CHIEF COMPLAINT: Dysphagia secondary to achalasia

PRESENT ILLNESS: 85 y/o male with achalasia and a esophageal diverticulum s/p 3
botox injections and medical therapy at an OSH now here for
surgical treatment.  Patient has had chronic dysphagia for many
years which worsened in [**2163**] when patient could no longer take
in solids and he presented with weight loss and worsened
dysphagia to an OSH.  Workup at OSH showed achalasia.  Patient
was treated conservatively with dietary modification and
continued to have difficulty swallowing. Patient pursued his
first botox treatment in [**2165-6-15**] and experienced almost 8
months of relief before he returned to baseline dysagia and
second attempt at botox in [**2166-2-13**], which was unsuccessful in
alleviating symptoms, prompting another attempt
in [**2166-4-15**] with botox which was also unsuccessful.  He was
referred to [**Hospital1 18**] for surgical therapy.

MEDICAL HISTORY: PMH:
atrial flutter, atrial fibrillation - patient went into
a-flutter
and asystole during first attempt at botox in [**5-/2165**] and since
reverted to atrial fibrillation (on coumadin stopped [**2166-5-1**] and
now controlled on diltiazem)
hypertension
glaucoma
diabetes mellitus, type 2
hyperlipidemia
macular degeneration in left eye
pneumonia during admission for bloody stools

MEDICATION ON ADMISSION: Meds from transfer from OSH:
TPN
diltiazem infusion
lasix 60 mg IV daily
xopenex nebulizers TID with atrovent
timolol eye drops
insulin sliding scale
ativan 0.5 mg IV q4hrs prn anxiety
digoxin 0.125 mg IV every 36 hours
ativan 1 mg IV qhs
protonix 40 mg IV BID
atenolol 75 mg PO BID on hold as patient unable to take PO
amiodarone 100 mg PO BID on hold as unable to take PO
Zocor 20 mg PO at bedtime on hold
K Dur 20 meq PO daily on hold
folic acid PO daily on hold
Casodex 50 mg PO daily on hold
Heparin subcutaneously 5000 units [**Hospital1 **]

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Physical Exam:
Vitals: T 96.8 HR 80 BP 100/56 RR 18 SaO2 95% 2LNC
Gen: Elderly gentleman who appears his stated age, NAD, AAOx3
Cardiac: irregularly irregular heart rate
Resp: B/l rhonchi in anterior lung fields, clear to auscultation
posteriorly except for coarse wheezing at the b/l bases, right
greater than left.
Abdomen: Non-distended, multiple petechiae marking sites of
lovenox injections, bowel sounds present but hypoactive, soft,
non-tender to palpation
Ext: Non edematous, calves non-tender, no erythema

FAMILY HISTORY: Mother died of MI at [**Age over 90 **] y/o. No recollection of family members
with esophageal dismotility.

SOCIAL HISTORY: Married for 60 years, 4 kids, 9 grandchildren, WW2 veteran
served in [**Country 16225**]; smoked 1.5 PPD x 30-40 years and quit 5 years
ago; social alcohol drinker prior to current severe dysphagia
Achalasia and cardiospasm,Diaphragmatic hernia with obstruction,Unspecified protein-calorie malnutrition,Dysphagia, unspecified,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Atrial fibrillation,Malignant neoplasm of prostate,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified glaucoma,Macular degeneration (senile), unspecified,Long-term (current) use of anticoagulants
Achalasia & cardiospasm,Diaphragm hernia w obstr,Protein-cal malnutr NOS,Dysphagia NOS,Hypertension NOS,Hyperlipidemia NEC/NOS,Atrial fibrillation,Malign neopl prostate,DMII wo cmp nt st uncntr,Glaucoma NOS,Macular degeneration NOS,Long-term use anticoagul
Admission Date:  [**2166-5-26**]              Discharge Date:   [**2166-6-3**]

Date of Birth:  [**2081-5-3**]             Sex:   M

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1481**]
Chief Complaint:
Dysphagia secondary to achalasia

Major Surgical or Invasive Procedure:
[**Doctor Last Name **] myotomy with fundoplication
Percutneous Endoscopic Gastrostomy

History of Present Illness:
85 y/o male with achalasia and a esophageal diverticulum s/p 3
botox injections and medical therapy at an OSH now here for
surgical treatment.  Patient has had chronic dysphagia for many
years which worsened in [**2163**] when patient could no longer take
in solids and he presented with weight loss and worsened
dysphagia to an OSH.  Workup at OSH showed achalasia.  Patient
was treated conservatively with dietary modification and
continued to have difficulty swallowing. Patient pursued his
first botox treatment in [**2165-6-15**] and experienced almost 8
months of relief before he returned to baseline dysagia and
second attempt at botox in [**2166-2-13**], which was unsuccessful in
alleviating symptoms, prompting another attempt
in [**2166-4-15**] with botox which was also unsuccessful.  He was
referred to [**Hospital1 18**] for surgical therapy.


Past Medical History:
PMH:
atrial flutter, atrial fibrillation - patient went into
a-flutter
and asystole during first attempt at botox in [**5-/2165**] and since
reverted to atrial fibrillation (on coumadin stopped [**2166-5-1**] and
now controlled on diltiazem)
hypertension
glaucoma
diabetes mellitus, type 2
hyperlipidemia
macular degeneration in left eye
pneumonia during admission for bloody stools

Social History:
Married for 60 years, 4 kids, 9 grandchildren, WW2 veteran
served in [**Country 16225**]; smoked 1.5 PPD x 30-40 years and quit 5 years
ago; social alcohol drinker prior to current severe dysphagia


Family History:
Mother died of MI at [**Age over 90 **] y/o. No recollection of family members
with esophageal dismotility.


Physical Exam:
Physical Exam:
Vitals: T 96.8 HR 80 BP 100/56 RR 18 SaO2 95% 2LNC
Gen: Elderly gentleman who appears his stated age, NAD, AAOx3
Cardiac: irregularly irregular heart rate
Resp: B/l rhonchi in anterior lung fields, clear to auscultation
posteriorly except for coarse wheezing at the b/l bases, right
greater than left.
Abdomen: Non-distended, multiple petechiae marking sites of
lovenox injections, bowel sounds present but hypoactive, soft,
non-tender to palpation
Ext: Non edematous, calves non-tender, no erythema

Labs:

137 / 100 / 35
---------------< 98
4.0/  24  / 1.2

Ca 9.5 Mg 2.0 P 4.0
Alb 3.8

    14.0
8.4>-----<254
    41.3

PT 13.7 PTT 34.5 INR 1.2


Pertinent Results:
[**2166-5-31**] 04:18AM BLOOD WBC-6.1 RBC-3.61* Hgb-11.0* Hct-33.7*
MCV-93 MCH-30.4 MCHC-32.6 RDW-15.0 Plt Ct-239
[**2166-5-31**] 04:18AM BLOOD Plt Ct-239
[**2166-5-27**] 02:23PM BLOOD PT-14.6* PTT-39.3* INR(PT)-1.3*
[**2166-6-3**] 07:15AM BLOOD Glucose-98 UreaN-19 Creat-0.9 Na-139
K-4.3 Cl-105 HCO3-27 AnGap-11
[**2166-5-29**] 01:34AM BLOOD Digoxin-1.0

Brief Hospital Course:
Patient was received as transfer from OSH on [**2166-5-26**].  He was
admitted to the ICU for maintanance of a diltiazem drip for his
atrial fibrillation.

He was taken to the operating room on [**2166-5-27**] for laparascopic
[**Doctor Last Name **] myotomy and fundoplication.  The surgery proceded without
complication and he was returned back to the ICU for
continuation of his diltiazem drip.

Barium swallow on POD 1 revealed that no contrast passed from
the lower esophagus into the stomach over 15 minutes.  Mr.
[**Known lastname 24344**] was kept NPO with his HOB elevated to prevent aspiration.
 CXR on POD 2 revealed contrast still in esophagus with small
amount of contrast in the stomach.  CXR on POD 3 showed most of
the contrast passed through but with some residual in the
esophagus.  He was taken to the OR later in the day on [**2166-5-30**]
(POD 3), for placement of a PEG tube.

Of note cardiovascularly, he was weaned off of the diltiazem to
a rate-controlled afib on lopressor 4 mg IV every four hours on
POD 2. By POD 3, the patient was transferred to the floor of IV
diltiazem gtt.

On POD4, the patient was started on clear liquids, which he
tolerated without difficulty. He was advanced to full liquids on
POD5. This was also tolerated without evidence of regurgitation
or aspiration. He was given mechanincal soft solids on the
morning of POD7.

On POD 5, the patient experienced loose stools and on POD 6, a
stool sample was sent for microbacterial analysis. The results
are pending at the time of discharge. However, the patient
remained afebrile without leukocytosis or hemodynamic
instability. He was discharged from the hospital on POD 7.

Medications on Admission:
Meds from transfer from OSH:
TPN
diltiazem infusion
lasix 60 mg IV daily
xopenex nebulizers TID with atrovent
timolol eye drops
insulin sliding scale
ativan 0.5 mg IV q4hrs prn anxiety
digoxin 0.125 mg IV every 36 hours
ativan 1 mg IV qhs
protonix 40 mg IV BID
atenolol 75 mg PO BID on hold as patient unable to take PO
amiodarone 100 mg PO BID on hold as unable to take PO
Zocor 20 mg PO at bedtime on hold
K Dur 20 meq PO daily on hold
folic acid PO daily on hold
Casodex 50 mg PO daily on hold
Heparin subcutaneously 5000 units [**Hospital1 **]

Discharge Medications:
1. Heparin (Porcine) 5,000 unit/mL Solution [**Hospital1 **]: One (1) mL
Injection TID (3 times a day).
2. Albuterol Sulfate 2.5 mg /3 mL (0.083 %) Solution for
Nebulization [**Hospital1 **]: One (1) Nebulizer Inhalation Q6H (every 6
hours) as needed for SOB .
3. Timolol Maleate 0.5 % Drops [**Hospital1 **]: One (1) Drop Ophthalmic
DAILY (Daily).
4. Thiamine HCl 100 mg Tablet [**Hospital1 **]: One (1) Tablet PO DAILY
(Daily).
5. Lorazepam 0.5 mg Tablet [**Hospital1 **]: One (1) Tablet PO HS (at
bedtime) as needed for anxiety, sleep.
6. Amiodarone 200 mg Tablet [**Hospital1 **]: 0.5 Tablet PO BID (2 times a
day).
7. Simvastatin 10 mg Tablet [**Hospital1 **]: Two (2) Tablet PO HS (at
bedtime).
8. Digoxin 125 mcg Tablet [**Hospital1 **]: One (1) Tablet PO Q36H (every 36
hours).
9. Folic Acid 1 mg Tablet [**Hospital1 **]: One (1) Tablet PO DAILY (Daily).

10. Atenolol 25 mg Tablet [**Hospital1 **]: Three (3) Tablet PO BID (2 times
a day): Hold for HR<60 or SBP<100.
11. Oxycodone-Acetaminophen 5-325 mg/5 mL Solution [**Hospital1 **]: 5-10 MLs
PO Q6H (every 6 hours) as needed for Pain.
12. Lansoprazole 30 mg Tablet,Rapid Dissolve, DR [**Last Name (STitle) **]: One (1)
Tablet,Rapid Dissolve, DR [**Last Name (STitle) **] DAILY (Daily).


Discharge Disposition:
Extended Care

Facility:
[**Location (un) 582**] - [**Location (un) 7658**]

Discharge Diagnosis:
Achalasia
Atrial fibrillation
Hypertension
Glaucoma
Diabetes mellitus, type 2
Hyperlipidemia
Macular degeneration in left eye
History of pneumonia


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - requires assistance or aid (walker
or cane).


Discharge Instructions:
Please call Dr.[**Name (NI) 1482**] office or return to the hospital if
you experience fevers greater than 101 degrees, chills,
uncontrolable nausea/vomiting/diarrhea, inability to eat, or
redness or drainage from your wounds.
Avoid heavy lifting until follow-up visit. Showering is okay,
but avoid tub bathing or swimming until follow-up visit.
Please administer all medications via G-tube. Please flush
G-tube with 10cc saline TID.

Followup Instructions:
Please call Dr.[**Name (NI) 1482**] office at ([**Telephone/Fax (1) 1483**] for a
follow-up appointment. Plan for follow-up visit in [**8-28**] days
after discharge.
{'Achalasia and cardiospasm,Diaphragmatic hernia with obstruction,Unspecified protein-calorie malnutrition,Dysphagia, unspecified,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Atrial fibrillation,Malignant neoplasm of prostate,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified glaucoma,Macular degeneration (senile), unspecified,Long-term (current) use of anticoagulants'}


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: Dysphagia secondary to achalasia

PRESENT ILLNESS: 85 y/o male with achalasia and a esophageal diverticulum s/p 3
botox injections and medical therapy at an OSH now here for
surgical treatment.  Patient has had chronic dysphagia for many
years which worsened in [**2163**] when patient could no longer take
in solids and he presented with weight loss and worsened
dysphagia to an OSH.  Workup at OSH showed achalasia.  Patient
was treated conservatively with dietary modification and
continued to have difficulty swallowing. Patient pursued his
first botox treatment in [**2165-6-15**] and experienced almost 8
months of relief before he returned to baseline dysagia and
second attempt at botox in [**2166-2-13**], which was unsuccessful in
alleviating symptoms, prompting another attempt
in [**2166-4-15**] with botox which was also unsuccessful.  He was
referred to [**Hospital1 18**] for surgical therapy.

MEDICAL HISTORY: PMH:
atrial flutter, atrial fibrillation - patient went into
a-flutter
and asystole during first attempt at botox in [**5-/2165**] and since
reverted to atrial fibrillation (on coumadin stopped [**2166-5-1**] and
now controlled on diltiazem)
hypertension
glaucoma
diabetes mellitus, type 2
hyperlipidemia
macular degeneration in left eye
pneumonia during admission for bloody stools

MEDICATION ON ADMISSION: Meds from transfer from OSH:
TPN
diltiazem infusion
lasix 60 mg IV daily
xopenex nebulizers TID with atrovent
timolol eye drops
insulin sliding scale
ativan 0.5 mg IV q4hrs prn anxiety
digoxin 0.125 mg IV every 36 hours
ativan 1 mg IV qhs
protonix 40 mg IV BID
atenolol 75 mg PO BID on hold as patient unable to take PO
amiodarone 100 mg PO BID on hold as unable to take PO
Zocor 20 mg PO at bedtime on hold
K Dur 20 meq PO daily on hold
folic acid PO daily on hold
Casodex 50 mg PO daily on hold
Heparin subcutaneously 5000 units [**Hospital1 **]

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Physical Exam:
Vitals: T 96.8 HR 80 BP 100/56 RR 18 SaO2 95% 2LNC
Gen: Elderly gentleman who appears his stated age, NAD, AAOx3
Cardiac: irregularly irregular heart rate
Resp: B/l rhonchi in anterior lung fields, clear to auscultation
posteriorly except for coarse wheezing at the b/l bases, right
greater than left.
Abdomen: Non-distended, multiple petechiae marking sites of
lovenox injections, bowel sounds present but hypoactive, soft,
non-tender to palpation
Ext: Non edematous, calves non-tender, no erythema

FAMILY HISTORY: Mother died of MI at [**Age over 90 **] y/o. No recollection of family members
with esophageal dismotility.

SOCIAL HISTORY: Married for 60 years, 4 kids, 9 grandchildren, WW2 veteran
served in [**Country 16225**]; smoked 1.5 PPD x 30-40 years and quit 5 years
ago; social alcohol drinker prior to current severe dysphagia 

### Response:
{'Achalasia and cardiospasm,Diaphragmatic hernia with obstruction,Unspecified protein-calorie malnutrition,Dysphagia, unspecified,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Atrial fibrillation,Malignant neoplasm of prostate,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified glaucoma,Macular degeneration (senile), unspecified,Long-term (current) use of anticoagulants'}
