CHIEF COMPLAINT: symptomatic rectal dysfunction, large parastomal hernia

PRESENT ILLNESS: 50M s/p anal squamous ca treated w/ chemoradiation w. subsequent
anal stricture requiring sigmoid colectomy, end colostomy,
mucous fistula.  Followed by Dr [**Last Name (STitle) 1120**] with discussions of stoma
reversal and parastomal hernia repair after anal
stricture dilatation.  His radiation history is distant ([**2114**]).
Mr.[**Known lastname 73917**] has abdominal pain consistent with his chronic abdominal
pain, for which he takes many medications. Patient is scheduled
to undergo colostomy resite, hernia repair, component
separation, and segmental colectomy.

MEDICAL HISTORY: PMH: anal SCC, anal stricture, large abdominal hernia, chronic
abdominal pain, CAD, PVD, ?OSA, HTN, hypercholesterolemia
vitamin D deficiency
PSH: sigmoid colectomy and dilatation, 2 LLE stents,

MEDICATION ON ADMISSION: Cilostazol 100'', Plavix 75', VitD2 50,000 uqwk, Nexium 40',
Mehadone 20''prn, lopressor 100'', Roxicet 5mgq6h, colace, MVI

ALLERGIES: Cymbalta / Morphine / Nortriptyline

PHYSICAL EXAM: On Discharge:
VS: 98.8 98.1 81 92 108/70 20 98(2L)
HEENT: normal EOM, PERL
CVS: RRR, normal S1, S2
Resp: CTAB
[**Last Name (un) **]: soft, appropriately tender, non-distended, wound vac in
place, ostomy debrided prior to discharge, adquate ostomy
outputl
Ext: warm, no edema, distal aspects of left foot still pain.
Good distal pulses.

FAMILY HISTORY: noncontributory

SOCIAL HISTORY: originally from [**Country 3400**]
lives with wife, no children
quit tobacco 2 months ago, previously 1 ppd x 2 years
no EtOH in 14 years
Other colostomy and enterostomy complication,Hydronephrosis,Acidosis,Paralytic ileus,Persistent postoperative fistula,Acute posthemorrhagic anemia,Drug-induced psychotic disorder with hallucinations,Incisional hernia without mention of obstruction or gangrene,Personal history of malignant neoplasm of rectum, rectosigmoid junction, and anus,Morbid obesity,Peritoneal adhesions (postoperative) (postinfection),Other chronic pain,Lumbago,Pain in limb,Unspecified vitamin D deficiency,Obstructive sleep apnea (adult)(pediatric),Orchitis and epididymitis, unspecified,Surgical operation with formation of external stoma causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Accidents occurring in residential institution,Fever, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Intravenous anesthetics causing adverse effects in therapeutic use
Colstmy/enteros comp NEC,Hydronephrosis,Acidosis,Paralytic ileus,Persist postop fistula,Ac posthemorrhag anemia,Drug psy dis w hallucin,Incisional hernia,Hx-rectal & anal malign,Morbid obesity,Peritoneal adhesions,Chronic pain NEC,Lumbago,Pain in limb,Vitamin D deficiency NOS,Obstructive sleep apnea,Orchitis/epididymit NOS,Abn react-external stoma,Accid in resident instit,Fever NOS,DMII wo cmp nt st uncntr,Adv eff intraven anesth
Admission Date:  [**2128-5-24**]              Discharge Date:   [**2128-6-18**]

Date of Birth:  [**2078-2-19**]             Sex:   M

Service: SURGERY

Allergies:
Cymbalta / Morphine / Nortriptyline

Attending:[**First Name3 (LF) 3376**]
Chief Complaint:
symptomatic rectal dysfunction, large parastomal hernia

Major Surgical or Invasive Procedure:
[**2128-5-24**]: Laparotomy and lysis of adhesions, takedown colostomy,
takedown splenic flexure, segmental colectomy with end
colostomy, resiting of stoma to RLQ, component separation
closure, surgimend repair of old stoma site

History of Present Illness:
50M s/p anal squamous ca treated w/ chemoradiation w. subsequent
anal stricture requiring sigmoid colectomy, end colostomy,
mucous fistula.  Followed by Dr [**Last Name (STitle) 1120**] with discussions of stoma
reversal and parastomal hernia repair after anal
stricture dilatation.  His radiation history is distant ([**2114**]).
Mr.[**Known lastname 73917**] has abdominal pain consistent with his chronic abdominal
pain, for which he takes many medications. Patient is scheduled
to undergo colostomy resite, hernia repair, component
separation, and segmental colectomy.


Past Medical History:
PMH: anal SCC, anal stricture, large abdominal hernia, chronic
abdominal pain, CAD, PVD, ?OSA, HTN, hypercholesterolemia
vitamin D deficiency
PSH: sigmoid colectomy and dilatation, 2 LLE stents,

Social History:
originally from [**Country 3400**]
lives with wife, no children
quit tobacco 2 months ago, previously 1 ppd x 2 years
no EtOH in 14 years


Family History:
noncontributory

Physical Exam:
On Discharge:
VS: 98.8 98.1 81 92 108/70 20 98(2L)
HEENT: normal EOM, PERL
CVS: RRR, normal S1, S2
Resp: CTAB
[**Last Name (un) **]: soft, appropriately tender, non-distended, wound vac in
place, ostomy debrided prior to discharge, adquate ostomy
outputl
Ext: warm, no edema, distal aspects of left foot still pain.
Good distal pulses.

Pertinent Results:
Micro/Imaging:
[**2128-6-10**] bcx P
[**2128-6-8**] bcx P
[**2128-6-8**] ucx negative
[**2128-6-7**] bcx P
[**2128-6-7**] cxr negative
[**2128-6-7**] CT abd prelim:sm dehiscent, w/small loc collection at
open incision
[**2128-6-7**] nicotine none detected
[**2128-6-7**] ucx negative
[**2128-6-4**] Renogram resolved R hydronephrosis, fatty liver, unable
to r/o cirrhosis
[**2128-6-1**] bcx negative
[**2128-5-31**] CT abd R hydroureteronephrosis larg R kidney and no
exreted contrast
[**2128-5-31**] bcx negative
[**2128-5-30**] ucx negative
[**2128-5-30**] bcx negative
[**2128-5-26**] ucx negative
[**2128-5-25**] ucx negative

Brief Hospital Course:
ICU Course: Admitted [**5-24**] after surgical re-siting of colostomy
from PACU for pain control. Unable to control pain with large
doses of Dilaudid, fentanyl, methadone and Ketamine, so was
intubated and sedated for pain control. Anaesthesia was
consulted and with lidocaine bolus, Ketamine drip, ketorolac iv,
methadone iv, and dexmedetomidine was able to extubate the
patient and achieve evidence of physiologic control of pain
(improved NR, BP). Patient did still endorse [**10-31**] pain. Patient
then developed hallucinations that resolved with titration off
of the Ketamine. Once he was more than 7 days off Plavix he was
transitioned from dexmedetomidine to epidural with bupivacaine
with improvement in pain control. He was continue on bupivacaine
and methadone with prn Ativan and stable in terms of pain
control for transfer to the floor. Several other medical issues
were addressed during his ICU course as follows: Hypotension
attributed to blood loss with surgery and pain medications,
initially given 1 LNS, then observed per surgery's order with
UOP 15-20 ml/hr. Anemia: marked HCT drip POD3 attributed to
fluid mobilization, trended. Diminished dorsalis pedis pulse
left: [**Month/Year (2) 1106**] surgery was consulted and felt no limb
threatening ischemia, recommended non-invasives and no need for
antibiotics. His terazosin was stopped while a Foley is in
place, he was continued on his home PPI, and CPAP.

Once the patient no longer required IV methadone he was
transferred to the floor. On [**5-27**] patient reported having left
foot pain. [**Month/Day (4) **] surgery was consuled to rule ischemia.  They
ruled out acute ischemia and advised him to follow-up as
outpatient with [**Month/Day (4) 1106**] surgery (appointment list).  On [**6-1**]
his epidural was discontinued  and on [**6-2**] his plavix was
restared and his diet was advanced to clears.  [**5-31**] CT ABD:
Right-sided hydroureteronephrosis with enlarged right kidney and
noexcretion of contrast.  Urology was consulted and on their
recommendation he underwent a lasix renogram which showed
resolved R hydronephrosis [**6-3**]. Plastic surgery opened his wound
at bedside for foul smelling drainage initially thought to be
fat necrosis however this eventually was found to have gross
stool. CT scan was performed and revealed ostomy leak to his
wound superficial to the fascia and the patient was made NPO.  A
wound vac was placed over this wound.  He continued to have low
grade fevers but no growth on blood or urine cultures ([**6-7**],
[**6-8**], [**6-10**] cxs).  On [**6-8**] TPN was started as it was determined
he would need to remain NPO for some time with this ostomy leak.
 The wound vac was changed on a daily basis per plastic surgery
recommendations. On POD21 [**6-14**], patient was started on sips
which he tolerated well.  His diet was advanced. On POD23 [**6-16**]
he tolerated a regular diet. His TPN was weaned and then
stopped.  On POD25 he was discharged in good condition
tolerating a regular diet.  His wound vac was removed with
instructions to have VNA services to help replace the wound vac
at home with his home wound vac.  His wound was packed with
moist to dry and he was discharged to home.


Medications on Admission:
Cilostazol 100'', Plavix 75', VitD2 50,000 uqwk, Nexium 40',
Mehadone 20''prn, lopressor 100'', Roxicet 5mgq6h, colace, MVI

Discharge Medications:
1. Gabapentin 300 mg Capsule Sig: Three (3) Capsule PO Q8H
(every 8 hours).
Disp:*270 Capsule(s)* Refills:*0*
2. Quetiapine 25 mg Tablet Sig: Two (2) Tablet PO TID (3 times a
day).
Disp:*180 Tablet(s)* Refills:*0*
3. Acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO Q 8H
(Every 8 Hours) as needed for pain.
4. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
5. Tizanidine 2 mg Tablet Sig: Three (3) Tablet PO TID (3 times
a day) as needed for pain.
Disp:*126 Tablet(s)* Refills:*0*
6. Methadone 40 mg Tablet, Soluble Sig: One (1) Tablet, Soluble
PO TID (3 times a day).
Disp:*90 Tablet, Soluble(s)* Refills:*0*
7. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO twice
a day as needed for constipation.
8. Cilostazol 100 mg Tablet Sig: One (1) Tablet PO twice a day.



Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
Peristomal Hernia


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
You were admitted to the hospital for treatment of your  Ventral
hernia, parastomal hernia, rectal dysfunction with requirement
for redo colostomy. Your procedure was complicated by your pain
managment, however after being managed with chronic pain your
pain level is now controled. You will need to follow-up with the
chronic pain clinic for tapering of the methadone. If you become
very sleepy or confused please seek medical attention. Do not
take any additional pain medications except for the ones
prescribed for you at discharge.

You have an open surgical wound on your abdomen which you will
go home with a vac dressing with vna to monitor this. You should
leave the vac in place at home. Please shower on days when the
VAC is changes prior to when the VNA visits to your house.
Please monitor for signs and symptoms of infection, like change
in color of drainage (green, brown, bright red), increased pain,
foul odor, or if you develop a fever. If you develop these
symptoms please call the office or go to the emergency room. It
is very important that you monitor the appearance of your wound.

Your ostomy is slightly retracted, it is important that you
monitor the stool output in the ostomy bag, if this suddenly
decreases please call the office or go to the emergency room. If
you become nauseated, have increased abdominal distension,
develop abdominal pain not relieved with medication, vomit, or
cannot tolerate food please come to the emergency department.
Continue to care for your ostomy as instructed by the ostomy
nurse.

Please keep your follow up appointments. Please keep your
follow-up appointment with [**Hospital 1106**] surgery for your left leg
pain.

Call your Primary care provider with any issues or concerns.


Followup Instructions:
Provider: [**Name10 (NameIs) **] LAB Phone:[**Telephone/Fax (1) 1237**] Date/Time:[**2128-6-25**]
1:30
Provider: [**Name10 (NameIs) **] LAB Phone:[**Telephone/Fax (1) 1237**] Date/Time:[**2128-6-25**]
2:15
Provider: [**Name10 (NameIs) 251**] [**Last Name (NamePattern4) 1490**], MD Phone:[**Telephone/Fax (1) 1237**]
Date/Time:[**2128-6-30**] 9:15

Please make a follow-up appointment with Dr. [**Last Name (STitle) 1120**] for 2 weeks,
please call ([**Telephone/Fax (1) 3378**] to make an appointment.

An appointment has been made for you in the chronic pain clinic
for [**2128-7-14**] at 130pm, we would like you to be seen sooner
so you are on a cancelation list. The chronic pain clinic number
chronic pain clinic [**Telephone/Fax (1) 1652**].

Please keep this appointment. Your lopressor is on hold, please
make a follow-up appointment with this provider.
{'Other colostomy and enterostomy complication,Hydronephrosis,Acidosis,Paralytic ileus,Persistent postoperative fistula,Acute posthemorrhagic anemia,Drug-induced psychotic disorder with hallucinations,Incisional hernia without mention of obstruction or gangrene,Personal history of malignant neoplasm of rectum, rectosigmoid junction, and anus,Morbid obesity,Peritoneal adhesions (postoperative) (postinfection),Other chronic pain,Lumbago,Pain in limb,Unspecified vitamin D deficiency,Obstructive sleep apnea (adult)(pediatric),Orchitis and epididymitis, unspecified,Surgical operation with formation of external stoma causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Accidents occurring in residential institution,Fever, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Intravenous anesthetics causing adverse effects in therapeutic 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: symptomatic rectal dysfunction, large parastomal hernia

PRESENT ILLNESS: 50M s/p anal squamous ca treated w/ chemoradiation w. subsequent
anal stricture requiring sigmoid colectomy, end colostomy,
mucous fistula.  Followed by Dr [**Last Name (STitle) 1120**] with discussions of stoma
reversal and parastomal hernia repair after anal
stricture dilatation.  His radiation history is distant ([**2114**]).
Mr.[**Known lastname 73917**] has abdominal pain consistent with his chronic abdominal
pain, for which he takes many medications. Patient is scheduled
to undergo colostomy resite, hernia repair, component
separation, and segmental colectomy.

MEDICAL HISTORY: PMH: anal SCC, anal stricture, large abdominal hernia, chronic
abdominal pain, CAD, PVD, ?OSA, HTN, hypercholesterolemia
vitamin D deficiency
PSH: sigmoid colectomy and dilatation, 2 LLE stents,

MEDICATION ON ADMISSION: Cilostazol 100'', Plavix 75', VitD2 50,000 uqwk, Nexium 40',
Mehadone 20''prn, lopressor 100'', Roxicet 5mgq6h, colace, MVI

ALLERGIES: Cymbalta / Morphine / Nortriptyline

PHYSICAL EXAM: On Discharge:
VS: 98.8 98.1 81 92 108/70 20 98(2L)
HEENT: normal EOM, PERL
CVS: RRR, normal S1, S2
Resp: CTAB
[**Last Name (un) **]: soft, appropriately tender, non-distended, wound vac in
place, ostomy debrided prior to discharge, adquate ostomy
outputl
Ext: warm, no edema, distal aspects of left foot still pain.
Good distal pulses.

FAMILY HISTORY: noncontributory

SOCIAL HISTORY: originally from [**Country 3400**]
lives with wife, no children
quit tobacco 2 months ago, previously 1 ppd x 2 years
no EtOH in 14 years 

### Response:
{'Other colostomy and enterostomy complication,Hydronephrosis,Acidosis,Paralytic ileus,Persistent postoperative fistula,Acute posthemorrhagic anemia,Drug-induced psychotic disorder with hallucinations,Incisional hernia without mention of obstruction or gangrene,Personal history of malignant neoplasm of rectum, rectosigmoid junction, and anus,Morbid obesity,Peritoneal adhesions (postoperative) (postinfection),Other chronic pain,Lumbago,Pain in limb,Unspecified vitamin D deficiency,Obstructive sleep apnea (adult)(pediatric),Orchitis and epididymitis, unspecified,Surgical operation with formation of external stoma causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Accidents occurring in residential institution,Fever, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Intravenous anesthetics causing adverse effects in therapeutic use'}
