CHIEF COMPLAINT: Abdominal pain, nausea, vomiting, diarrhea.

PRESENT ILLNESS: This patient was transferred
from the medical service to the surgical service on [**2144-3-19**],
postoperatively.  She is a 62 year old female with a history
of sarcoidosis with pulmonary involvement and hepatic
involvement who was initially admitted to the medical service
on [**2144-3-10**], with a five day history of nausea, vomiting and
diarrhea and a one day history of epigastric pain.

MEDICAL HISTORY: 1.  Sarcoidosis with pulmonary and hepatic involvement
diagnosed in [**2137**], and treated with steroids.
2.  Cirrhosis diagnosed [**10-30**], by CT with grade II esophageal
varices.
3.  Osteoporosis.
4.  Cholelithiasis diagnosed [**10-30**], on CT.
5.  Hypertension.
6.  Hypercholesterolemia.
7.  Aortic stenosis with left ventricular dysfunction.
8.  Status post umbilical hernia repair.
9.  Hip fracture, status post open reduction, internal
fixation on [**2142**].
10. Right total knee replacement [**2141**].
11. Right total hip replacement in [**2133**].
12. Status post total abdominal hysterectomy with bilateral
salpingo-oophorectomy.
13. Bilateral cataracts.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Ventral, unspecified, hernia with obstruction,Cirrhosis of liver without mention of alcohol,Portal hypertension,Aortic valve disorders,Sarcoidosis,Lung involvement in other diseases classified elsewhere,Accidental puncture or laceration during a procedure, not elsewhere classified,Accidental cut, puncture, perforation or hemorrhage during surgical operation
Obstr ventral hernia NOS,Cirrhosis of liver NOS,Portal hypertension,Aortic valve disorder,Sarcoidosis,Lung involv in oth dis,Accidental op laceration,Acc cut/hem in surgery
Admission Date:  [**2144-3-10**]     Discharge Date:  [**2144-3-27**]

Date of Birth:   [**2082-1-26**]     Sex:  F

Service:  #58

CHIEF COMPLAINT:  Abdominal pain, nausea, vomiting, diarrhea.

HISTORY OF PRESENT ILLNESS:  This patient was transferred
from the medical service to the surgical service on [**2144-3-19**],
postoperatively.  She is a 62 year old female with a history
of sarcoidosis with pulmonary involvement and hepatic
involvement who was initially admitted to the medical service
on [**2144-3-10**], with a five day history of nausea, vomiting and
diarrhea and a one day history of epigastric pain.

Right upper quadrant ultrasound showed at the time showed a
thickened gallbladder with a common bile duct of 1.2
centimeters and elevated liver enzymes.  Of note, her liver
enzymes have been elevated in the past.  She underwent an
endoscopic retrograde cholangiopancreatography which showed
portal hypertensive gastropathy and compression of the portal
vein by the common bile duct without any stones.

She was treated with antibiotics and then underwent a MRCP.
She continued to have crampy abdominal pain and a CT scan of
the abdomen was performed on [**2144-3-12**], which showed ascites
and a large ventral hernia.

She was seen by the hepatology service at this point
regarding operative risks for possible hernia repair.  The
hepatology consult suggested 30% risk mortality and also
suggested conservative treatment with Actigall, Aldactone and
paracentesis.

She continued to have emesis and a nasogastric tube was
placed by Dr. [**Last Name (STitle) 519**] on [**2144-3-13**].  She continued to have high
nasogastric output and pain and nausea and then underwent an
upper gastrointestinal and small bowel follow through on
[**2144-3-18**], which revealed high grade ileal obstruction.  At
this point, the decision was made to operate on her and she
was subsequently transferred to the surgical service
postoperatively.

PAST MEDICAL HISTORY:
1.  Sarcoidosis with pulmonary and hepatic involvement
diagnosed in [**2137**], and treated with steroids.
2.  Cirrhosis diagnosed [**10-30**], by CT with grade II esophageal
varices.
3.  Osteoporosis.
4.  Cholelithiasis diagnosed [**10-30**], on CT.
5.  Hypertension.
6.  Hypercholesterolemia.
7.  Aortic stenosis with left ventricular dysfunction.
8.  Status post umbilical hernia repair.
9.  Hip fracture, status post open reduction, internal
fixation on [**2142**].
10. Right total knee replacement [**2141**].
11. Right total hip replacement in [**2133**].
12. Status post total abdominal hysterectomy with bilateral
salpingo-oophorectomy.
13. Bilateral cataracts.

MEDICATIONS ON TRANSFER TO SERVICE:
1.  Actigall 300 mg p.o. t.i.d.
2.  Aldactone 50 mg p.o. q.d.
3.  Hydrocortisone 25 mg b.i.d.
4.  Protonix 40 mg p.o. q.d.
5.  Toradol.
6.  Zofran.

MEDICATIONS AS OUTPATIENT.
1.  Evista.
2.  Prednisone 10 mg p.o. q.d.

HOSPITAL COURSE:  The patient underwent an exploratory
laparotomy with ventral herniorrhaphy with competent
separation and lysis of adhesions on [**2144-3-19**].
Postoperatively, she was transferred to the Intensive Care
Unit intubated because of her prior history.  She was stable
overnight and was extubated in the early a.m. of [**2144-3-20**].
She continued to be stable and was deemed ready for discharge
to the regular floor on [**2144-3-21**].

Subsequently, her postoperative course has been
uncomplicated.  She was started on sips on [**2144-3-23**], after
passing flatus and having a bowel movement.  She tolerated
the sips well.  She was on peripheral nutrition during this
time.  She was slowly advanced over the next couple of days
to a regular diet which she tolerated well.

She did have some ascites which had slightly increased in
size postoperatively.  She has two [**Location (un) 1661**]-[**Location (un) 1662**] drains in
the abdomen which have been draining probable ascitic fluid.
She continues to be followed by the liver service while on
the floor postoperatively.

She was deemed ready for discharge by both services on
[**2144-3-27**].  She was discharged home with the [**Location (un) 1661**]-[**Location (un) 1662**] in
situ with a plan to discontinue them during the postoperative
visit.  She had a visiting nurse [**First Name8 (NamePattern2) **] [**Last Name (Titles) 1661**]-[**Location (un) 1662**] care.

MEDICATIONS ON DISCHARGE:
1.  Lasix 20 mg p.o. q.d.
2.  Lopressor 12.5 mg p.o. b.i.d.
3.  Aldactone 50 mg p.o. b.i.d.
4.  Prednisone 10 mg p.o. b.i.d. times two days and then 10
mg p.o. q.d.
5.  Protonix 40 mg p.o. q.d.
6.  Actigall 300 mg p.o. t.i.d.

TREATMENT:  She is to have q.d. dressing changes to
[**Location (un) 1661**]-[**Location (un) 1662**] sites by VNA.  Record [**Location (un) 1661**]-[**Location (un) 1662**] output.

FOLLOW-UP:
1.  Dr. [**Last Name (STitle) 519**] on [**2144-4-10**], at 9:45 a.m.
2.  Follow-up with the liver service, appointment set up.




                          [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 520**], M.D.  [**MD Number(1) 521**]

Dictated By:[**Last Name (NamePattern1) 2209**]

MEDQUIST36

D:  [**2144-3-28**]  09:18
T:  [**2144-3-29**]  10:46
JOB#:  [**Job Number 12569**]


Admission Date:  [**2144-3-10**]     Discharge Date:  [**2144-3-27**]

Date of Birth:   [**2082-1-26**]     Sex:  F

Service:  #58

CHIEF COMPLAINT:  Abdominal pain, nausea, vomiting, diarrhea.

HISTORY OF PRESENT ILLNESS:  This patient was transferred
from the medical service to the surgical service on [**2144-3-19**],
postoperatively.  She is a 62 year old female with a history
of sarcoidosis with pulmonary involvement and hepatic
involvement who was initially admitted to the medical service
on [**2144-3-10**], with a five day history of nausea, vomiting and
diarrhea and a one day history of epigastric pain.

Right upper quadrant ultrasound showed at the time showed a
thickened gallbladder with a common bile duct of 1.2
centimeters and elevated liver enzymes.  Of note, her liver
enzymes have been elevated in the past.  She underwent an
endoscopic retrograde cholangiopancreatography which showed
portal hypertensive gastropathy and compression of the portal
vein by the common bile duct without any stones.

She was treated with antibiotics and then underwent a MRCP.
She continued to have crampy abdominal pain and a CT scan of
the abdomen was performed on [**2144-3-12**], which showed ascites
and a large ventral hernia.

She was seen by the hepatology service at this point
regarding operative risks for possible hernia repair.  The
hepatology consult suggested 30% risk mortality and also
suggested conservative treatment with Actigall, Aldactone and
paracentesis.

She continued to have emesis and a nasogastric tube was
placed by Dr. [**Last Name (STitle) 519**] on [**2144-3-13**].  She continued to have high
nasogastric output and pain and nausea and then underwent an
upper gastrointestinal and small bowel follow through on
[**2144-3-18**], which revealed high grade ileal obstruction.  At
this point, the decision was made to operate on her and she
was subsequently transferred to the surgical service
postoperatively.

PAST MEDICAL HISTORY:
1.  Sarcoidosis with pulmonary and hepatic involvement
diagnosed in [**2137**], and treated with steroids.
2.  Cirrhosis diagnosed [**10-30**], by CT with grade II esophageal
varices.
3.  Osteoporosis.
4.  Cholelithiasis diagnosed [**10-30**], on CT.
5.  Hypertension.
6.  Hypercholesterolemia.
7.  Aortic stenosis with left ventricular dysfunction.
8.  Status post umbilical hernia repair.
9.  Hip fracture, status post open reduction, internal
fixation on [**2142**].
10. Right total knee replacement [**2141**].
11. Right total hip replacement in [**2133**].
12. Status post total abdominal hysterectomy with bilateral
salpingo-oophorectomy.
13. Bilateral cataracts.

MEDICATIONS ON TRANSFER TO SERVICE:
1.  Actigall 300 mg p.o. t.i.d.
2.  Aldactone 50 mg p.o. q.d.
3.  Hydrocortisone 25 mg b.i.d.
4.  Protonix 40 mg p.o. q.d.
5.  Toradol.
6.  Zofran.

MEDICATIONS AS OUTPATIENT.
1.  Evista.
2.  Prednisone 10 mg p.o. q.d.

HOSPITAL COURSE:  The patient underwent an exploratory
laparotomy with ventral herniorrhaphy with competent
separation and lysis of adhesions on [**2144-3-19**].
Postoperatively, she was transferred to the Intensive Care
Unit intubated because of her prior history.  She was stable
overnight and was extubated in the early a.m. of [**2144-3-20**].
She continued to be stable and was deemed ready for discharge
to the regular floor on [**2144-3-21**].

Subsequently, her postoperative course has been
uncomplicated.  She was started on sips on [**2144-3-23**], after
passing flatus and having a bowel movement.  She tolerated
the sips well.  She was on peripheral nutrition during this
time.  She was slowly advanced over the next couple of days
to a regular diet which she tolerated well.

She did have some ascites which had slightly increased in
size postoperatively.  She has two [**Location (un) 1661**]-[**Location (un) 1662**] drains in
the abdomen which have been draining probable ascitic fluid.
She continues to be followed by the liver service while on
the floor postoperatively.

She was deemed ready for discharge by both services on
[**2144-3-27**].  She was discharged home with the [**Location (un) 1661**]-[**Location (un) 1662**] in
situ with a plan to discontinue them during the postoperative
visit.  She had a visiting nurse [**First Name8 (NamePattern2) **] [**Last Name (Titles) 1661**]-[**Location (un) 1662**] care.

MEDICATIONS ON DISCHARGE:
1.  Lasix 20 mg p.o. q.d.
2.  Lopressor 12.5 mg p.o. b.i.d.
3.  Aldactone 50 mg p.o. b.i.d.
4.  Prednisone 10 mg p.o. b.i.d. times two days and then 10
mg p.o. q.d.
5.  Protonix 40 mg p.o. q.d.
6.  Actigall 300 mg p.o. t.i.d.

TREATMENT:  She is to have q.d. dressing changes to
[**Location (un) 1661**]-[**Location (un) 1662**] sites by VNA.  Record [**Location (un) 1661**]-[**Location (un) 1662**] output.

FOLLOW-UP:
1.  Dr. [**Last Name (STitle) 519**] on [**2144-4-10**], at 9:45 a.m.
2.  Follow-up with the liver service, appointment set up.




                          [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 520**], M.D.  [**MD Number(1) 521**]

Dictated By:[**Last Name (NamePattern1) 2209**]

MEDQUIST36

D:  [**2144-3-28**]  09:18
T:  [**2144-3-29**]  10:46
JOB#:  [**Job Number 12568**]
{'Ventral, unspecified, hernia with obstruction,Cirrhosis of liver without mention of alcohol,Portal hypertension,Aortic valve disorders,Sarcoidosis,Lung involvement in other diseases classified elsewhere,Accidental puncture or laceration during a procedure, not elsewhere classified,Accidental cut, puncture, perforation or hemorrhage during surgical 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, nausea, vomiting, diarrhea.

PRESENT ILLNESS: This patient was transferred
from the medical service to the surgical service on [**2144-3-19**],
postoperatively.  She is a 62 year old female with a history
of sarcoidosis with pulmonary involvement and hepatic
involvement who was initially admitted to the medical service
on [**2144-3-10**], with a five day history of nausea, vomiting and
diarrhea and a one day history of epigastric pain.

MEDICAL HISTORY: 1.  Sarcoidosis with pulmonary and hepatic involvement
diagnosed in [**2137**], and treated with steroids.
2.  Cirrhosis diagnosed [**10-30**], by CT with grade II esophageal
varices.
3.  Osteoporosis.
4.  Cholelithiasis diagnosed [**10-30**], on CT.
5.  Hypertension.
6.  Hypercholesterolemia.
7.  Aortic stenosis with left ventricular dysfunction.
8.  Status post umbilical hernia repair.
9.  Hip fracture, status post open reduction, internal
fixation on [**2142**].
10. Right total knee replacement [**2141**].
11. Right total hip replacement in [**2133**].
12. Status post total abdominal hysterectomy with bilateral
salpingo-oophorectomy.
13. Bilateral cataracts.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Ventral, unspecified, hernia with obstruction,Cirrhosis of liver without mention of alcohol,Portal hypertension,Aortic valve disorders,Sarcoidosis,Lung involvement in other diseases classified elsewhere,Accidental puncture or laceration during a procedure, not elsewhere classified,Accidental cut, puncture, perforation or hemorrhage during surgical operation'}
