CHIEF COMPLAINT: Acute, severe abdominal pain

PRESENT ILLNESS: 68 yo male with a histoy of gallstone pancreatitis and
pancreatic abscess drainage [**12-16**], presented with severe
abdominal pain on [**2185-9-16**] since 7 PM the night before. He
described it as constant, radiating to his chest and RUQ, with
some mild radiation to his back between his shoulder blades. He
denied any fever, chills, nausea, vomiting, constipation, or
diarrhea. He also denied any shortness of breath or diaphoresis.
He had been tolerating a regualr diet at home.

MEDICAL HISTORY: DVT and PE
gallstone pancreatitis
diverticulosis
liver cysts s/p partial hepatectomy
BPH
dyslipidemia

MEDICATION ON ADMISSION: Coumadin 5mg alternating with 7.5mg QD
Flomax

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On admission:

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Lives with his wife.  Denies tobacco.  Occasional EtOH.
Acute pancreatitis,Calculus of gallbladder and bile duct with acute and chronic cholecystitis, with obstruction,Accidental puncture or laceration during a procedure, not elsewhere classified,Hydrops of gallbladder,Peritoneal adhesions (postoperative) (postinfection),Incisional hernia without mention of obstruction or gangrene,Other iatrogenic hypotension,Cyst of kidney, acquired,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Personal history of venous thrombosis and embolism
Acute pancreatitis,Gal&bil cal w/ac&ch w ob,Accidental op laceration,Hydrops of gallbladder,Peritoneal adhesions,Incisional hernia,Iatrogenc hypotnsion NEC,Cyst of kidney, acquired,BPH w/o urinary obs/LUTS,Hx-ven thrombosis/embols
Admission Date:  [**2185-9-16**]              Discharge Date:   [**2185-9-28**]

Date of Birth:  [**2117-5-20**]             Sex:   M

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 148**]
Chief Complaint:
Acute, severe abdominal pain

Major Surgical or Invasive Procedure:
ERCP - [**2185-9-17**]
Exploratory laparotomy, lysis of adhesions, partial small bowel
resection, Roux-en-Y cholecystoenterostomy - [**2185-9-20**]


History of Present Illness:
68 yo male with a histoy of gallstone pancreatitis and
pancreatic abscess drainage [**12-16**], presented with severe
abdominal pain on [**2185-9-16**] since 7 PM the night before. He
described it as constant, radiating to his chest and RUQ, with
some mild radiation to his back between his shoulder blades. He
denied any fever, chills, nausea, vomiting, constipation, or
diarrhea. He also denied any shortness of breath or diaphoresis.
He had been tolerating a regualr diet at home.

Past Medical History:
DVT and PE
gallstone pancreatitis
diverticulosis
liver cysts s/p partial hepatectomy
BPH
dyslipidemia

Social History:
Lives with his wife.  Denies tobacco.  Occasional EtOH.


Family History:
non-contributory

Physical Exam:
On admission:

99.0F   65   114/75   20   94%RA
A&O X 3, NAD
NC/AT, PERRL, EOMI, sclera anicteric
Heart irregular, some missed beats, no murmur appreciated
Lungs CTAB, no w/r/r
Abd soft, mild tenderness to palpation in epigastric region and
RUQ. - [**Doctor Last Name 515**],
no masses felt, no hernias, +BS x 4, no guarding or rebound
tenderness. Old scar inferior to R. costal margin.
Ext. no c/c/e, distal pulses 2+ b/l
Rectal- normal tone, heme negative

Pertinent Results:
POTASSIUM-4.0  LIPASE-148*
GLUCOSE-108* UREA N-19 CREAT-0.9 SODIUM-140 POTASSIUM-5.4*
CHLORIDE-107 TOTAL CO2-22 ANION GAP-16
ALT(SGPT)-95* AST(SGOT)-187* CK(CPK)-122 ALK PHOS-183*
AMYLASE-324* TOT BILI-1.4
LIPASE-951*  cTropnT-<0.01  CK-MB-2
ALBUMIN-4.1 CALCIUM-9.1 PHOSPHATE-3.5 MAGNESIUM-2.0
WBC-10.2# RBC-4.69# HGB-14.3# HCT-42.0# MCV-90# MCH-30.5
MCHC-34.0 RDW-13.4
PLT SMR-LOW PLT COUNT-126*  PT-19.7* PTT-29.5 INR(PT)-2.6
WBC-11.8* RBC-4.27* Hgb-13.1* Hct-37.9* MCV-89 MCH-30.5
MCHC-34.4 RDW-13.1 Plt Ct-158
URINE Blood-NEG Nitrite-NEG Protein-NEG Glucose-NEG Ketone-NEG
Bilirub-NEG Urobiln-NEG pH-5.0 Leuks-NEG

RUQ US ([**9-16**]): Cholelithiasis, without evidence of cholecystitis.
Six mm, nonobstructing stone within the mid pole of the right
kidney.

ERCP ([**9-17**]): The common duct, left hepatic duct, and cystic duct
appeared normal. 3 stones are noted in the gallbladder, one of
which was located in the gallbladder neck. By report,
sphincterotomy was performed.

Bilateral LE US ([**9-22**]): No evidence of deep venous thrombosis

Brief Hospital Course:
On [**2185-9-16**], Mr. [**Known lastname 59755**] was admitted to the Gold Surgery
service with acute gallstone pancreatitis under the care of Dr.
[**Last Name (STitle) **]. He was made NPO, hydrated, and started on IV
antibiotics. On HD 1, he was noted to have PVC's while on
telemetry. His EKG showed an irregular rhythm with a rate of 70
BPM, unchanged from previous EKGs. He complained of some mild
chest pain and RUQ pain that he has had since admission, and his
cardiac enzymes were all normal. This irregular rhythm was
noticed on admission and was monitored.
Overnight on HD 1, Mr. [**Known lastname 59755**] received 6 Units of FFP and
vitamin K for an INR of 2.6, in preparation for an ERCP the
following day. On HD 2 he underwent an ERCP by Dr. [**Last Name (STitle) 59756**] that
showed 3 stones in the gallbladder and a possible filling defect
in the CBD. A sphincterotomy was performed. For the next 2 days,
the patient remained stable on the floor. He was transfused 4
more units of FFP and 1 unit of platelets. He was scheduled for
the OR for an exploratory laparotomy and probable open
cholecystectomy on [**2185-9-20**].
On [**2185-9-20**] Mr. [**Known lastname 59755**] went to the OR. Because of his history
of severe pancreatitis, there were tenuous adhesions of the
bowel in the whole abdomen.
The gallbladder was firm and showed evidence of chronic
cholecystitis with a rubbery thick wall. It was plastered to the
edge of the liver and was almost indistinguishable from that
capsule. The duodenum was plastered to the porta hepatis and to
the cystic duct area. The ductal orifice was socked in
inflammation. Multiple stones were felt in the gallbladder and
at that point it was obvious that an open cholecystectomy would
be impossible. It was then decided to perform an internal
drainage procedure and removal of the gallstones. In order to do
this, the lower abdomen had to be completely unadhesed. There
were multiple onerous adhesions to the
anterior abdominal wall and small bowel that was a set up for a
torsion or obstruction in the future. A primary resection of 1
foot of small bowel was performed and re-anastomosed. The
gallbladder was finally drained with a Roux limb side-to-side
cholecystoenterostomy.
POD 1, Mr. [**Known lastname 59755**] spent in the ICU because of the extent of
surgery and the fact that he experienced a SBP drop in the OR to
approximately 70. He did very well and was extubated on POD 1.
He was transferred to the floor. A vascular consult was obtained
because of his history of DVT/PE. LE US was performed that
showed no evidence clot progression. His pain was well
controlled with PCA morphine. He did have a postoperative fever
of 100.7. All cultures were negative Sips of clear liquids were
started on POD 5. He did very well and his diet was advanced
slowly over the next 2 days. Pain control was switched to po
Percocet and he did very well. He had been OOB and ambulating
with PT. He was discharged home on POD 8 with home PT and
follow-up with Dr. [**Last Name (STitle) **] in [**3-17**] weeks.


Medications on Admission:
Coumadin 5mg alternating with 7.5mg QD
Flomax

Discharge Medications:
1. Tamsulosin 0.4 mg Capsule, Sust. Release 24HR Sig: One (1)
Capsule, Sust. Release 24HR PO HS (at bedtime).
2. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4-6H (every 4 to 6 hours) as needed.
Disp:*40 Tablet(s)* Refills:*0*
3. Pantoprazole Sodium 40 mg Tablet, Delayed Release (E.C.) Sig:
One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
[**Hospital **] Home Health Care

Discharge Diagnosis:
Gallstone pancreatitis


Discharge Condition:
Good

Discharge Instructions:
Please resume all pre-hospital medications EXCEPT Coumadin. You
do not need to take this anymore. Please call your doctor or go
to the ER if you experience any high fever >101.5F, severe pain,
worsening nausea and vomiting, or foul smelling/pus from wound.

Followup Instructions:
Please follow-up with Dr. [**Last Name (STitle) **] in [**3-17**] weeks. Call
[**Telephone/Fax (1) 1231**] for an appointment.
{'Acute pancreatitis,Calculus of gallbladder and bile duct with acute and chronic cholecystitis, with obstruction,Accidental puncture or laceration during a procedure, not elsewhere classified,Hydrops of gallbladder,Peritoneal adhesions (postoperative) (postinfection),Incisional hernia without mention of obstruction or gangrene,Other iatrogenic hypotension,Cyst of kidney, acquired,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Personal history of venous thrombosis and embolism'}


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: Acute, severe abdominal pain

PRESENT ILLNESS: 68 yo male with a histoy of gallstone pancreatitis and
pancreatic abscess drainage [**12-16**], presented with severe
abdominal pain on [**2185-9-16**] since 7 PM the night before. He
described it as constant, radiating to his chest and RUQ, with
some mild radiation to his back between his shoulder blades. He
denied any fever, chills, nausea, vomiting, constipation, or
diarrhea. He also denied any shortness of breath or diaphoresis.
He had been tolerating a regualr diet at home.

MEDICAL HISTORY: DVT and PE
gallstone pancreatitis
diverticulosis
liver cysts s/p partial hepatectomy
BPH
dyslipidemia

MEDICATION ON ADMISSION: Coumadin 5mg alternating with 7.5mg QD
Flomax

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On admission:

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Lives with his wife.  Denies tobacco.  Occasional EtOH. 

### Response:
{'Acute pancreatitis,Calculus of gallbladder and bile duct with acute and chronic cholecystitis, with obstruction,Accidental puncture or laceration during a procedure, not elsewhere classified,Hydrops of gallbladder,Peritoneal adhesions (postoperative) (postinfection),Incisional hernia without mention of obstruction or gangrene,Other iatrogenic hypotension,Cyst of kidney, acquired,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Personal history of venous thrombosis and embolism'}
