CHIEF COMPLAINT: Symptomatic, expanding, known abdominal
aortic aneurysm.

PRESENT ILLNESS: This is a 35 year old, black
male, with known abdominal aortic aneurysm, hypertension,
hypercholesterolemia; complained of a two week history of
increased abdominal pain and back pain.  Patient complained
of nausea but no vomiting.

MEDICAL HISTORY: Abdominal aortic aneurysm.
Hypertension.  Hypercholesterolemia.

MEDICATION ON ADMISSION: Lopressor.
Lipitor.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Father died at the age of 51 from a ruptured
abdominal aortic aneurysm.

SOCIAL HISTORY: The patient does not smoke cigarettes.  He
has not had alcohol for the last month.  He has a history of
prior drug use.  The patient lives alone.  He has been
employed as a chef at various hotels in [**Location (un) 86**] in the past.
Abdominal aneurysm without mention of rupture,Hemorrhage complicating a procedure,Acute posthemorrhagic anemia,Congestive heart failure, unspecified,Unspecified essential hypertension,Other specified cardiac dysrhythmias,Pure hypercholesterolemia,Diverticulosis of colon (without mention of hemorrhage)
Abdom aortic aneurysm,Hemorrhage complic proc,Ac posthemorrhag anemia,CHF NOS,Hypertension NOS,Cardiac dysrhythmias NEC,Pure hypercholesterolem,Dvrtclo colon w/o hmrhg
Admission Date:  [**2119-10-10**]       Discharge Date:  [**2119-10-21**]

Date of Birth:   [**2084-5-18**]       Sex:  M

Service:

CHIEF COMPLAINT:  Symptomatic, expanding, known abdominal
aortic aneurysm.

HISTORY OF PRESENT ILLNESS:  This is a 35 year old, black
male, with known abdominal aortic aneurysm, hypertension,
hypercholesterolemia; complained of a two week history of
increased abdominal pain and back pain.  Patient complained
of nausea but no vomiting.

Most recent ultrasound in [**2119-5-7**] showed a 4.6 cm
abdominal aortic aneurysm.  The patient's father died at the
age of 51 with a ruptured abdominal aortic aneurysm.  The
patient is a Jehovah's witness who would accept blood
transfusion only in a life-threatening circumstance.

The patient had been followed by Dr. [**Last Name (STitle) **] in the past but
the patient had refused surgery. On the day of presentation,
he complained of increasing sharp abdominal and back pain.

PAST MEDICAL HISTORY:  Abdominal aortic aneurysm.
Hypertension.  Hypercholesterolemia.

PAST SURGICAL HISTORY:  None.

FAMILY HISTORY:  Father died at the age of 51 from a ruptured
abdominal aortic aneurysm.

SOCIAL HISTORY:  The patient does not smoke cigarettes.  He
has not had alcohol for the last month.  He has a history of
prior drug use.  The patient lives alone.  He has been
employed as a chef at various hotels in [**Location (un) 86**] in the past.

ALLERGIES:  No known drug allergies.

MEDICATIONS ON ADMISSION:
Lopressor.
Lipitor.

PHYSICAL EXAMINATION:  Vital signs reveal a pulse of 78;
respirations of 20; blood pressure 181/121; oxygen saturation
equal to 95% on room air.  General:  Alert, cooperative,
black male in no acute distress.  Chest: Lungs clear
bilaterally.  Heart: Regular rate and rhythm without murmur.
Abdomen soft.  Tender diffusely.  Unable to palpate the aorta
secondary to girth.  Bowel sounds present. Rectal examination
was heme negative.  No lower extremity edema.  Femoral and
dorsalis pedis pulses are 3+ bilaterally.  Neurologic
examination:  Nonfocal.

LABORATORY DATA:  White blood cell count of 9.7; hemoglobin
of 15.8; hematocrit of 46.7; platelets 297,000; PT of 12.4;
PTT 28.2; INR of 1.0.  Sodium of 140; potassium of 4.5;
chloride 102; C02 of 29; BUN 18; creatinine 1.1; glucose 77.
CK 172.  MB 3; troponin less than 0.1.

Electrocardiogram showed a sinus bradycardia with a sinus
arrhythmia at a rate of 67.  No acute ischemic changes.

Chest x-ray showed cardiomegaly; no acute pulmonary disease.

Echocardiogram on [**2119-1-4**] showed an ejection fraction between
50 and 55%.  Persantine MIBI study in [**2119-5-7**] was
negative.

HOSPITAL COURSE:  On admission, the patient had an abdominal
CT scan which showed an enlarging abdominal aortic aneurysm
to 5.1 times 4.5 cm. There was no leak.  A retroaortic renal
vein had been found in the [**2119-4-6**] study.  The patient was
admitted to the surgical Intensive Care Unit for management
of the uncontrolled hypertension with intravenous
antihypertensive.  Surgery was planned for the following day
emergently; however, the patient refused to consent for
surgery until his family arrived at the hospital from out of
state.  The patient is a Jehovah's witness and refused blood
transfusion unless the situation was life-threatening.

On [**2119-10-12**], the patient underwent an abdominal aortic
aneurysm resection with a 16 mm tube graft.  The patient's
postoperative hematocrit in the Post Anesthesia Care Unit
dropped to 20.0.  The patient was taken back to the operating
room for exploration and repair of any bleeding sites. No
active bleeding was seen. There was an estimated blood loss
of two liters.  Cell [**Doctor Last Name 10105**] was used.  The patient was
transfused five units of packed red blood cells; one unit of
platelets; four units of fresh frozen plasma and 1500 cc of
Crystalloid.  Post transfusion hematocrit was 35.  The
patient was transferred to the Surgical Intensive Care Unit
for close monitoring.

On [**2119-10-17**], the patient was transferred from the Surgical
Intensive Care Unit to the VICU.  His nasogastric tube was
maintained.  On the following day, the patient's nasogastric
tube was removed but he was kept n.p.o.  The Foley was
removed. His intravenous fluid was running 15 70 cc per hour.
Telemetry was stopped and his perioperative Kefzol was
stopped as well.

On [**2119-10-19**], the patient was started on clears in the morning
and was advanced to solid food in the evening without
difficulty.  He was able to ambulate well in the hallways.
At the time of dictation, the patient's abdominal incision
was clean, dry and intact.  He had palpable pedal pulses.
The patient will be discharged home with his girlfriend who
will bring him to [**Name (NI) 12000**] to recuperate.  The patient will
return in two weeks for staple removal by Dr. [**Last Name (STitle) **]. The
patient has been advised that he must take his
antihypertensive medications.  He has been started on 20 mg
of Lisinopril q. day and his Lopressor is being titrated.  He
has been receiving 10 to 20 mg of intravenous Hydralazine q.
four to six hours to keep his systolic blood pressure less
than 160.

MEDICATIONS ON DISCHARGE:
Lopressor 75 mg p.o. twice a day (Hold for systolic blood
pressure less than 110 and heart rate less than 55).
Lisinopril 20 mg p.o. q. day (Hold for systolic blood
pressure less than 110).
Percocet one to two tablets p.o. every four to six hours prn
for pain.
Acetaminophen 325 to 650 mg p.o. q. day.

CONDITION ON DISCHARGE:
Satisfactory.

DISPOSITION:  Home.

PRIMARY DIAGNOSES:
Symptomatic expanding known abdominal aortic aneurysm.
Abdominal aortic aneurysm resection with tube graft on
[**2119-10-13**].
Re-exploration for bleeding on [**2119-10-14**].
Blood loss anemia, status post transfusion.
Uncontrolled hypertension.





                            [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], M.D.  2914

Dictated By:[**Last Name (NamePattern1) 3954**]
MEDQUIST36

D:  [**2119-10-20**]  04:24
T:  [**2119-10-20**]  19:45
JOB#:  [**Job Number 43054**]


Admission Date:                   Discharge Date:  [**2119-10-21**]

Date of Birth:   [**2084-5-18**]       Sex:  M

Service:  Vascular

CHIEF COMPLAINT:  Abdominal and back pain times three days.

HISTORY OF PRESENT ILLNESS:  The patient is a 38-year-old
male with known abdominal aortic aneurysm who was offered a
repair but refused even in light of the fact that there is a
positive family history.  The patient has noted increased
abdominal pain over the last several weeks but really bad
over the last three days, which radiates to the back.  He
does admit to some nausea and vomiting but no fever or
chills.  The pain is consistent and has become progressive.
The patient is now evaluated in the Emergency Room and
admitted to the vascular service, ICU, for continued care.

PAST MEDICAL HISTORY:  Hypertension, abdominal aortic
aneurysm of 5.6 cm, Jehovah's witness.

PAST SURGICAL HISTORY:  None.

ALLERGIES:  No known drug allergies.

MEDICATIONS:  Include Lopressor, Lisinopril, doses not
remarked.

HOSPITAL COURSE:  The patient was initially evaluated in the
Emergency Room.  Routine labs were obtained.  His admitting
hematocrit was 46.7, white count 9.7, BUN 18, creatinine 1.1,
potassium 4.5, coags were normal.  LFTs were negative.  He
was begun on an Esmolol drip and Nipride to control his blood
pressure.  He was given Zofran for nausea and Ativan for
anxiety.  He was transferred to the SICU for continued
monitoring and care.

Emergent abdominal CT was obtained which showed an infrarenal
abdominal aortic aneurysm with no thrombus.  It extended to
the bifurcation, the left common iliac was 1.6 cm, right
common iliac artery was 1.4 cm, left common femoral artery
was 1.3 cm, the right common femoral was 1.3 cm.  An
echocardiogram was obtained which showed an ejection fraction
of 50-55%.  Mibi done in [**5-9**] wave changes, no
angina.  Overnight the back pain subsided and there was no
abdominal pain.  Blood pressure was under control with
Nipride and Labetalol drips, with systolic of 110 to 130 and
diastolic 70-80.  Heart rates were in the 60's.  Abdominal
exam was unremarkable.  Femoral pulses were palpable.  The
patient is aware of a need for urgent repair but awaits
family prior to undergoing surgery and he will accept Cell
[**Doctor Last Name **] blood and accept blood and blood products only if life
threatening emergency.  Patient's blood pressure remained
under control and the patient was taken to surgery on [**2119-10-12**]
and he underwent a repair of abdominal aorta with a 16 mm
tube Dacron graft.  He tolerated the procedure well and was
transferred to the ICU for continued monitoring and care.  He
was followed by cardiology during this intensive care stay.
He had routine EKGs and enzymes drawn postoperatively.  His
postoperative hematocrit was 21.8, down from 31.2.  He was
transfused.  He was placed on a PCA for analgesic control. He
returned to the OR for re-exploration for bleeding.  There
was no active source of bleeding.  The patient returned to
the ICU for continued care.  His hematocrit stabilized at
34.3, BUN and creatinine remained stable.  Coags were normal.
 Postoperative day #1 at about 3 in the morning, the resident
was called to the patient's bedside for systolic hypertension
with a systolic blood pressure of 166 and a mean arterial
pressure of 118, CCB was 13 to 14, O2 sats were 96% on three
liters.  They felt that the increase in the hypertension was
secondary to fluid mobilization and he was given Lasix and
diuresed with excellent response.  His hematocrit remained
stable at 36.2.  His chest x-ray showed a low lung volume of
mild failure.  Over the next 24 hours the patient required
Labetalol added to his regimen for antihypertensive control
and additional dose of Lasix.  His hematocrit remained stable
at 33.1, BUN 13, creatinine 0.8.  NG remained in place and he
remained in the ICU.  By postoperative day #4 the patient was
weaned off his Nitroglycerin and his blood pressure was under
control.  Hematocrit remained stable.  He continued to remain
NPO.  Nasogastric tube was removed and the patient was
transferred to the VICU for continued monitoring and care.

Postoperative day #6 the patient passed flatus but he
remained npo.  Social service followed the patient for family
and patient support.  Sips were started on postoperative day
#7 and advanced to clears on postoperative day #8.  By
postoperative day #8 the patient was tolerating





                            [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], M.D.  2914

Dictated By:[**Last Name (NamePattern1) 1479**]
MEDQUIST36

D:  [**2119-10-20**]  21:15
T:  [**2119-10-20**]  21:17
JOB#:  [**Job Number 43055**]
{'Abdominal aneurysm without mention of rupture,Hemorrhage complicating a procedure,Acute posthemorrhagic anemia,Congestive heart failure, unspecified,Unspecified essential hypertension,Other specified cardiac dysrhythmias,Pure hypercholesterolemia,Diverticulosis of colon (without mention of hemorrhage)'}


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, expanding, known abdominal
aortic aneurysm.

PRESENT ILLNESS: This is a 35 year old, black
male, with known abdominal aortic aneurysm, hypertension,
hypercholesterolemia; complained of a two week history of
increased abdominal pain and back pain.  Patient complained
of nausea but no vomiting.

MEDICAL HISTORY: Abdominal aortic aneurysm.
Hypertension.  Hypercholesterolemia.

MEDICATION ON ADMISSION: Lopressor.
Lipitor.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Father died at the age of 51 from a ruptured
abdominal aortic aneurysm.

SOCIAL HISTORY: The patient does not smoke cigarettes.  He
has not had alcohol for the last month.  He has a history of
prior drug use.  The patient lives alone.  He has been
employed as a chef at various hotels in [**Location (un) 86**] in the past. 

### Response:
{'Abdominal aneurysm without mention of rupture,Hemorrhage complicating a procedure,Acute posthemorrhagic anemia,Congestive heart failure, unspecified,Unspecified essential hypertension,Other specified cardiac dysrhythmias,Pure hypercholesterolemia,Diverticulosis of colon (without mention of hemorrhage)'}
