CHIEF COMPLAINT: 

PRESENT ILLNESS: Patient is a 43-year-old
gentleman with a two month history of abdominal pain and
jaundice, who was subsequently investigated and accounted for
by a biliary stricture.  A CTA has also shown a dilated
pancreatic duct and a hypodense mass at the lower
head/uncinate of the pancreas.  Calcifications were also
present in this area and there was some concern for a
malignancy.  The patient was being admitted for a planned
Whipple resection of the pancreatic head.

MEDICAL HISTORY: 1. Ankylosing spondylitis.
2. Status post bilateral hip replacements in [**2162**] and [**2163**].
3. Status post hernia repair.
4. Peptic ulcer disease in past.

MEDICATION ON ADMISSION: 

ALLERGIES: 1. Codeine which gives hives.
2. Percocet.
3. Demerol.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Chronic pancreatitis,Chronic cholecystitis,Obstruction of bile duct,Lymphadenitis, unspecified, except mesenteric,Hip joint replacement
Chronic pancreatitis,Chronic cholecystitis,Obstruction of bile duct,Lymphadenitis NOS,Joint replaced hip
Admission Date:  [**2165-11-28**]       Discharge Date:  [**2165-12-5**]

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

Service:  Gold Surgery

ADMISSION DIAGNOSIS:  Bile duct stricture.

HISTORY OF PRESENT ILLNESS:  Patient is a 43-year-old
gentleman with a two month history of abdominal pain and
jaundice, who was subsequently investigated and accounted for
by a biliary stricture.  A CTA has also shown a dilated
pancreatic duct and a hypodense mass at the lower
head/uncinate of the pancreas.  Calcifications were also
present in this area and there was some concern for a
malignancy.  The patient was being admitted for a planned
Whipple resection of the pancreatic head.

As of note, patient also has a history of ankylosing
spondylitis and has had difficult intubations in the past.
For this reason, Dr. [**Last Name (STitle) **] from Anesthesiology was asked
to evaluate him before the surgery in lieu of management of
his airway.

PAST MEDICAL HISTORY:
1. Ankylosing spondylitis.
2. Status post bilateral hip replacements in [**2162**] and [**2163**].
3. Status post hernia repair.
4. Peptic ulcer disease in past.

MEDICATION:  Morphine sulfate.

ALLERGIES:
1. Codeine which gives hives.
2. Percocet.
3. Demerol.

PHYSICAL EXAMINATION:  At the time of presentation, patient's
vital signs:  Patient was afebrile and vital signs were
stable.  Patient was in no acute distress and was alert and
oriented times three.  Patient had a regular, rate, and
rhythm.  Clear to auscultation bilaterally.  Abdomen is soft,
nondistended, nontender.

CT scan showed a hypodense mass with calcifications and
dilated pancreatic duct with cut-off.  These findings were
consistent with a pancreatic mass and possible cystadenoma.

HOSPITAL COURSE:  Patient was taken to the OR on [**2165-11-28**] for a planned Whipple resection of the pancreatic head.
This procedure was not performed due to the inability to
dissect the pancreas safely from the arterial supply.
Instead a choledochojejunostomy and open cholecystectomy was
performed.  Patient tolerated that procedure well and there
were no immediate postoperative complications.  Patient was
initially managed in the SICU and on postoperative day one,
the patient was successfully extubated.  Since there were no
other events, the patient was transferred to the floor later
that evening.

On postoperative day two, the patient had persistent pain
control issues, and the patient was placed on Dilaudid PCA.

On postoperative day three, the nasogastric tube and Foley
were discontinued.  Due to the persistent pain issues, a Pain
consult was requested and they recommended continuing the
Dilaudid PCA along with the addition of Toradol.

On postoperative day four, the patient was started on sips.

On postoperative day five, the patient was complaining of a
cough, and a sputum culture and chest x-ray were sent, which
were both negative.

By postoperative day six, the patient was tolerating a
general diet.  Patient was also switched to p.o. pain
medications, and was successfully controlled on OxyContin 20
mg 3x a day, and Dilaudid 4 mg every four hours.  Due to some
complaints of abdominal pain, the wounds were explored, were
examined, and a 2 cm area of the right incisional wound was
opened, and pus was subsequently expressed.  The wound was
then packed with wet-to-dry dressings and the patient
subsequently felt some improvement in his pain.  The patient
remained afebrile during his hospital course.

On postoperative day seven, patient was tolerating a regular
diet and no further pus could be expressed from his wound.
Patient felt to be ready for discharge with home services for
daily wound care.

DISCHARGE CONDITION:  Stable.

DISCHARGE DIAGNOSES:  Status post choledochojejunostomy and
cholecystectomy.

DISCHARGE MEDICATIONS:
1. Protonix 40 mg p.o. q.d.
2. Clonidine patch 0.1 mg transdermal q Friday.
3. Oxycodone 20 mg tablets sustained release one tablet p.o.
q.8h.
4. Dilaudid 2 mg tablets 1-2 tablets p.o. q.4h. prn for pain.
5. Colace 100 mg capsules one capsule p.o. b.i.d.

DISCHARGE INSTRUCTIONS:  Patient is to be discharged home
with VNA services.

FOLLOW-UP INSTRUCTIONS:  Patient is to followup with Dr.
[**Last Name (STitle) **] within one week.  Patient is also to followup with
Dr. [**Last Name (STitle) 497**] on [**2165-12-20**].



                            [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], M.D.  [**MD Number(1) **]

Dictated By:[**Name8 (MD) 3430**]
MEDQUIST36

D:  [**2165-12-5**]  08:37
T:  [**2165-12-5**]  08:38
JOB#:  [**Job Number 106194**]
{'Chronic pancreatitis,Chronic cholecystitis,Obstruction of bile duct,Lymphadenitis, unspecified, except mesenteric,Hip joint replacement'}


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
gentleman with a two month history of abdominal pain and
jaundice, who was subsequently investigated and accounted for
by a biliary stricture.  A CTA has also shown a dilated
pancreatic duct and a hypodense mass at the lower
head/uncinate of the pancreas.  Calcifications were also
present in this area and there was some concern for a
malignancy.  The patient was being admitted for a planned
Whipple resection of the pancreatic head.

MEDICAL HISTORY: 1. Ankylosing spondylitis.
2. Status post bilateral hip replacements in [**2162**] and [**2163**].
3. Status post hernia repair.
4. Peptic ulcer disease in past.

MEDICATION ON ADMISSION: 

ALLERGIES: 1. Codeine which gives hives.
2. Percocet.
3. Demerol.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Chronic pancreatitis,Chronic cholecystitis,Obstruction of bile duct,Lymphadenitis, unspecified, except mesenteric,Hip joint replacement'}
