CHIEF COMPLAINT: "abnormal CT findings"

PRESENT ILLNESS: PCP: [**Name10 (NameIs) **],[**First Name3 (LF) **] M. [**Telephone/Fax (1) 6820**]
.
Patient is a 46 year old male with history of small bowel
obstruction and adhesions secondary to repair of gastroschisis
as an infant. He presented today to the emergency room with
crampy abdominal pain. Per his family, he had been having nausea
and vomiting for the last two weeks. Overnight and into the
morning of presentation, he was "doubled over" in abdominal
pain, and his roommate called 911.  His work-up in the ED was
notable for an elevated lactate of 3.0 and leukocytosis of 11.1.
A CT scan was concerning for possible internal hernia.

MEDICAL HISTORY: gastroschisis s/p repair
prior large bowel obstruction

MEDICATION ON ADMISSION: none

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS 100.2  98.8  78  122/70  20  99RA
Gen: NAD, alert
CV: RRR
Pulm: CTAB
Abd: soft, nontender, nondistended
Inc: clean/dry/intact, staples
Ext: no edema, wwp

FAMILY HISTORY: The patient is the youngest of four brothers and three sisters.
[**Name (NI) **] himself has no children.  His parents died at the age of 85.
His father died from a stroke and his mother died from breast
and pancreatic cancer.

SOCIAL HISTORY: The patient worked as a multimedia manager at [**Company 7709**] College.
He does not smoke.  He drinks alcohol only socially and he
exercises on a regular basis.
Intestinal or peritoneal adhesions with obstruction (postoperative) (postinfection),Acute posthemorrhagic anemia,Unspecified pleural effusion,Other respiratory complications,Pulmonary collapse,Postprocedural fever,Unspecified disorder of kidney and ureter
Intestinal adhes w obstr,Ac posthemorrhag anemia,Pleural effusion NOS,Respiratory comp NEC,Pulmonary collapse,Postprocedural fever,Renal & ureteral dis NOS
Admission Date:  [**2151-8-29**]              Discharge Date:   [**2151-9-4**]

Date of Birth:  [**2104-11-16**]             Sex:   M

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1**]
Chief Complaint:
"abnormal CT findings"

Major Surgical or Invasive Procedure:
Exploratory laparotomy; extensive lysis of adhesions (greater
than 2 hours); wedge resection of stomach; small-bowel
resection; reduction of internal hernia.


History of Present Illness:
PCP: [**Name10 (NameIs) **],[**First Name3 (LF) **] M. [**Telephone/Fax (1) 6820**]
.
Patient is a 46 year old male with history of small bowel
obstruction and adhesions secondary to repair of gastroschisis
as an infant. He presented today to the emergency room with
crampy abdominal pain. Per his family, he had been having nausea
and vomiting for the last two weeks. Overnight and into the
morning of presentation, he was "doubled over" in abdominal
pain, and his roommate called 911.  His work-up in the ED was
notable for an elevated lactate of 3.0 and leukocytosis of 11.1.
A CT scan was concerning for possible internal hernia.

Past Medical History:
gastroschisis s/p repair
prior large bowel obstruction


Social History:
The patient worked as a multimedia manager at [**Company 7709**] College.
He does not smoke.  He drinks alcohol only socially and he
exercises on a regular basis.


Family History:
The patient is the youngest of four brothers and three sisters.
[**Name (NI) **] himself has no children.  His parents died at the age of 85.
His father died from a stroke and his mother died from breast
and pancreatic cancer.


Physical Exam:
VS 100.2  98.8  78  122/70  20  99RA
Gen: NAD, alert
CV: RRR
Pulm: CTAB
Abd: soft, nontender, nondistended
Inc: clean/dry/intact, staples
Ext: no edema, wwp

Pertinent Results:
[**2151-8-29**] 09:00AM   WBC-11.1* RBC-4.70 HGB-14.4 HCT-43.7 MCV-93
MCH-30.7 MCHC-33.0 RDW-13.5
[**2151-8-29**] 09:14AM   LACTATE-3.0* K+-4.0

Brief Hospital Course:
OR course:
The patient was taken to the OR and underwent an exploratory
laparotomy; extensive lysis of adhesions (greater than 2 hours);
wedge resection of stomach; small-bowel resection; and reduction
of internal hernia.
.
[**Hospital Unit Name 153**] course:
Patient was initially admitted to the [**Hospital Unit Name 153**] for altered mental
status and inability to extubate.  He still had an NGT, as well
as a foley catheter.  His mental status improved, and he was
extubated later that day.  Elevated bilirubin levels and
creatinine levels were noted at that time.
.
FLOOR course:
The patient was transferred to the floor once he was extubated
the same day of the operation.  His foley catheter was removed
on [**8-31**], and the patient voided.
His NGT was removed, but the patient had a postop ileus.  He
experienced flatus by [**9-2**], and his diet was advanced from NPO
to sips to clears on [**9-3**] and then to regular diet on [**9-4**].
.
His postoperative course was complicated by fever and elevated
bilirubin levels immediately postop.  His preoperative abx of
kefzol and flagyl had been continued until [**8-30**].  The dosage of
kefzol was increased to 1g q8h.  His LFTs were monitored, and
the Tbili rose to a high of 2.5 on [**8-31**].  His WBC rose to a high
of 11.6 on [**8-31**].  A RUQ U/S on [**9-1**] was unrevealing; there were
no GB stones or dilation of the ducts.  Cultures were negative.
After [**8-31**], the bilirubin and WBC gradually trended back down to
normal.  Simultaneously, the patient's hct trended down from
42.8 to 27.9 postoperatively.  The patient was asymptomatic and
had no blood per rectum or hematemasis.  Labs showed no evidence
of hemolysis.  The team thought that it was possible that he had
bled internally.  He was not transfused, and by [**9-4**], his Hct
was back up to 30.6.
.
At the time of discharge, the patient's pain was well-controlled
on PO pain medications, and he was ambulating, voiding to the
toilet, having flatus and bowel movements, and tolerating
regular diet.  He had been afebrile for more than 24 hours
without medications.

Medications on Admission:
none

Discharge Medications:
1. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain for 2 weeks.
Disp:*30 Tablet(s)* Refills:*0*
2. Colace 100 mg Capsule Sig: One (1) Capsule PO twice a day for
2 weeks.
Disp:*28 Capsule(s)* Refills:*1*


Discharge Disposition:
Home

Discharge Diagnosis:
Primary:
Small-bowel obstruction
(strangulating secondary to internal hernia).


Discharge Condition:
Stable
Tolerating a regular diet
Adequate pain control with oral medication


Discharge Instructions:
Please call your doctor or return to the ER for any of the
following:
* If you are vomiting and cannot keep in fluids or your
medications.
* You are getting dehydrated due to continued vomiting,
diarrhea or other reasons. Signs of dehydration include dry
mouth, rapid heartbeat or feeling dizzy or faint when standing.
* You see blood or dark/black material when you vomit or have a
bowel movement.
* Your pain is not improving within 8-12 hours or not gone
within 24 hours. Call or return immediately if your pain is
getting worse or is changing location or moving to your chest or

back.
*Avoid lifting objects > 5lbs until your follow-up appointment
with the surgeon.
*Avoid driving or operating heavy machinery while taking pain
medications.
* You have shaking chills, or a fever greater than 101.5 (F)
degrees or 38(C) degrees.
* Any serious change in your symptoms, or any new symptoms that
concern you.
* Please resume all regular home medications and take any new
meds
as ordered.
* Continue to ambulate several times per day.
.
Incision Care:
-Your staples will be removed at your follow-up appointment with
Dr. [**Last Name (STitle) **].
-You may shower, and wash surgical incisions.
-Avoid swimming and baths until your follow-up appointment.
-Please call the doctor if you have increased pain, swelling,
redness, or drainage from the incision sites.


Followup Instructions:
1. Please follow-up with Dr. [**Last Name (STitle) **] [**Telephone/Fax (1) 9**] in [**12-18**]
weeks for removal of incisional staples.
2. Follow-up with your PCP as needed.
{'Intestinal or peritoneal adhesions with obstruction (postoperative) (postinfection),Acute posthemorrhagic anemia,Unspecified pleural effusion,Other respiratory complications,Pulmonary collapse,Postprocedural fever,Unspecified disorder of kidney and ureter'}


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: "abnormal CT findings"

PRESENT ILLNESS: PCP: [**Name10 (NameIs) **],[**First Name3 (LF) **] M. [**Telephone/Fax (1) 6820**]
.
Patient is a 46 year old male with history of small bowel
obstruction and adhesions secondary to repair of gastroschisis
as an infant. He presented today to the emergency room with
crampy abdominal pain. Per his family, he had been having nausea
and vomiting for the last two weeks. Overnight and into the
morning of presentation, he was "doubled over" in abdominal
pain, and his roommate called 911.  His work-up in the ED was
notable for an elevated lactate of 3.0 and leukocytosis of 11.1.
A CT scan was concerning for possible internal hernia.

MEDICAL HISTORY: gastroschisis s/p repair
prior large bowel obstruction

MEDICATION ON ADMISSION: none

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS 100.2  98.8  78  122/70  20  99RA
Gen: NAD, alert
CV: RRR
Pulm: CTAB
Abd: soft, nontender, nondistended
Inc: clean/dry/intact, staples
Ext: no edema, wwp

FAMILY HISTORY: The patient is the youngest of four brothers and three sisters.
[**Name (NI) **] himself has no children.  His parents died at the age of 85.
His father died from a stroke and his mother died from breast
and pancreatic cancer.

SOCIAL HISTORY: The patient worked as a multimedia manager at [**Company 7709**] College.
He does not smoke.  He drinks alcohol only socially and he
exercises on a regular basis. 

### Response:
{'Intestinal or peritoneal adhesions with obstruction (postoperative) (postinfection),Acute posthemorrhagic anemia,Unspecified pleural effusion,Other respiratory complications,Pulmonary collapse,Postprocedural fever,Unspecified disorder of kidney and ureter'}
