CHIEF COMPLAINT: Nausea, vomiting, epigastric pain

PRESENT ILLNESS: HPI: 66F s/p lap chole ~1 year ago who presents with epigastric
pain after a fatty meal.  She presents here with substantial
epigastric pain, and LFT abnormalities indicative of an
obstructed biliary system without jaundice.  Findings are
concerning for retained gallstone pancreatitis.  The patient had
fluctuates of blood pressure and heart rate as well as
tachypnea,
prompting the ED to suddenly obtain a CTA Torso to rule out PE
while still evaluating the abdomen.  CTA Chest was negative, but
the abdomen scan demonstrated dilated extra- and intra- hepatic
ducts, keeping with the presumed diagnosis.

MEDICAL HISTORY: Little medical care in several years.
Presentation to [**Hospital3 **] where had stress test (full results
not available)
LBBB ([**2141**])
PE at age 21 while on OCPs
DM type II
Hyperlipidemia
Gallstones
GERD
Anxiety, panic attacks
Hemorrhoids
H/o toxin-induced hepatitis from overdose of OTC medication
Anemia
"Congenital [**Last Name **] problem in which blood was flowing the wrong
way"

MEDICATION ON ADMISSION: VitD-2 400U', calcium carbonate 600'', ASA 81', lisinopril 20',
simvastatin 20', omeprazole 20', metformin 1000'

ALLERGIES: Codeine / Dilaudid (PF)

PHYSICAL EXAM: Upon presentation to [**Hospital1 18**]:
97.6 74 194/104 18 99% RA
GENERAL: NAD, concerned and anxious about her pain control and
what is causing her pain
CV: s1 s2 no murmur
Lungs: CTA - some mild diminishing of sounds at the bases
Abdomen: mild RUQ tenderness, epigastric tenderness elicited but
otherwise soft and mildly distended
Vitals thirty minutes later
HR 123  BP 224/100

FAMILY HISTORY: No blood clots or liver disease. Brother with hypertension and
heart disease of some type.

SOCIAL HISTORY: Takes care of an elderly woman for work. Walks up and down
stairs during work, sometimes feels shortness of breath. Notes
that she has been anxious related to a disagreement with her
boss lately. No EtOH or drug use ever. Smoked up until age 30.
Not sexually active.
Unspecified septicemia,Acute pancreatitis,Calculus of bile duct without mention of cholecystitis, with obstruction,Cholangitis,Sepsis,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Panic disorder without agoraphobia,Anemia, unspecified,Other and unspecified hyperlipidemia,Esophageal reflux,Leukocytosis, unspecified,Personal history of venous thrombosis and embolism,Other acquired absence of organ,Personal history of tobacco use
Septicemia NOS,Acute pancreatitis,Choledochlith NOS w obst,Cholangitis,Sepsis,DMII wo cmp nt st uncntr,Panic dis w/o agorphobia,Anemia NOS,Hyperlipidemia NEC/NOS,Esophageal reflux,Leukocytosis NOS,Hx-ven thrombosis/embols,Acq absence of organ NEC,History of tobacco use
Admission Date:  [**2145-11-21**]              Discharge Date:   [**2145-11-24**]

Date of Birth:  [**2078-12-12**]             Sex:   F

Service: SURGERY

Allergies:
Codeine / Dilaudid (PF)

Attending:[**First Name3 (LF) 598**]
Chief Complaint:
Nausea, vomiting, epigastric pain


Major Surgical or Invasive Procedure:
[**2145-11-21**] ERCP

History of Present Illness:
HPI: 66F s/p lap chole ~1 year ago who presents with epigastric
pain after a fatty meal.  She presents here with substantial
epigastric pain, and LFT abnormalities indicative of an
obstructed biliary system without jaundice.  Findings are
concerning for retained gallstone pancreatitis.  The patient had
fluctuates of blood pressure and heart rate as well as
tachypnea,
prompting the ED to suddenly obtain a CTA Torso to rule out PE
while still evaluating the abdomen.  CTA Chest was negative, but
the abdomen scan demonstrated dilated extra- and intra- hepatic
ducts, keeping with the presumed diagnosis.


Past Medical History:
Little medical care in several years.
Presentation to [**Hospital3 **] where had stress test (full results
not available)
LBBB ([**2141**])
PE at age 21 while on OCPs
DM type II
Hyperlipidemia
Gallstones
GERD
Anxiety, panic attacks
Hemorrhoids
H/o toxin-induced hepatitis from overdose of OTC medication
Anemia
"Congenital [**Last Name **] problem in which blood was flowing the wrong
way"

Social History:
Takes care of an elderly woman for work. Walks up and down
stairs during work, sometimes feels shortness of breath. Notes
that she has been anxious related to a disagreement with her
boss lately. No EtOH or drug use ever. Smoked up until age 30.
Not sexually active.


Family History:
No blood clots or liver disease. Brother with hypertension and
heart disease of some type.

Physical Exam:
Upon presentation to [**Hospital1 18**]:
97.6 74 194/104 18 99% RA
GENERAL: NAD, concerned and anxious about her pain control and
what is causing her pain
CV: s1 s2 no murmur
Lungs: CTA - some mild diminishing of sounds at the bases
Abdomen: mild RUQ tenderness, epigastric tenderness elicited but
otherwise soft and mildly distended
Vitals thirty minutes later
HR 123  BP 224/100


Pertinent Results:
[**2145-11-21**] 02:49AM   GLUCOSE-199* UREA N-17 CREAT-0.8 SODIUM-142
POTASSIUM-3.5 CHLORIDE-110* TOTAL CO2-20* ANION GAP-16
[**2145-11-21**] 02:49AM   ALT(SGPT)-623* AST(SGOT)-409* ALK PHOS-524*
AMYLASE-[**2156**]* TOT BILI-2.7*
[**2145-11-21**] 02:49AM   LIPASE-6095*
[**2145-11-21**] 02:49AM   ALBUMIN-3.6 CALCIUM-8.9 PHOSPHATE-3.7
MAGNESIUM-1.5*
[**2145-11-21**] 02:49AM   WBC-14.6*# RBC-4.64 HGB-12.0 HCT-36.8 MCV-79*
MCH-25.9* MCHC-32.7 RDW-15.1
[**2145-11-21**] 02:49AM   NEUTS-86* BANDS-4 LYMPHS-5* MONOS-5 EOS-0
BASOS-0 ATYPS-0 METAS-0 MYELOS-0

CT Chest/ABD:
CT CHEST WITH AND WITHOUT CONTRAST: The IV bolus timing is
slightly
suboptimal, but there is no filling defect in the central, lobar
or segmental pulmonary arteries. Of note, there is a right
aberrant subclavian artery.  The remaining mediastinal vessels
are unremarkable. Patchy bibasilar opacities are nonspecific,
but could represent atelectasis, but cannot rule out aspiration
or pneumonia. There is no pleural effusion. Evaluation of small
pulmonary nodule is limited in the presence of patchy opacity,
but there is no large lung pulmonary lesion.
The heart is normal in size without pericardial effusion. Aortic
valvular
calcifications are noted. Small mediastinal and hilar lymph
nodes are not
pathologically enlarged. There is no axillary lymphadenopathy.

CT ABDOMEN WITH IV CONTRAST: The liver is normal without focal
lesion. The
patient has undergone interval cholecystectomy. Mild
intrahepatic and
extrahepatic biliary ductal dilatation is new from prior, with
the common bile duct measuring up to 8-9 mm. There is
enlargement of the pancreatic head and neck with minimal
adjacent peripancreatic fat stranding. The pancreas enhances
normally without peripancreatic fluid collections. There is no
calcified stone in the biliary tract.

The spleen is within normal limits. A hyperdense exophytic cyst
arising from the lower pole of the left kidney is unchanged. The
stomach, duodenum and loops of small bowel are normal. There is
no free air, lymphadenopathy, or fluid. Abdominal aorta is
normal in caliber.

BONE WINDOW: There are no lytic or sclerotic lesions. Multilevel

degenerative changes are mild-to-moderate.

IMPRESSION:
1. Limited evaluation of the subsegmental pulmonary arteries. No
pulmonary
embolism within the main, lobar, or segmental branches.

2. Interval increased prominence of pancreatic head and neck,
with mild
peripancreatic fat stranding, compatible with pancreatitis.

3. Interval cholecystectomy with new, mild intra-hepatic and
extrahepatic
biliary ductal dilatation. While no calcified intraluminal
biliary stone is identified, CT is insensitive for
choledocholithiasis. Consider MRCP for further evaluation.

4. Bilateral patchy opacities in the lung bases. Differential
considerations include pneumonia, aspiration, or atelectasis.





Brief Hospital Course:
She was admitted to the ACS service and underwent ERCP with
sphincterotomy where a 10 mm stone and drained pus were removed.
She was started on Cipro and Flagyl IV early on.

On the day following her ERCP she was noted with tachypnea and
low oxygen saturations. CXR showed pulmonary edema, she was
given IV Lasix with resolution of her symptoms.

As her GI symptoms resolved her diet was upgraded to regular for
which she was able to tolerate. Her home medications were
restarted as well. She was discharged to home on oral Cipro and
Flagyl and will follow up in [**Hospital 2536**] clinic in [**1-20**] weeks.



Medications on Admission:
VitD-2 400U', calcium carbonate 600'', ASA 81', lisinopril 20',
simvastatin 20', omeprazole 20', metformin 1000'

Discharge Medications:
1. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day) as needed for constipation.
2. senna 8.6 mg Tablet Sig: 1-2 Tablets PO BID (2 times a day)
as needed for constipation.
3. lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

4. ciprofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q12H
(every 12 hours) for 7 days.
Disp:*14 Tablet(s)* Refills:*0*
5. metronidazole 500 mg Tablet Sig: One (1) Tablet PO TID (3
times a day) for 7 days.
Disp:*21 Tablet(s)* Refills:*0*
6. Tylenol 325 mg Tablet Sig: Two (2) Tablet PO every 4-6 hours
as needed for pain.


Discharge Disposition:
Home

Discharge Diagnosis:
Cholangitis/Gallstone pancreatitis

Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.

Discharge Instructions:
You were hospitalized with inlammation of your biliary system
and underwent and ERCP procedure where some of the excess
contents that were contributing to this inflammation were
removed.

You are being being discharged on antibitoics, please complete
the course as prescribed.

You may resume your heome medications as prescribed.

If taking narcotics for pain be sure to take a laxative and
stool softener to prevent constipation.

Followup Instructions:
Follow up in [**1-20**] weeks in [**Hospital 2536**] clinic, call [**Telephone/Fax (1) 600**] for an
appointment.

Follow up with your PCP [**Last Name (NamePattern4) **] [**1-20**] weeks for a general physical, you
will need to call for an appointment.

                             [**First Name8 (NamePattern2) **] [**Name8 (MD) **] MD [**MD Number(2) 601**]

Completed by:[**2145-12-1**]
{'Unspecified septicemia,Acute pancreatitis,Calculus of bile duct without mention of cholecystitis, with obstruction,Cholangitis,Sepsis,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Panic disorder without agoraphobia,Anemia, unspecified,Other and unspecified hyperlipidemia,Esophageal reflux,Leukocytosis, unspecified,Personal history of venous thrombosis and embolism,Other acquired absence of organ,Personal history of tobacco use'}


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: Nausea, vomiting, epigastric pain

PRESENT ILLNESS: HPI: 66F s/p lap chole ~1 year ago who presents with epigastric
pain after a fatty meal.  She presents here with substantial
epigastric pain, and LFT abnormalities indicative of an
obstructed biliary system without jaundice.  Findings are
concerning for retained gallstone pancreatitis.  The patient had
fluctuates of blood pressure and heart rate as well as
tachypnea,
prompting the ED to suddenly obtain a CTA Torso to rule out PE
while still evaluating the abdomen.  CTA Chest was negative, but
the abdomen scan demonstrated dilated extra- and intra- hepatic
ducts, keeping with the presumed diagnosis.

MEDICAL HISTORY: Little medical care in several years.
Presentation to [**Hospital3 **] where had stress test (full results
not available)
LBBB ([**2141**])
PE at age 21 while on OCPs
DM type II
Hyperlipidemia
Gallstones
GERD
Anxiety, panic attacks
Hemorrhoids
H/o toxin-induced hepatitis from overdose of OTC medication
Anemia
"Congenital [**Last Name **] problem in which blood was flowing the wrong
way"

MEDICATION ON ADMISSION: VitD-2 400U', calcium carbonate 600'', ASA 81', lisinopril 20',
simvastatin 20', omeprazole 20', metformin 1000'

ALLERGIES: Codeine / Dilaudid (PF)

PHYSICAL EXAM: Upon presentation to [**Hospital1 18**]:
97.6 74 194/104 18 99% RA
GENERAL: NAD, concerned and anxious about her pain control and
what is causing her pain
CV: s1 s2 no murmur
Lungs: CTA - some mild diminishing of sounds at the bases
Abdomen: mild RUQ tenderness, epigastric tenderness elicited but
otherwise soft and mildly distended
Vitals thirty minutes later
HR 123  BP 224/100

FAMILY HISTORY: No blood clots or liver disease. Brother with hypertension and
heart disease of some type.

SOCIAL HISTORY: Takes care of an elderly woman for work. Walks up and down
stairs during work, sometimes feels shortness of breath. Notes
that she has been anxious related to a disagreement with her
boss lately. No EtOH or drug use ever. Smoked up until age 30.
Not sexually active. 

### Response:
{'Unspecified septicemia,Acute pancreatitis,Calculus of bile duct without mention of cholecystitis, with obstruction,Cholangitis,Sepsis,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Panic disorder without agoraphobia,Anemia, unspecified,Other and unspecified hyperlipidemia,Esophageal reflux,Leukocytosis, unspecified,Personal history of venous thrombosis and embolism,Other acquired absence of organ,Personal history of tobacco use'}
