sounds anteriorly, Decreased BS b/l, few
scattered rhonci.  left chest tube in place with no air leak
noted
abd - BS hypoactive; TTP diffusely but particulary in RLQ.
bandage in place with JP drain with bilious fluid.  + tympany to
percussion
ext - warm, no edema. Multiple echymosis.
neuro - alert and awake. No focal abnormalities.


Pertinent Results:
[**2119-2-9**] 09:51PM   GLUCOSE-162* UREA N-22* CREAT-0.9 SODIUM-145
POTASSIUM-3.6 CHLORIDE-110* TOTAL CO2-26 ANION GAP-13
[**2119-2-9**] 09:51PM   ALT(SGPT)-17 AST(SGOT)-16 LD(LDH)-253* ALK
PHOS-106 AMYLASE-25 TOT BILI-0.4
[**2119-2-9**] 09:51PM   LIPASE-8
[**2119-2-9**] 09:51PM   ALBUMIN-2.6* CALCIUM-7.1* PHOSPHATE-3.3
MAGNESIUM-2.2
[**2119-2-9**] 09:51PM   WBC-8.0 RBC-3.40* HGB-10.0* HCT-31.0* MCV-91
MCH-29.3 MCHC-32.1 RDW-16.3*
[**2119-2-9**] 09:51PM   NEUTS-96.0* LYMPHS-2.0* MONOS-1.8* EOS-0.2
BASOS-0.1
[**2119-2-9**] 09:51PM   PLT COUNT-229
[**2119-2-9**] 09:51PM   PT-16.3* PTT-29.8 INR(PT)-1.5*
.
EKG: sinus, no significant ST segment changes.
.
[**2119-2-10**]
[**Year (4 digits) **]:
Impression: Normal major papilla.
Cannulation of the biliary duct was successful and deep with a
Autotome 44 using a free-hand technique. Contrast medium was
injected resulting in complete opacification.  Slight
extravasation was noted at the cystic duct remnant.  The calibre
and course of the intrahepatic ducts and the CBD was normal; no
filling defects were noted.  A 10cm by 9mm Cotton [**Doctor Last Name **] biliary
stent was placed successfully.  Otherwise normal [**Doctor Last Name **] to third
part of the duodenum
.
[**2119-2-9**]
Chest x-ray

Tubing projected over the left lower hemithorax could be a
pleural drain,
impinges on the mediastinum and then could be folded quite
sharply, to the
point of occlusion. Clinical examination recommended. Thickening
of the left apical pleural margin extends into the mediastinum
is new concerning for hematoma related to line insertion
attempt. No radiopaque central venous catheter is seen. Mild
left lower lobe atelectasis is new. Heart size is normal.
Stomach is moderately distended with air and a right upper
quadrant drainage catheter is at the lower margin of the liver

.
[**2119-2-10**]

Left basal pleural tube is sharply folded as it impinges on the
mediastinum, and may be effectively occluded. Pleural effusion,
if any, is small. No pneumothorax. Lobular thickening of the
left apical pleural margin could be either loculated effusion or
extrapleural hematoma from attempted line placement, as
discussed with the house officer caring for this patient earlier
in the day. Severe left lung atelectasis is unchanged.
.
Marked azygos distention in part reflects supine positioning
nevertheless
indicates elevated central venous pressure or volume. The heart
is probably not enlarged.

.
[**2119-2-10**] 5:13 am PERITONEAL FLUID

   GRAM STAIN (Final [**2119-2-10**]):
      REPORTED BY PHONE TO [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] @ 6:05A [**2119-2-9**].
      1+    (<1 per 1000X FIELD):   POLYMORPHONUCLEAR
LEUKOCYTES.
      2+   (1-5 per 1000X FIELD):   GRAM NEGATIVE ROD(S).

   FLUID CULTURE (Preliminary):
      REPORTED BY PHONE TO DR [**First Name (STitle) **],J [**2119-2-11**] 3PM.
      GRAM NEGATIVE ROD(S).    MODERATE GROWTH.

   ANAEROBIC CULTURE (Preliminary):


Brief Hospital Course:
MICU COURSE:

63 y/o female with COPD,diabetes, and h/o DVT is transfered from
OSH after exploratory laparotomy for bile duct leak following
cholecystectomy, also s/p left CVL placement with subsequent PTX
s/p left chest tube placement, transferred here for [**Month/Day/Year **] to
address continued bile duct leak.  [**Month/Day/Year **] done and stent placed
without difficulty.  Patient electively intubated during
procedure and successfully extubated.

# Bile duct leak:
Patient underwent cholecystecomy on [**2-1**], followed by
exploratory laparotomy on [**2-7**] found to have 2 cm hole at cystic
duct with bilious drainiage, and 1L of bilious ascites, and
likely peritonitis given acute abdomen on vanco/levo/flagyl
Transferred to [**Hospital1 18**] for [**Hospital1 **].  She remained hemodynamically
stable throughout hospital stay.  [**Hospital1 **] was performed on [**2119-2-10**]
and a stent successfully placed.  Antibiotics changed to
vanco/zosyn for better GNR coverage, as peritoneal fluid grew
GNRs, yet to be speciated.  She should have a repeat [**Date Range **] in 8
weeks to remove the stent and to reassess.  Her diet should be
advanced slowly as tolerated.

# Left Pneumothorax:
In context of subclavian attempt at OSH s/p chest tube
placement.  On arrival to [**Hospital1 18**], x-ray revealed malpositioning
of chest tube.  Thoracics was consulted for removal.  On serial
chest x-rays here, PTX resolved.

# COPD:
Was intubated at [**Hospital1 **] postoperatively, but self extubated.
Transferred on ventimask 50% FIO2.   On chronic po steroids at
home, transitioned to IV regimen initially as she was NPO.
Should be transitioned back to her home regimen as tolerated.

# History of DVT/PE:
On coumadin as outpatient which was held in preparation for [**Hospital1 **]
and removal of chest tube.  Heparin resumed following these
procedures.

Medications on Admission:
MEDICATIONS ON TRANSFER:
1. Fortical 1 spray each nostril every 48 hrs
2. Vitamin B12 1000 mcg every 30 days
3. Dilaudid PCA (dose unclear)
4. Narcan PRN
5. Zofran 4 mg IV q6H PRN
6. Dilaudid 1 mg q4H PRN
7. tylenol 650 mg Q6H PRN
8. Lopressor 5 mg IV q2H PRN HR>120
9. Fentanyl Citrate 25 mcg q30 mins PRN
10. HISS
11. Solumedrol 20 mg IV x 3 days
12. Spiriva inhaler 1 puff daily
13. Advair 500/50 puff [**Hospital1 **]
14. Xopenex 1.25 mg q4H PRN
15. Coumadin 2 mg daily (currently held)
16. Protonix 40 mg IV daily
17. Levofloxacin 500 mg IV daily
18. Metronidazole 500 q8H
19. Vancomycin 1 gm q12h
20. TPN daily
.
ADMISSION MEDICATIONS:
1. KCL 40 meq 3 x daily
2. Spiriva 18 mcg INH daily
3. Fortical 1 spray alternating nostrils daily
4. Vitamin D 400 units daily
5. Prednisone 30 mg daily
6. Mag oxide 400 mg [**Hospital1 **]
7. MVI daily
8. Trazadone 50 mg qhs
9. Advair 1 puff [**Hospital1 **]
10. Amoxicillin 500 mg [**Hospital1 **]
11. Neurontin 300 mg TID
12. Oxycodone 50 mg q6H PRN
13. Singulair 10 mg daily
14. Cymbalta 60 mg daily
15. Lasix 40 mg daily
16. Protonix 40 mg [**Hospital1 **]
17. Synthroid 112 mcg daily
18. B12 1000 mcg IM monthly
19. Iron 325 mg daily
20. Oxycontin 20 mg [**Hospital1 **]
21. Xopenex 1 puf q4H PRN
22. Dilaudid 2 mg PO q4H PRN
23. Coumadin 2 mg daily
24. Ativan 0.5 mg [**Hospital1 **]
25. Albuterol INH q4h prn
26. Atroven neb q4H PRN


Discharge Medications:
1. Albuterol Sulfate 2.5 mg /3 mL (0.083 %) Solution for
Nebulization Sig: One (1)  Inhalation Q6H (every 6 hours) as
needed.
2. Ipratropium Bromide 0.02 % Solution Sig: One (1)  Inhalation
Q6H (every 6 hours).
3. Bupivacaine (PF) 0.25 % (2.5 mg/mL) Solution Sig: One (1) ML
Injection INFUSION (continuous infusion).
4. Pantoprazole 40 mg Recon Soln Sig: One (1) Recon Soln
Intravenous Q24H (every 24 hours).
5. Vancomycin in Dextrose 1 gram/200 mL Piggyback Sig: One (1)
Intravenous Q 12H (Every 12 Hours).
6. Levothyroxine 200 mcg Recon Soln Sig: One (1) Recon Soln
Injection DAILY (Daily).
7. Piperacillin-Tazobactam-Dextrs 4.5 gram/100 mL Piggyback Sig:
One (1)  Intravenous Q8H (every 8 hours).
8. Methylprednisolone Sodium Succ 40 mg/mL Recon Soln Sig: One
(1) Recon Soln Injection Q24H (every 24 hours).
9. Lorazepam 2 mg/mL Syringe Sig: One (1)  Injection Q4H (every
4 hours) as needed for anxiety.


Discharge Disposition:
Extended Care

Discharge Diagnosis:
Primary
# Bile duct leak
# Left pneumothorax s/p chest tube placement at OSH
Secondary
# COPD
# DVT/PE


Discharge Condition:
Hemodynamically stable


Discharge Instructions:
You were admitted to the [**Hospital1 18**] for an [**Hospital1 **].  This procedure went
well and you had a stent placed to fix your biliary leak.  You
were intubated during the procedure and successfully extubated
following the [**Hospital1 **].  You should have a repeat [**Hospital1 **] in 8 weeks to
have the stent removed.  Your diet should be advanced as
tolerated.  You also had your chest tube removed on this
admission.

Followup Instructions:
You have the following appointments for repeat [**Hospital1 **]
Provider: [**Name Initial (NameIs) **] 2 (ST-4) GI ROOMS Date/Time:[**2119-4-11**] 8:00
Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 2839**], MD Phone:[**Telephone/Fax (1) 463**]
Date/Time:[**2119-4-11**] 8:00



Completed by:[**2119-2-12**]
{'Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Chronic airway obstruction, not elsewhere classified,Personal history of venous thrombosis and embolism,Long-term (current) use of anticoagulants'}


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: Transfered from OSH s/p cholecystectomy with bile leak followed
by ex lap with drainage of bilious fluid, and pneumothorax s/p
CVL placement being transferred for [**First Name3 (LF) **] to correct continue
leak

PRESENT ILLNESS: 61 yo female with h/o DM2, COPD on home O2, h/o DVT/[**Hospital **]
transferred from [**Hospital3 4107**].  She underwent cholecystectomy
on [**2-1**] then represented to [**Hospital3 4107**] for abdominal pain.
She was found to have significant ileus and ascites, and
underwent exploratory laparotomy which showed a 2cm hole in the
base of the systic duct with 1 Liter bilious ascites.  There was
ischemic bowel with massive ileus and distention due to bile
peritonitis.  Her hospitalization was also complicated by a CVL
placement with subsequent pneumothorax. A left sided chest tube
was place, and also a right femoral line was placed. She is
being transferred here for [**Hospital3 **] in AM to fix the continued bile
leakage.  Of note, she has been treated with vancomycin,
metronidazole, and levofloxacin at [**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) **] for
peritonitis.
.
Currently, she states she is having severe pain in her abdomen.
She denies CP.  Her breathing is slightly labored, but she
thinks that's secondary to her large abdomen.  She otherwise
denies fevers, chills, headache, or any other symptoms.  She
request pain medications.  She was on a dilaudid PCA at the OSH.

MEDICAL HISTORY: 1. Diabetes
2. Chronoc obstructive pulmonary disease
3. T9-10 vertebral fractures.
4. h/o DVT/PE
5. Chronic back pain
6. Right knee osteonecrosis s/p right knee replacement [**Doctor First Name **]
7. Hyperthyroidism
8. Anxiety
9. Enterococcus bactermia

MEDICATION ON ADMISSION: MEDICATIONS ON TRANSFER:
1. Fortical 1 spray each nostril every 48 hrs
2. Vitamin B12 1000 mcg every 30 days
3. Dilaudid PCA (dose unclear)
4. Narcan PRN
5. Zofran 4 mg IV q6H PRN
6. Dilaudid 1 mg q4H PRN
7. tylenol 650 mg Q6H PRN
8. Lopressor 5 mg IV q2H PRN HR>120
9. Fentanyl Citrate 25 mcg q30 mins PRN
10. HISS
11. Solumedrol 20 mg IV x 3 days
12. Spiriva inhaler 1 puff daily
13. Advair 500/50 puff [**Hospital1 **]
14. Xopenex 1.25 mg q4H PRN
15. Coumadin 2 mg daily (currently held)
16. Protonix 40 mg IV daily
17. Levofloxacin 500 mg IV daily
18. Metronidazole 500 q8H
19. Vancomycin 1 gm q12h
20. TPN daily
.
ADMISSION MEDICATIONS:
1. KCL 40 meq 3 x daily
2. Spiriva 18 mcg INH daily
3. Fortical 1 spray alternating nostrils daily
4. Vitamin D 400 units daily
5. Prednisone 30 mg daily
6. Mag oxide 400 mg [**Hospital1 **]
7. MVI daily
8. Trazadone 50 mg qhs
9. Advair 1 puff [**Hospital1 **]
10. Amoxicillin 500 mg [**Hospital1 **]
11. Neurontin 300 mg TID
12. Oxycodone 50 mg q6H PRN
13. Singulair 10 mg daily
14. Cymbalta 60 mg daily
15. Lasix 40 mg daily
16. Protonix 40 mg [**Hospital1 **]
17. Synthroid 112 mcg daily
18. B12 1000 mcg IM monthly
19. Iron 325 mg daily
20. Oxycontin 20 mg [**Hospital1 **]
21. Xopenex 1 puf q4H PRN
22. Dilaudid 2 mg PO q4H PRN
23. Coumadin 2 mg daily
24. Ativan 0.5 mg [**Hospital1 **]
25. Albuterol INH q4h prn
26. Atroven neb q4H PRN

ALLERGIES: Celebrex / Zithromax / Sulfa (Sulfonamides)

PHYSICAL EXAM: vitals - T 98.8 P 120 ST BP 154/74 RR 17 89% O2 sat on 4L NC
gen - Alert awake,
heent - MMM, No icterus, no signs of conjunctivitis
cv - S1S2 RRR
pulm - Coarse breath sounds anteriorly, Decreased BS b/l, few
scattered rhonci.  left chest tube in place with no air leak
noted
abd - BS hypoactive; TTP diffusely but particulary in RLQ.
bandage in place with JP drain with bilious fluid.  + tympany to
percussion
ext - warm, no edema. Multiple echymosis.
neuro - alert and awake. No focal abnormalities.

FAMILY HISTORY: NC

SOCIAL HISTORY: Widowed. lives independently. Denies alcohol, smoking. 

### Response:
{'Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Chronic airway obstruction, not elsewhere classified,Personal history of venous thrombosis and embolism,Long-term (current) use of anticoagulants'}
