CHIEF COMPLAINT: Abdominal Pain

PRESENT ILLNESS: 56 year old male with h/o EtOH abuse/narcotic dependence, CAD
s/p MI, HTN initially transferred from [**Hospital3 **] to
[**Hospital1 18**] [**2103-8-12**] for concern of AAA rupture vs ischemic bowel. The
pt reports 2-3 days of diffuse abdominal pain prior to
admission, associated with N/V (no hemetemesis), [**10-15**] unable to
describe character, exacerbating/relieving factors. (+)
anorexia. No diarrhea, BRBPR, fevers, chills, chest pain,
shortness of breath. His brother visited him, noted he was "not
acting right" and was diaphoretic and called EMS -> [**Hospital1 63695**]. There, he was noted to be bradycardic (HR 40s) for
which he received 0.5 mg atropine X 1. He was hypertensive with
sbp 180s and a nitro gtt was started. He was noted to be
acidotic (7.062/72.1/100) with acute renal failure (Cr 5.3) and
CK 3000. Reportedly, his NG lavage revealed ~ 100 cc maroon
blood and his rectal exam showed gross blood. He received 2u
PRBC and was emergently intubated and transfered to [**Hospital1 18**] for
further management. Given reports that he had fallen 2 days
earlier (the patient does not recall this event), the patient
was evaluated by trauma surgery. He underwent extensive CT
imaging (head, neck, chest, abdominal, pelvis), which was most
notable for ileal thickening. He was extubated this a.m., and,
given no clear surgical cause was found, he is being transferred
to medicine for further management.

MEDICAL HISTORY: PMHx:
1) CAD: h/o MI
2) Narcotic dependence
3) h/o cluster headaches
4) HTN
5) s/p appendectomy
6) s/p knee surgery
7) h/o left hip dislocation s/p closed reduction [**2-10**]
8) ? cancer: diagnosed in [**State 108**], told he had 4 months to live.

MEDICATION ON ADMISSION: 

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PE:
Gen:awake, in NAD, restless in bed
HEENT: no cervical LAD, no JVD appreciated
Cardiac: RRR, no MRG
Pulm: CTAB in all lung fields, no WRR
Abd: non-tender, non-distended, soft, + BS throughout
Ext: no C/C/E in bilateral LE
Neuro: oriented x 1 only, awake, answers questions, but confused

FAMILY HISTORY: 3 brothers, mother, father with DM and CAD. Mother died at age
67 yrs of MI, father died at 77 yrs of MI, brother had MI in his
40s

SOCIAL HISTORY: Pt reports drinks ~ 1 drink/month, however per his brother he is
a heavy drinker. Denies other drug use. (+) tobacco [**2-8**] ppd X 40
yrs. He lives alone on disability.
Unspecified septicemia,Septic shock,Acute kidney failure, unspecified,Hyperpotassemia,Unspecified drug dependence, continuous,Pneumonitis due to inhalation of food or vomitus,Intestinal infection due to Clostridium difficile,Toxic encephalopathy,Rhabdomyolysis,Acute gastritis, with hemorrhage,Benign neoplasm of colon,Severe sepsis
Septicemia NOS,Septic shock,Acute kidney failure NOS,Hyperpotassemia,Drug depend NOS-contin,Food/vomit pneumonitis,Int inf clstrdium dfcile,Toxic encephalopathy,Rhabdomyolysis,Acute gastritis w hmrhg,Benign neoplasm lg bowel,Severe sepsis
Admission Date:  [**2103-8-12**]              Discharge Date:   [**2103-8-20**]

Date of Birth:  [**2047-8-2**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 348**]
Chief Complaint:
Abdominal Pain

Major Surgical or Invasive Procedure:
Intubation

History of Present Illness:
56 year old male with h/o EtOH abuse/narcotic dependence, CAD
s/p MI, HTN initially transferred from [**Hospital3 **] to
[**Hospital1 18**] [**2103-8-12**] for concern of AAA rupture vs ischemic bowel. The
pt reports 2-3 days of diffuse abdominal pain prior to
admission, associated with N/V (no hemetemesis), [**10-15**] unable to
describe character, exacerbating/relieving factors. (+)
anorexia. No diarrhea, BRBPR, fevers, chills, chest pain,
shortness of breath. His brother visited him, noted he was "not
acting right" and was diaphoretic and called EMS -> [**Hospital1 63695**]. There, he was noted to be bradycardic (HR 40s) for
which he received 0.5 mg atropine X 1. He was hypertensive with
sbp 180s and a nitro gtt was started. He was noted to be
acidotic (7.062/72.1/100) with acute renal failure (Cr 5.3) and
CK 3000. Reportedly, his NG lavage revealed ~ 100 cc maroon
blood and his rectal exam showed gross blood. He received 2u
PRBC and was emergently intubated and transfered to [**Hospital1 18**] for
further management. Given reports that he had fallen 2 days
earlier (the patient does not recall this event), the patient
was evaluated by trauma surgery. He underwent extensive CT
imaging (head, neck, chest, abdominal, pelvis), which was most
notable for ileal thickening. He was extubated this a.m., and,
given no clear surgical cause was found, he is being transferred
to medicine for further management.


Past Medical History:
PMHx:
1) CAD: h/o MI
2) Narcotic dependence
3) h/o cluster headaches
4) HTN
5) s/p appendectomy
6) s/p knee surgery
7) h/o left hip dislocation s/p closed reduction [**2-10**]
8) ? cancer: diagnosed in [**State 108**], told he had 4 months to live.


Social History:
Pt reports drinks ~ 1 drink/month, however per his brother he is
a heavy drinker. Denies other drug use. (+) tobacco [**2-8**] ppd X 40
yrs. He lives alone on disability.


Family History:
3 brothers, mother, father with DM and CAD. Mother died at age
67 yrs of MI, father died at 77 yrs of MI, brother had MI in his
40s

Physical Exam:
PE:
Gen:awake, in NAD, restless in bed
HEENT: no cervical LAD, no JVD appreciated
Cardiac: RRR, no MRG
Pulm: CTAB in all lung fields, no WRR
Abd: non-tender, non-distended, soft, + BS throughout
Ext: no C/C/E in bilateral LE
Neuro: oriented x 1 only, awake, answers questions, but confused


Pertinent Results:
[**8-12**] CT chest/abd/pelvis without contrast: Right hilar LAD, small
bilateral pleural effusion, no focal lungs consolidation,
thickening in distal ileum (infectious vs ischemic), limited
oral contrast reaching bowel, although no clear evidence of
obstruction, small amt of free fluid around liver/spleen.
.
[**8-12**] Head CT: No ICH, fracture
.
[**8-12**] CT C-spine: mild degenerative changes in mid cervical spine
w/o fracture
.
[**8-12**] CXR: no acute cardiopulmonary abnormality.

EKG on admission [**8-12**]- TWI and 1 mm depressions in II, III, and
aVF
EKG on [**8-13**]- TWI and ST depressions resolved, NSR, normal
intervals

Brief Hospital Course:
1) GI bleeding: given report of (+) lavage, concern for UGI
process. Potential UGI sources include PUD, varices, gastritis,
[**Doctor First Name 329**]-[**Doctor Last Name **] tear, gastroenteritis. Also some reports of rectal
bleeding at OSH (though guiac neg to date here), could be c/w
hemmorrhoid, polyp, colon CA, ischemic bowel, diverticuli, IBD.

- 2 large bore IVs
- transfuse for hct > 30 given hx CAD, hct stable over
admission, no signs of active bleeding, no transfusion necessary

- daily hct check
- GI consult --> they will performed EGD and Colonoscopy --> EGD
revealed duodenitis and gastritis. A colonoscopy revealed a
hyperplastic polyp 20
cm from the anal verge
- guaiced all stools- negative
.
2) Pneumonia- RLL PNA on CXR, fever resolved, satting well on RA
on the floor. Pt's hypoxia also probably has a component of
Emphysema
- Albuterol and Atrovent Nebs PRN
- Levofloxacin, Flagyl PO Day 4 -> discharged on 1 more week
Levo, 10 days Flagyl
- Advair started for component of COPD
.
3) Anisocoria- probably long-standing from old injury- pt. has
no sx of HA, normal Neuro exam
- monitor pupils, monitor for signs of HA, changes in Neuro exam
-> no changes over admission
.
4) EtOH Withdrawal
- Diazepam tapered and then d/ced for auto-taper, pt. did
exhibit any further signs of withdrawal on the floor
- Thiamine, Folate
.
5) Acute Renal Failure- resolved with IVF, most likely [**2-7**]
Rhabdomyolysis, Cr 4.4 on admission -> 0.6 in discharge
- Urine eos negative
- US Abd --> no hydronephrosis
- monitored lytes
.
6) Troponin Leak- most likely [**2-7**] demand ischemia
- held ASA until UGIB is investigated
- lipids WNL
- TTE --> LVEF > 55%, no WMA, no AR, trace MR
- continued metoprolol
.
7) C diff- may explain Abd pain on presentation, no diarrhea
over admission
- PO Flagyl day 4 -> discharged with 10 more days for 2 week
course
.
8) Prophy-
- Thiamine, Folate
- Hep SC
- Pantoprazole
.
9) Access- 2 large bore IVs
.
10) Code- full code
.


Discharge Disposition:
Home

Discharge Diagnosis:
C difficile colitis, Gastritis, Pneumonia, Acute Renal Failure
(resolved)


Discharge Condition:
Good- Acute renal failure has resolved, breathing comfortably on
room air, with no more episodes of upper or lower GI bleeding.
No fevers for 1 week.


Discharge Instructions:
Please take all medications as prescribed.

Please follow up with Dr. [**First Name (STitle) **] on [**2103-9-7**].

We gave you a prescription for Levaquin, which is an antibiotic
for Pneumonia.  You should take it as directed for 7 more days.

We gave you a prescription for Flagyl, which is an antibiotic
for an infection in your intestine called C difficile colitis.
You should take it as directed for 10 more days.

Please continue your normal medications prescribed by Dr.
[**First Name (STitle) **], including your Atenolol, HCTZ and Accupril for your
blood pressure, and your Advair inhaler for your Emphysema.

Please call Dr [**First Name (STitle) **] or go to the ER if you have chest pain,
shortness of breath, cough up blood, have blood in your stool,
are making significantly less urine than usual, or have any
other symptoms that concern you.

Followup Instructions:
Please follow up with your Primary Care Doctor, Dr. [**First Name (STitle) **].  You
have an appointment scheduled with him on [**Last Name (LF) 2974**], [**9-7**]
at 1:30. You can call his office at [**Telephone/Fax (1) 63696**] if you need to
change the appointment.  Dr. [**First Name (STitle) **] should check your Creatinine
to watch your kidney function and follow up on the results of
the biopsies the GI Doctors took of your stomach and your Colon.



Completed by:[**2103-9-10**]
{'Unspecified septicemia,Septic shock,Acute kidney failure, unspecified,Hyperpotassemia,Unspecified drug dependence, continuous,Pneumonitis due to inhalation of food or vomitus,Intestinal infection due to Clostridium difficile,Toxic encephalopathy,Rhabdomyolysis,Acute gastritis, with hemorrhage,Benign neoplasm of colon,Severe sepsis'}


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

PRESENT ILLNESS: 56 year old male with h/o EtOH abuse/narcotic dependence, CAD
s/p MI, HTN initially transferred from [**Hospital3 **] to
[**Hospital1 18**] [**2103-8-12**] for concern of AAA rupture vs ischemic bowel. The
pt reports 2-3 days of diffuse abdominal pain prior to
admission, associated with N/V (no hemetemesis), [**10-15**] unable to
describe character, exacerbating/relieving factors. (+)
anorexia. No diarrhea, BRBPR, fevers, chills, chest pain,
shortness of breath. His brother visited him, noted he was "not
acting right" and was diaphoretic and called EMS -> [**Hospital1 63695**]. There, he was noted to be bradycardic (HR 40s) for
which he received 0.5 mg atropine X 1. He was hypertensive with
sbp 180s and a nitro gtt was started. He was noted to be
acidotic (7.062/72.1/100) with acute renal failure (Cr 5.3) and
CK 3000. Reportedly, his NG lavage revealed ~ 100 cc maroon
blood and his rectal exam showed gross blood. He received 2u
PRBC and was emergently intubated and transfered to [**Hospital1 18**] for
further management. Given reports that he had fallen 2 days
earlier (the patient does not recall this event), the patient
was evaluated by trauma surgery. He underwent extensive CT
imaging (head, neck, chest, abdominal, pelvis), which was most
notable for ileal thickening. He was extubated this a.m., and,
given no clear surgical cause was found, he is being transferred
to medicine for further management.

MEDICAL HISTORY: PMHx:
1) CAD: h/o MI
2) Narcotic dependence
3) h/o cluster headaches
4) HTN
5) s/p appendectomy
6) s/p knee surgery
7) h/o left hip dislocation s/p closed reduction [**2-10**]
8) ? cancer: diagnosed in [**State 108**], told he had 4 months to live.

MEDICATION ON ADMISSION: 

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PE:
Gen:awake, in NAD, restless in bed
HEENT: no cervical LAD, no JVD appreciated
Cardiac: RRR, no MRG
Pulm: CTAB in all lung fields, no WRR
Abd: non-tender, non-distended, soft, + BS throughout
Ext: no C/C/E in bilateral LE
Neuro: oriented x 1 only, awake, answers questions, but confused

FAMILY HISTORY: 3 brothers, mother, father with DM and CAD. Mother died at age
67 yrs of MI, father died at 77 yrs of MI, brother had MI in his
40s

SOCIAL HISTORY: Pt reports drinks ~ 1 drink/month, however per his brother he is
a heavy drinker. Denies other drug use. (+) tobacco [**2-8**] ppd X 40
yrs. He lives alone on disability. 

### Response:
{'Unspecified septicemia,Septic shock,Acute kidney failure, unspecified,Hyperpotassemia,Unspecified drug dependence, continuous,Pneumonitis due to inhalation of food or vomitus,Intestinal infection due to Clostridium difficile,Toxic encephalopathy,Rhabdomyolysis,Acute gastritis, with hemorrhage,Benign neoplasm of colon,Severe sepsis'}
