CHIEF COMPLAINT: Abdominal pain and fever

PRESENT ILLNESS: Ms. [**Known lastname 59386**] is a [**Age over 90 **] year-old female who experienced 1 episode
of severe, crampy abdominal pain 2 days prior to admission prior
to going to sleep.  The pain was located in her epigastrium and
gradually dissipated on its own.  It has not returned since.  It
was accompanied by shaking chills.  She has felt weak and
lethargic and was brought to the hospital by her neighbor.  She
currently denies abdominal pain, fever, chills, nausea, and
vomiting.  Her BMs and voiding have been normal.  At
[**Hospital1 18**]-[**Location (un) 620**] a RUQ Ultrasound revealed a large gall bladder
stone and lab work was significant for transaminitis and
hyperbilirubinemia.  She was transferred to [**Hospital1 18**]-Main for
urgent ERCP and monitoring.

MEDICAL HISTORY: hyperthyroidism
Macular degeneration
s/p TAH BSO
s/p nephrectomy
s/p appendectomy
s/p hip hemiarthroplasty
s/p cataract surgery bilateral

MEDICATION ON ADMISSION: Multivitamin

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On Discharge:
VS: Temp 98.8, HR 71, BP 133/59, RR 16, O2 sat 95% on room air
Gen: no acute distress
CV: RRR
Pulm: clear bilaterally
Abd: soft, nontender, nondistended
Ext: no edema

FAMILY HISTORY: Non-contributory.

SOCIAL HISTORY: She lives alone and is completely independent.  She is a
nonsmoker, no EtOH, no illicit drugs.
Calculus of gallbladder and bile duct without cholecystitis, without mention of obstruction,Cholangitis,Bacteremia,Urinary tract infection, site not specified,Hemorrhage complicating a procedure,Thyrotoxicosis without mention of goiter or other cause, and without mention of thyrotoxic crisis or storm,Macular degeneration (senile), unspecified,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation
Gall&bil cal w/o cho w/o,Cholangitis,Bacteremia,Urin tract infection NOS,Hemorrhage complic proc,Thyrotox NOS no crisis,Macular degeneration NOS,Abn react-surg proc NEC
Admission Date:  [**2150-2-1**]              Discharge Date:   [**2150-2-10**]


Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 6346**]
Chief Complaint:
Abdominal pain and fever

Major Surgical or Invasive Procedure:
ERCP [**2-3**]
ERCP [**2-5**]
EGD [**2-5**]


History of Present Illness:
Ms. [**Known lastname 59386**] is a [**Age over 90 **] year-old female who experienced 1 episode
of severe, crampy abdominal pain 2 days prior to admission prior
to going to sleep.  The pain was located in her epigastrium and
gradually dissipated on its own.  It has not returned since.  It
was accompanied by shaking chills.  She has felt weak and
lethargic and was brought to the hospital by her neighbor.  She
currently denies abdominal pain, fever, chills, nausea, and
vomiting.  Her BMs and voiding have been normal.  At
[**Hospital1 18**]-[**Location (un) 620**] a RUQ Ultrasound revealed a large gall bladder
stone and lab work was significant for transaminitis and
hyperbilirubinemia.  She was transferred to [**Hospital1 18**]-Main for
urgent ERCP and monitoring.

Past Medical History:
hyperthyroidism
Macular degeneration
s/p TAH BSO
s/p nephrectomy
s/p appendectomy
s/p hip hemiarthroplasty
s/p cataract surgery bilateral

Social History:
She lives alone and is completely independent.  She is a
nonsmoker, no EtOH, no illicit drugs.


Family History:
Non-contributory.

Physical Exam:
On Discharge:
VS: Temp 98.8, HR 71, BP 133/59, RR 16, O2 sat 95% on room air
Gen: no acute distress
CV: RRR
Pulm: clear bilaterally
Abd: soft, nontender, nondistended
Ext: no edema

Pertinent Results:
Admission labs:
[**2150-2-2**] 03:06AM BLOOD WBC-9.8 RBC-3.78* Hgb-11.6* Hct-33.2*
MCV-88 MCH-30.6 MCHC-34.9 RDW-12.6 Plt Ct-140*
[**2150-2-2**] 03:06AM BLOOD PT-15.3* PTT-27.9 INR(PT)-1.3*
[**2150-2-2**] 03:06AM BLOOD Glucose-121* UreaN-18 Creat-1.0 Na-139
K-3.6 Cl-105 HCO3-26 AnGap-12
[**2150-2-2**] 03:06AM BLOOD ALT-318* AST-292* AlkPhos-116 Amylase-35
TotBili-4.9*
[**2150-2-2**] 03:06AM BLOOD Lipase-14
[**2150-2-2**] 03:06AM BLOOD Albumin-3.5 Calcium-8.6 Phos-2.9 Mg-2.0

Discharge labs:
[**2150-2-8**] 08:10AM BLOOD WBC-7.7# RBC-3.45* Hgb-10.2* Hct-31.1*
MCV-90 MCH-29.7 MCHC-32.9 RDW-13.5 Plt Ct-335#
[**2150-2-8**] 08:10AM BLOOD Glucose-112* UreaN-12 Creat-0.9 Na-132*
K-4.8 Cl-101 HCO3-25 AnGap-11
[**2150-2-7**] 08:05AM BLOOD ALT-52* AST-35 LD(LDH)-146 AlkPhos-117
Amylase-95 TotBili-0.7
[**2150-2-7**] 08:05AM BLOOD Lipase-58
[**2150-2-8**] 08:10AM BLOOD Calcium-8.7 Phos-3.1 Mg-2.1

Brief Hospital Course:
Mrs. [**Known lastname 59386**] was transferred from [**Hospital1 18**]-[**Location (un) 620**] for an urgent
ERCP and monitoring.  She was admitted to the SICU on [**2150-2-1**]
with a diagnosis of cholangitis and a UTI.  She was started on
IV Zosyn for broad spectrum coverage.  An ERCP was attempted on
[**2150-2-2**] but deep cannulation of the biliary tree was
unsuccessful.  A limited cholangiogram at that time showed
mildly dilated biliary tree with no filling defect.  Blood
cultures drawn at [**Location (un) 620**] revealed gram-negative bacteria that
was pansensitive.  A urine culture grew E.coli.  Repeat cultures
drawn on arrival at [**Hospital1 18**]-Main are no growth.  She remained in
the SICU post-ERCP for monitoring.  Her LFTs and bilirubin
trended downward and she was tranferred to the floor on [**2150-2-4**].
A repeat ERCP was performed on [**2150-2-5**] and revealed a CBD
measuring 12mm and an 8mm stone in the distal third of the CBD.
The stone was successfully removed and a sphincterotomy was
performed.  While in the recovery room after the ERCP she had an
episode of hematemesis.  An urgent EGD was performed and
revealed a large amount of fresh blood in the duodenum with
active bleeding in the sphincterotomy site.  Hemostasis was
successfully obtained with epinephrine injections and
electrocautery.  She was transferred to the [**Hospital Unit Name 153**] for monitoring
overnight and transferred back to the floor on [**2150-2-6**].  She has
been afebrile throughout her hospital stay and her hemodynamics
have been stable.  A physical therapy consult was obtained and
they recommended discharge to a rehab facility.  Her hematocrit
has been stable at 31.  Her bilirubin and LFTs have normalized
except for a slight elevation in her ALT of 57.  She is
tolerating a regular diet and having regular nonbloody BMs.  She
has been screened and accepted by a rehab facility.

Medications on Admission:
Multivitamin

Discharge Medications:
1. Hexavitamin     Tablet Sig: One (1) Cap PO DAILY (Daily).
2. Ferrous Sulfate 325 mg (65 mg Iron) Tablet Sig: One (1)
Tablet PO DAILY (Daily).
3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
4. Famotidine 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
5. Trimethoprim-Sulfamethoxazole 160-800 mg Tablet Sig: One (1)
Tablet PO BID (2 times a day) for 10 days.
6. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).


Discharge Disposition:
Extended Care

Facility:
[**Hospital1 599**] of [**Location (un) 55**]

Discharge Diagnosis:
Cholelithiasis/Choledocholithiasis
Cholangitis
E. Coli Bacteremia
Post ERCP ampullary bleeding
UTI


Discharge Condition:
Good


Discharge Instructions:
Call your surgeon if you experience:
- fever >101.5
- chills
- increasing pain not controlled by medication
- persistent nausea/vomiting
- inability to eat or drink

Antibiotic regimen: Patient is currently on
Sulfameth/Trimethoprim DS 1 TAB PO BID. This regimen will be
completed on [**2149-2-20**].

New medications since admission: Lopressor 25mg orally twice a
day.

Resume all of your home medications.

Followup Instructions:
Follow up with Dr. [**First Name (STitle) 2819**] in 2 weeks.  Call his office at ([**Telephone/Fax (1) 35203**] to schedule your appointment.

Please follow-up with your Primary Care Physician, [**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) **]
[**Last Name (NamePattern1) 3142**] in [**2-4**] weeks.



Completed by:[**2150-2-10**]
{'Calculus of gallbladder and bile duct without cholecystitis, without mention of obstruction,Cholangitis,Bacteremia,Urinary tract infection, site not specified,Hemorrhage complicating a procedure,Thyrotoxicosis without mention of goiter or other cause, and without mention of thyrotoxic crisis or storm,Macular degeneration (senile), unspecified,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}


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: Abdominal pain and fever

PRESENT ILLNESS: Ms. [**Known lastname 59386**] is a [**Age over 90 **] year-old female who experienced 1 episode
of severe, crampy abdominal pain 2 days prior to admission prior
to going to sleep.  The pain was located in her epigastrium and
gradually dissipated on its own.  It has not returned since.  It
was accompanied by shaking chills.  She has felt weak and
lethargic and was brought to the hospital by her neighbor.  She
currently denies abdominal pain, fever, chills, nausea, and
vomiting.  Her BMs and voiding have been normal.  At
[**Hospital1 18**]-[**Location (un) 620**] a RUQ Ultrasound revealed a large gall bladder
stone and lab work was significant for transaminitis and
hyperbilirubinemia.  She was transferred to [**Hospital1 18**]-Main for
urgent ERCP and monitoring.

MEDICAL HISTORY: hyperthyroidism
Macular degeneration
s/p TAH BSO
s/p nephrectomy
s/p appendectomy
s/p hip hemiarthroplasty
s/p cataract surgery bilateral

MEDICATION ON ADMISSION: Multivitamin

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On Discharge:
VS: Temp 98.8, HR 71, BP 133/59, RR 16, O2 sat 95% on room air
Gen: no acute distress
CV: RRR
Pulm: clear bilaterally
Abd: soft, nontender, nondistended
Ext: no edema

FAMILY HISTORY: Non-contributory.

SOCIAL HISTORY: She lives alone and is completely independent.  She is a
nonsmoker, no EtOH, no illicit drugs. 

### Response:
{'Calculus of gallbladder and bile duct without cholecystitis, without mention of obstruction,Cholangitis,Bacteremia,Urinary tract infection, site not specified,Hemorrhage complicating a procedure,Thyrotoxicosis without mention of goiter or other cause, and without mention of thyrotoxic crisis or storm,Macular degeneration (senile), unspecified,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}
