CHIEF COMPLAINT: Liver Abscess

PRESENT ILLNESS: Patient presented to [**Hospital3 **] with five day history of
cough, LBP, HA, fever. Work-up revealed a liver abscess
secondary to diverticulitis. Dr. [**First Name (STitle) **] of [**Hospital1 18**]-IR was
contact[**Name (NI) **] by Dr. [**Last Name (STitle) **] of [**Hospital3 **], and it was arranged
for the patient to be transferred to [**Hospital1 18**] for drainage of the
hepatic abscess.

MEDICAL HISTORY: COPD
Bronchitis
Diverticulosis

MEDICATION ON ADMISSION: Motrin and Tylenol prn

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On transfer: 102.8, 120, 140/20, 25, 95%4L.  Appeared anxious,
lungs with bibasilar wheezes and decreased breath sounds
bilaterally. Tachycardic. Abdomen soft, TTP RUQ, no rebound or
guarding. Rectal normal tone, no mass. Extremities without
edema.

FAMILY HISTORY: 

SOCIAL HISTORY: Married, retired-waitress, has 4 children. Smokes 1ppd,
occasional EtOH.
Abscess of liver,Abscess of intestine,Obstructive chronic bronchitis without exacerbation,Unspecified pleural effusion,Diverticulitis of colon (without mention of hemorrhage)
Abscess of liver,Intestinal abscess,Obst chr bronc w/o exac,Pleural effusion NOS,Dvrtcli colon w/o hmrhg
Admission Date:  [**2181-7-5**]              Discharge Date:   [**2181-7-10**]

Date of Birth:  [**2123-10-26**]             Sex:   F

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 668**]
Chief Complaint:
Liver Abscess

Major Surgical or Invasive Procedure:
CT-guided drainage of liver abscess, pelvic fluid collection
CT-guided thoracentesis and catheter upsize

History of Present Illness:
Patient presented to [**Hospital3 **] with five day history of
cough, LBP, HA, fever. Work-up revealed a liver abscess
secondary to diverticulitis. Dr. [**First Name (STitle) **] of [**Hospital1 18**]-IR was
contact[**Name (NI) **] by Dr. [**Last Name (STitle) **] of [**Hospital3 **], and it was arranged
for the patient to be transferred to [**Hospital1 18**] for drainage of the
hepatic abscess.

Past Medical History:
COPD
Bronchitis
Diverticulosis

Social History:
Married, retired-waitress, has 4 children. Smokes 1ppd,
occasional EtOH.

Physical Exam:
On transfer: 102.8, 120, 140/20, 25, 95%4L.  Appeared anxious,
lungs with bibasilar wheezes and decreased breath sounds
bilaterally. Tachycardic. Abdomen soft, TTP RUQ, no rebound or
guarding. Rectal normal tone, no mass. Extremities without
edema.

Pertinent Results:
[**2181-7-5**] 08:47PM   GLUCOSE-99 UREA N-10 CREAT-0.5 SODIUM-140
POTASSIUM-2.8* CHLORIDE-106 TOTAL CO2-21* ANION GAP-16
[**2181-7-5**] 08:47PM   ALT(SGPT)-64* AST(SGOT)-50* ALK PHOS-137*
AMYLASE-31 TOT BILI-0.8
[**2181-7-5**] 08:47PM   LIPASE-18
[**2181-7-5**] 08:47PM   WBC-17.7* RBC-4.10* HGB-12.1 HCT-35.3* MCV-86
MCH-29.6 MCHC-34.4 RDW-12.9
[**2181-7-5**] 08:47PM URINE  BLOOD-TR NITRITE-NEG PROTEIN-NEG
GLUCOSE-NEG KETONE-150 BILIRUBIN-NEG UROBILNGN-4* PH-5.0
LEUK-NEG

Brief Hospital Course:
Patient was brought to IR suite for CT-drainage of abscess and
became tachycardic and tachypneic post catheter insertion and
began to rigor. A post CT scan was performed and acute
pneumothorax was ruled out. Patient was transported to Holding
area where she was given IV fluid boluses and warm blankets.
Patient's temperature was 102.8 Transplant Surgery was called
(Dr. [**First Name (STitle) **] and Dr. [**Last Name (STitle) 9768**] and came to assess patient. A chest
x-ray was done and was normal. A decision was made to admit
patient to the SICU for observation overnight. Her [**Hospital1 **]
surgeon, Dr. [**Last Name (STitle) 43078**] ([**Telephone/Fax (1) 63941**]) was notified of events and
agreed that patient should remain at [**Hospital1 18**] for observation. She
was started on IV Ampi, Unasyn, and Levaquin. Fluid was sent
from the hepatic collection. This revealed the following:
[**2181-7-5**] 4:30 pm FLUID,OTHER      HEPATIC COLLECTION.

                            **FINAL REPORT [**2181-7-9**]**

   GRAM STAIN (Final [**2181-7-5**]):
      2+   (1-5 per 1000X FIELD):   POLYMORPHONUCLEAR
LEUKOCYTES.
      2+   (1-5 per 1000X FIELD):   GRAM POSITIVE COCCI.
                                    IN PAIRS AND CLUSTERS.
      SMEAR REVIEWED; RESULTS CONFIRMED.

   FLUID CULTURE (Final [**2181-7-8**]):
      STREPTOCOCCUS MILLERI GROUP.    MODERATE GROWTH.

   ANAEROBIC CULTURE (Final [**2181-7-9**]):    NO ANAEROBES ISOLATED.


Blood cultures from [**7-5**] and [**7-6**] were done and are pending.
Urine culture was negative. WBC was 17.8 with left shift and hct
33.4. On [**7-7**] she had an abd/pelvic CT that revealed a pelvic
collection. An 8 Fr pigtail catheter was placed with 5cc of
purulent fluid sent for culture. The collection was irrigated
and 100cc was aspirated out of pelvis.

[**2181-7-6**] 10:30 am ABSCESS     Site: PELVIS

                            **FINAL REPORT [**2181-7-10**]**

   GRAM STAIN (Final [**2181-7-6**]):
      2+   (1-5 per 1000X FIELD):   POLYMORPHONUCLEAR
LEUKOCYTES.
      2+   (1-5 per 1000X FIELD):   GRAM NEGATIVE ROD(S).
      2+   (1-5 per 1000X FIELD):   GRAM POSITIVE COCCI.
                                    IN PAIRS.
      1+    (<1 per 1000X FIELD):   GRAM POSITIVE ROD(S).

   WOUND CULTURE (Final [**2181-7-10**]):
      Due to mixed bacterial types ( >= 3 colony types) an
abbreviated
      workup is performed appropriate to the isolates recovered
from the
      site (including a screen for Pseudomonas aeruginosa,
Staphylococcus
      aureus and beta streptococcus).
      GRAM NEGATIVE ROD(S).    RARE GROWTH.
      VIRIDANS STREPTOCOCCI.    RARE GROWTH.
      BACILLUS SPECIES; NOT ANTHRACIS.    RARE GROWTH.
      GRAM POSITIVE RODS.    RARE GROWTH.  UNABLE TO IDENTFY
FURTHER.

   ANAEROBIC CULTURE (Final [**2181-7-10**]):
      BACTEROIDES FRAGILIS GROUP.    SPARSE GROWTH.
         BETA LACTAMASE POSITIVE.
She remained in the SICU until [**7-6**] when she was transferred to
the medical-surgical unit. She had temperatures of 99. R buttock
pain was relieved with IV dilaudid. O2 sats were in the low 90s
on 3L NC 02. She was 87% on room air and had wheezes. She was
given albuterol and atrovent nebs. A CXR was done on [**7-8**] that
demonstrated:"the lungs are hyperinflated and the diaphragms are
flattened, consistent with COPD. The heart is not enlarged,
though there is a left ventricular configuration. The aorta is
minimally unfolded. There is a small-to-moderate sized right
pleural effusion with underlying collapse and/or consolidation.
There is also a small left pleural effusion. There is borderline
upper zone redistribution, but no overt CHF. There is minimal
subsegmental atelectasis at the left base. Otherwise, there is
no evidence of focal infiltrate. Mild right convex scoliosis and
minimal degenerative spurring of the thoracic spine is
noted.Compared with [**2181-7-5**], the right pleural effusion with
associated collapse and/or consolidation and the tiny left
effusion are new."

She was advanced to a regular diet. She was voiding amber
colored urine. WBC decreased to 10.4 and hct 31.7. RUQ drain
decreased with minimal brown drainage. The L abuttock drain put
out minimal bloody drainage.

A repeat ABD/pelvic CT was done on [**2181-7-9**]. The liver catheter
was changed to a 10 Fr pig tail. An order to flush with 5-10cc
NS q shift was given to keep the tube patent. The pelvic pigtail
catheter was removed [**1-10**] non-ideal position.A thoracentesis of
250cc of fluid was removed from her chest.  An 8 Fr catheter was
placed in the left lung. Overnight, temperature was 99. HR was
82 with 02 sat of 95% on 3L NC. BP was 94/60. She had a total of
50cc from the liver drain and 10cc from the pleural pigtail.

On [**7-10**] a CXR revealed "
A pigtail pleural catheter is again demonstrated within the
right pleural space. There has been interval placement of a
second pleural catheter more posteriorly, terminating just above
the right costophrenic angle on the lateral view. Overall, the
right pleural effusion has slightly decreased in size compared
to the recent chest radiograph. A small left pleural effusion is
unchanged. There is no evidence of pneumothorax. The heart size
is normal and there is no evidence of mediastinal or hilar
lymphadenopathy.

IMPRESSION: Slight decrease in right pleural effusion following
placement of second pleural catheter. Residual small-to-moderate
pleural effusion remaining with partially loculated component
laterally. No pneumothorax."

Interventional radiology removed the chest pigtail on [**2181-7-10**] and
a repeat CXR was done post removal of chest pigtail.
She required assist with ambulation. She was tolerating a small
amount of regular food. A left peripheral iv was in place. She
was maintained on 3L of 02 NC with bilateral crackles at bases.
Abdomen was soft non-tender.
She was transferred back to [**Hospital3 **] via the ED where she
was set up by
her [**Hospital1 **] surgeon, Dr. [**Last Name (STitle) 43078**] to be seen in the ED by his
PA.


Medications on Admission:
Motrin and Tylenol prn

Discharge Medications:
1. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every
4 to 6 hours) as needed.
2. Heparin Sodium (Porcine) 5,000 unit/mL Solution Sig: One (1)
Injection [**Hospital1 **] (2 times a day).
3. Albuterol-Ipratropium 103-18 mcg/Actuation Aerosol Sig: [**12-10**]
Puffs Inhalation Q6H (every 6 hours) as needed.
4. Hydrocodone-Acetaminophen 5-500 mg Tablet Sig: 1-2 Tablets PO
Q4-6H (every 4 to 6 hours) as needed.
5. Ipratropium Bromide 0.02 % Solution Sig: One (1)  Inhalation
Q6H (every 6 hours).
6. Albuterol Sulfate 0.083 % Solution Sig: One (1)  Inhalation
Q6H (every 6 hours) as needed.
7. Sodium Chloride 0.9%  Flush 3 ml IV DAILY:PRN
Peripheral IV - Inspect site every shift
8. Ampicillin 2 gm IV Q6H
9. Levofloxacin 500 mg IV Q24H
10. Metronidazole 500 mg IV Q8H
11. Pantoprazole 40 mg IV Q24H
12. DiphenhydrAMINE HCl 25 mg IV HS:PRN insomnia


Discharge Disposition:
Extended Care

Discharge Diagnosis:
diverticulitis
drainage of hepatic abscess [**2181-7-5**] s/s diverticulitis
drainage of pelvic abscess
pleural effusion, right with thoracentesis [**2181-7-9**]
COPD
Heavy smoker


Discharge Condition:
stable

Discharge Instructions:
Call if fevers, chills, nausea, vomiting, increased abdominal
pain, increased drainage from drains.


Followup Instructions:
follow with [**Name8 (MD) **] MD- Dr. [**Last Name (STitle) 43078**]



Completed by:[**2181-7-10**]
{'Abscess of liver,Abscess of intestine,Obstructive chronic bronchitis without exacerbation,Unspecified pleural effusion,Diverticulitis of colon (without mention of hemorrhage)'}


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: Liver Abscess

PRESENT ILLNESS: Patient presented to [**Hospital3 **] with five day history of
cough, LBP, HA, fever. Work-up revealed a liver abscess
secondary to diverticulitis. Dr. [**First Name (STitle) **] of [**Hospital1 18**]-IR was
contact[**Name (NI) **] by Dr. [**Last Name (STitle) **] of [**Hospital3 **], and it was arranged
for the patient to be transferred to [**Hospital1 18**] for drainage of the
hepatic abscess.

MEDICAL HISTORY: COPD
Bronchitis
Diverticulosis

MEDICATION ON ADMISSION: Motrin and Tylenol prn

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On transfer: 102.8, 120, 140/20, 25, 95%4L.  Appeared anxious,
lungs with bibasilar wheezes and decreased breath sounds
bilaterally. Tachycardic. Abdomen soft, TTP RUQ, no rebound or
guarding. Rectal normal tone, no mass. Extremities without
edema.

FAMILY HISTORY: 

SOCIAL HISTORY: Married, retired-waitress, has 4 children. Smokes 1ppd,
occasional EtOH. 

### Response:
{'Abscess of liver,Abscess of intestine,Obstructive chronic bronchitis without exacerbation,Unspecified pleural effusion,Diverticulitis of colon (without mention of hemorrhage)'}
