CHIEF COMPLAINT: 

PRESENT ILLNESS: Patient is a 43-year-old male
with a history of chronic pancreatitis, alcohol abuse, and
ankylosing spondylitis.  Is transferred from an outside
hospital after he presented there with epigastric pain since
[**9-1**], which had worsened and was unresponsive to pain
medicine.  At the outside hospital, he was found to have
gallstones and a dilated common bile duct on ultrasound.
Laboratories at that time were significant for an ALT of 470,
AST of 173, T bilirubin of 3.5, amylase of 287, and lipase of
2070, all consistent with gallstone pancreatitis.

MEDICAL HISTORY: 1. Alcohol abuse.
2. Ankylosing spondylitis.
3. Status post umbilical hernia repair.

MEDICATION ON ADMISSION: 

ALLERGIES: 1. Demerol.
2. Codeine.
3. Percocet.

PHYSICAL EXAM: Vitals revealed a temperature of 97.0, heart
rate of 75, blood pressure of 121/84, respirations are 21,
and oxygen saturation of 98% on room air.  In general, he was
a well-nourished male, appearing stated age in no acute
distress, and alert and oriented times three.  HEENT revealed
pupils are equal, round, and reactive to light.  Extraocular
muscles were intact.  His oropharynx was with moist mucous
membranes, and he had no JVD or lymphadenopathy.  He had no
appreciable scleral icterus.  His heart was regular, there
were no murmurs, rubs, or gallops.  Lungs revealed bilateral
basilar crackles, but otherwise clear to auscultation.
Abdominal examination revealed mild epigastric tenderness to
palpation, and decreased bowel sounds.  He had no rebound or
guarding.  His extremities were without edema, and he had
dorsalis pedis pulses bilaterally.  On neurologic
examination, he was alert and oriented times three, and her
cranial nerves II through XII are intact bilaterally.
Sensation was intact bilaterally to light touch.  Strength is
[**6-3**] on upper and lower extremities, and his deep tendon
reflexes were [**3-3**] bilaterally.

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY: He has a history of alcohol abuse, and he
says that he quit two years ago.  He is married and lives
with his wife.  [**Name (NI) **] works as a private investigator.  He
denies any drug or tobacco use.
Chronic pancreatitis,Calculus of bile duct without mention of cholecystitis, with obstruction,Other and unspecified alcohol dependence, unspecified,Ankylosing spondylitis
Chronic pancreatitis,Choledochlith NOS w obst,Alcoh dep NEC/NOS-unspec,Ankylosing spondylitis
Admission Date:  [**2165-11-9**]     Discharge Date:  [**2165-11-13**]

Date of Birth:   [**2122-7-11**]     Sex:  M

Service:  General Medicine

HISTORY OF PRESENT ILLNESS:  Patient is a 43-year-old male
with a history of chronic pancreatitis, alcohol abuse, and
ankylosing spondylitis.  Is transferred from an outside
hospital after he presented there with epigastric pain since
[**9-1**], which had worsened and was unresponsive to pain
medicine.  At the outside hospital, he was found to have
gallstones and a dilated common bile duct on ultrasound.
Laboratories at that time were significant for an ALT of 470,
AST of 173, T bilirubin of 3.5, amylase of 287, and lipase of
2070, all consistent with gallstone pancreatitis.

Initial attempt at [**Hospital3 **] for ERCP was unsuccessful with
inability to sedate the patient and he was rescheduled for
ERCP under general anesthesia.  He underwent ERCP again on
[**2165-11-10**], was very difficult to intubate due to his
ankylosing spondylitis, and he was stabilized in the MICU
postoperatively due to result in bleeding and edema secondary
to intubation attempts.

ERCP on [**2165-11-10**] revealed a shelf-like stricture that was
15 mm of the common bile duct, near the junction of the
cystic duct.  He had a sphincterotomy, balloon dilation of
the common bile duct stricture, and a common bile duct stent
placed at this time.

After ERCP, he was feeling better, and denied any fevers,
chills, nausea, vomiting, diarrhea, and was reporting minimal
epigastric pain.

PAST MEDICAL HISTORY:
1. Alcohol abuse.
2. Ankylosing spondylitis.
3. Status post umbilical hernia repair.

SOCIAL HISTORY:  He has a history of alcohol abuse, and he
says that he quit two years ago.  He is married and lives
with his wife.  [**Name (NI) **] works as a private investigator.  He
denies any drug or tobacco use.

FAMILY HISTORY:  Noncontributory.

ALLERGIES:
1. Demerol.
2. Codeine.
3. Percocet.

MEDICATIONS ON TRANSFER FROM THE MICU:
1. Methylprednisolone 60 mg IV q.8h.
2. Sliding scale of regular insulin.
3. SubQ Heparin.
4. Pepcid 20 mg IV b.i.d.
5. Morphine 2-4 mg IV q.4h. prn.
6. Levofloxacin 500 mg IV q.d.
7. Flagyl 500 mg IV q.8h.
8. Zofran 2 mg IV q.6h. prn.

PHYSICAL EXAM:  Vitals revealed a temperature of 97.0, heart
rate of 75, blood pressure of 121/84, respirations are 21,
and oxygen saturation of 98% on room air.  In general, he was
a well-nourished male, appearing stated age in no acute
distress, and alert and oriented times three.  HEENT revealed
pupils are equal, round, and reactive to light.  Extraocular
muscles were intact.  His oropharynx was with moist mucous
membranes, and he had no JVD or lymphadenopathy.  He had no
appreciable scleral icterus.  His heart was regular, there
were no murmurs, rubs, or gallops.  Lungs revealed bilateral
basilar crackles, but otherwise clear to auscultation.
Abdominal examination revealed mild epigastric tenderness to
palpation, and decreased bowel sounds.  He had no rebound or
guarding.  His extremities were without edema, and he had
dorsalis pedis pulses bilaterally.  On neurologic
examination, he was alert and oriented times three, and her
cranial nerves II through XII are intact bilaterally.
Sensation was intact bilaterally to light touch.  Strength is
[**6-3**] on upper and lower extremities, and his deep tendon
reflexes were [**3-3**] bilaterally.

LABORATORIES ON TRANSFER:  CBC revealed white count of 6.0,
hematocrit 37.1, platelets of 301.  He had normal
chemistries.  He had a lipase of 33, down from 229, total
bilirubin of 0.8 down from 2.6, amylase of 47, down from 147,
LDH of 112, AST of 65 down from 96, ALT of 246, down from
289, and an alkaline phosphatase of 360 down from 384.  He
also had a normal calcium, magnesium, and phosphate.

HOSPITAL COURSE:
1. Gastrointestinal:  As mentioned above, patient was
transferred from an outside hospital with epigastric pain,
laboratory findings and ultrasound findings consistent with
gallstone pancreatitis.  He was transferred to [**Hospital1 346**] for ERCP, with a first attempt
failed due to inability to successfully sedate the patient,
therefore, he underwent second ERCP on [**2165-11-10**] with
general anesthesia.  At that time, findings included a 15 mm
common bile duct stricture, and he underwent sphincterotomy
and common bile duct stent placement.  It was also noted at
this time that he had drainage of sludge and pus from his
common bile duct.

Differential of his common bile duct stricture included PSC,
cholangiocarcinoma, and chronic pancreatitis, or some sort of
other external mass including a pancreatic tumor compressing
the common bile duct.  After ERCP, he had improving LFTs,
total bilirubin was decreasing, it was felt that the stent
was working fine.

At the time of ERCP, he had common bile duct brushings sent
for cytology, which revealed no malignant cells.  He also had
a CEA and AFP drawn, both of which are normal.  He had a
serum ANCA which was negative.  He also had a CA19-9 drawn
which is sent out and is currently pending.  He also had
hepatitis serologies drawn, which were all normal.

It was recommended by ERCP to be followed up with a CT
angiogram of the abdomen to rule out any pancreatic or other
mass in the area around the common bile duct possible
compressing common bile duct.

He underwent a CT angiogram, which revealed edema in the head
of the pancreas, but no obvious mass.  This was read out with
the attending radiologist, who recommended followup abdominal
CT in one month.

It was also recommended that he follow up with Dr. [**Last Name (STitle) 468**] in
the Department of Surgery for discussion of cholecystectomy
at a future date.  This appointment was scheduled for him.
He was also seen by the Hepatology service while admitted,
who recommended all of the above tests as already done, and
he will be followed up with Dr. [**First Name (STitle) **] as an outpatient, and this
appointment was made for him prior to him leaving.  He will
also need followup with ERCP in eight weeks for removal of
the common bile duct stent, and this appointment was made for
him as well.  He is also scheduled for a followup abdominal
CT in one month after discharge.

At the time of discharge, it was unclear the etiology of his
common bile duct stricture, however, it was felt that
cholangiocarcinoma and tumor at the head of the pancreas was
ruled out based on common bile duct cytology and his
abdominal CTA.  The idea of primary sclerosing cholangitis
was still being entertained, however, he had a normal ANCA,
and not have characteristic appearance of the common bile
duct for primary sclerosing cholangitis on his cholangiogram.

On the day of discharge, he is without abdominal pain,
fevers, or chills, and was tolerating p.o.

2. Infectious disease:  Patient reported one episode of
subjective fever prior to admission, however, he was afebrile
throughout his admission.  He was transferred to [**Hospital1 346**] on Unasyn, which was changed to
levofloxacin and Flagyl.  At the time of ERCP, pus drainage
from the common bile duct was noted, and he was continued on
levofloxacin and metronidazole to complete a 10 day course.

3. Musculoskeletal:  Patient has a history of ankylosing
spondylitis, which was not apparently active or worsening
upon admission.  He does not have a PCP currently and due to
recent move and change of his jobs, however, he will be
scheduling an appointment with his PCP at the time of
discharge for further maintenance of his ankylosing
spondylitis and other issues.

DISCHARGE DIAGNOSES:
1. Gallstone pancreatitis.
2. Choledocholithiasis.
3. Ankylosing spondylitis.

DISCHARGE MEDICATIONS:
1. Levofloxacin 500 mg q.d. x9 days.
2. Flagyl 500 mg t.i.d. x9 days.
3. Protonix 40 mg q.d.
4. Morphine 15 mg q.4-6h. prn for pain x5 days.

DISCHARGE CONDITION:  At the time of discharge, patient was
stable and without abdominal pain or fevers.  He was
tolerating p.o. and ambulating without difficulty.

FOLLOWUP:
1. He is to followup with Dr. [**Last Name (STitle) 468**] in the Department of
Surgery on [**2165-11-22**] at 9 a.m. to discuss further plans for
cholecystectomy.
2. He has an appointment with Dr. [**Last Name (STitle) 497**] in the Department of
Gastroenterology on [**2165-12-20**] at 12:20 p.m.
3. He has followup with Dr. [**Last Name (STitle) 10108**] with Gastroenterology on
[**1-2**] at 8 a.m. for ERCP and removal of common bile
duct stent.
4. He has followup in [**Company 191**] with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] on
[**2165-11-25**] at 10:30 a.m.  He will have this initial
appointment and his PCP will be changed to Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **].
5. He has an appointment as well for abdominal CAT scan on
[**2165-12-20**] at 11:30 a.m.

DISCHARGE STATUS:  Patient was discharged to home with the
above followup.



                          [**Doctor Last Name **] [**Name6 (MD) **] [**Name8 (MD) **], M.D.  [**MD Number(1) 5712**]

Dictated By:[**Last Name (NamePattern1) 14268**]

MEDQUIST36

D:  [**2165-11-13**]  16:53
T:  [**2165-11-14**]  11:59
JOB#:  [**Job Number 106186**]
{'Chronic pancreatitis,Calculus of bile duct without mention of cholecystitis, with obstruction,Other and unspecified alcohol dependence, unspecified,Ankylosing spondylitis'}


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: 

PRESENT ILLNESS: Patient is a 43-year-old male
with a history of chronic pancreatitis, alcohol abuse, and
ankylosing spondylitis.  Is transferred from an outside
hospital after he presented there with epigastric pain since
[**9-1**], which had worsened and was unresponsive to pain
medicine.  At the outside hospital, he was found to have
gallstones and a dilated common bile duct on ultrasound.
Laboratories at that time were significant for an ALT of 470,
AST of 173, T bilirubin of 3.5, amylase of 287, and lipase of
2070, all consistent with gallstone pancreatitis.

MEDICAL HISTORY: 1. Alcohol abuse.
2. Ankylosing spondylitis.
3. Status post umbilical hernia repair.

MEDICATION ON ADMISSION: 

ALLERGIES: 1. Demerol.
2. Codeine.
3. Percocet.

PHYSICAL EXAM: Vitals revealed a temperature of 97.0, heart
rate of 75, blood pressure of 121/84, respirations are 21,
and oxygen saturation of 98% on room air.  In general, he was
a well-nourished male, appearing stated age in no acute
distress, and alert and oriented times three.  HEENT revealed
pupils are equal, round, and reactive to light.  Extraocular
muscles were intact.  His oropharynx was with moist mucous
membranes, and he had no JVD or lymphadenopathy.  He had no
appreciable scleral icterus.  His heart was regular, there
were no murmurs, rubs, or gallops.  Lungs revealed bilateral
basilar crackles, but otherwise clear to auscultation.
Abdominal examination revealed mild epigastric tenderness to
palpation, and decreased bowel sounds.  He had no rebound or
guarding.  His extremities were without edema, and he had
dorsalis pedis pulses bilaterally.  On neurologic
examination, he was alert and oriented times three, and her
cranial nerves II through XII are intact bilaterally.
Sensation was intact bilaterally to light touch.  Strength is
[**6-3**] on upper and lower extremities, and his deep tendon
reflexes were [**3-3**] bilaterally.

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY: He has a history of alcohol abuse, and he
says that he quit two years ago.  He is married and lives
with his wife.  [**Name (NI) **] works as a private investigator.  He
denies any drug or tobacco use. 

### Response:
{'Chronic pancreatitis,Calculus of bile duct without mention of cholecystitis, with obstruction,Other and unspecified alcohol dependence, unspecified,Ankylosing spondylitis'}
