CHIEF COMPLAINT: 

PRESENT ILLNESS: Patient is a 45-year-old male
status post Roux-en-Y gastric bypass at an outside hospital
in [**2152-5-10**].  Postoperative course was complicated by
pancreatitis, duodenal stump leak, stricture.  She had a
gastric bypass revision and hepatic jejunostomy at [**Hospital1 1444**] in [**2152-12-10**].  The
patient returned to [**Hospital1 69**] with
a temperature of 104, complaining of rigors.  Denies nausea,
vomiting.  Denies pain.  Denies jaundice.

MEDICAL HISTORY: 1.  Obesity.
2.  Malnutrition, chronic TPN.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Cholangitis,Infection and inflammatory reaction due to other vascular device, implant, and graft,Intestinal or peritoneal adhesions with obstruction (postoperative) (postinfection),Other and unspecified postsurgical nonabsorption,Electrolyte and fluid disorders not elsewhere classified,Other and unspecified mycoses,Enlargement of lymph nodes,Anemia, unspecified
Cholangitis,React-oth vasc dev/graft,Intestinal adhes w obstr,Intest postop nonabsorb,Electrolyt/fluid dis NEC,Mycoses NEC & NOS,Enlargement lymph nodes,Anemia NOS
Admission Date:  [**2153-2-3**]       Discharge Date:  [**2153-2-20**]

Date of Birth:   [**2108-1-21**]       Sex:  M

Service:

HISTORY OF PRESENT ILLNESS:  Patient is a 45-year-old male
status post Roux-en-Y gastric bypass at an outside hospital
in [**2152-5-10**].  Postoperative course was complicated by
pancreatitis, duodenal stump leak, stricture.  She had a
gastric bypass revision and hepatic jejunostomy at [**Hospital1 1444**] in [**2152-12-10**].  The
patient returned to [**Hospital1 69**] with
a temperature of 104, complaining of rigors.  Denies nausea,
vomiting.  Denies pain.  Denies jaundice.

PAST MEDICAL HISTORY:
1.  Obesity.
2.  Malnutrition, chronic TPN.

PAST SURGICAL HISTORY:
1.  Status post Roux-en-Y and gastric bypass.
2.  Pancreatitis, status post biliary stricture.
3.  Status post gastric bypass revision [**12-11**].
4.  Status post biliary drain secondary to stricture.

ALLERGIES:  No known drug allergies.

MEDICATION:
1.  TPN.
2.  Augmentin 835 mg twice a day.

PHYSICAL EXAMINATION:  Pleasant, cooperative in acute
distress.  Temperature 102.1, heart rate 114, blood pressure
108/50.  Respiratory rate 20.  97% on room air.  Alert and
oriented times three, no jaundice, no icterus.  Pupils are
equal, round, and reactive to light and accommodation.
Extraocular movements intact.  Clear to auscultation
bilaterally.  Regular rate and rhythm with no murmurs.
Port-a-cath site clean, dry and intact.  Abdomen soft,
nontender, nondistended.

LABS:  White blood count 6.9, neutrophils 90%, no bands.
Hematocrit 30, platelets 170, sodium 137, potassium 4.2,
chloride 101, bicarbonate 24, BUN 20, creatinine .8.  Blood
sugar 177.  Calcium 9.2, mag 1.7, phos 27, AST 24, ALT 27,
alk phos 536, total bili 1.6, amylase .47, lipase 17, total
protein 6.4.

Chest x-ray: No effusions.
HOSPITAL COURSE:  The patient was admitted to surgery
service.  He was started on broad spectrum antibiotics
including Vancomycin, Zosyn and Tobramycin.  He was pan
cultured.  Surgery was consulted with a presumed diagnosis of
cholangitis.  The patient was also moved to Intensive Care
Unit.  [**2153-2-4**] the patient's biliary drain was changed
without complications.  On [**2153-2-7**] the patient was transfused
two units of packed red blood cells for anemia in
preparation.

The patient was taken to the operating room on [**2153-2-8**].
Diagnosis of small bowel obstruction.  Exploratory
laparotomy, revision of biliary limb Roux-en-Y bypass and
resection of gastric pouch, lysis of adhesion was performed.
Operation went without complications.

The patient was transferred to Post Anesthesia Care Unit in
stable condition.

Postop day one the patient is afebrile, vital signs stable.
Continued on TPN.  Starting to ambulate.  Continue broad
spectrum antibiotic per ID team.  Biliary culture started
growing yeast and he was started on Fluconazole.  Postop day
three the patient had Upper Gastrointestinal, small bowel
follow through which showed no leak.  The patient is
ambulating.  LFTs are improving.  He was started on stage
diet which he is tolerating well. Postop day four afebrile,
vital signs stable. Progressed to Stage II diet, patient is
tolerating well.  Postop day five the patient is afebrile,
vital signs stable.  The patient was switched to p.o. meds,
Foley was discontinued.  Postop day six the patient's G-tube
was capped without complications.  His tube feeds were
increased to 50 cc's an hour which the patient was tolerating
well.  His TPN was discontinued.  The patient was advanced to
Stage III diet.  On [**2153-2-16**] the patient had an episode of
emesis, no prodrome.  He had another swallow study, small
bowel follow through which showed dilated jejunum, bile
refluxing.  The patient was started on Erythromycin, Reglan
and bowel regimen which he is tolerating well.  He had
another episodes of bilious vomiting the next day but
otherwise was tolerating Stage IV diet, ambulating, no fever,
no chills.  Tobramycin was discontinued followed by Zosyn and
Erythromycin per ID recommendation.

Postop day 16 the patient is afebrile, vital signs
stable,tolerating Stage IV diet.  His tube feeds are cycled
at night which he is tolerating well.  Wound is clean, dry
and intact.  G-tube is capped.  No nausea, vomiting in two
days.  No concerns of an active issue.  Projected discharge
on [**2153-2-20**].

CONDITION ON DISCHARGE:  Stable.

DISPOSITION:  The patient is discharged home.  The patient a
will continue tube feeds with ProMod at night 100 cc's an
hour for 14 hours.  The patient will contact Dr. [**First Name (STitle) **] and Dr.[**Name (NI) 39264**] office for postoperative follow-up.

MEDICATIONS:
1.  ProMod 100 cc's an hour for 14 hours at night.
2.  Benadryl 25 mg one to two tabs p.o. q 6  hours p.r.n.
3.  Dilaudid 224 mg q 4 to 6 hours p.r.n. for pain
4.  Bisacodyl suppository 10 mg p.r. q day p.r.n.
5.  Zantac 150 mg p.o. twice a day
6.  Reglan 10 mg one tab p.o. three times a day for seven
    days.

DISCHARGE DIAGNOSIS:
1.  Small bowel obstruction, status post gastrojejunostomy
revision, cholangitis, biliary sepsis, anemia, malnutrition,
hypocalcemia, hypomagnesemia, hypokalemia, hypovolemia.






                            [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 3799**], M.D.  [**MD Number(1) 3800**]

Dictated By:[**Dictator Info **]
MEDQUIST36

D:  [**2153-2-19**]  16:40
T:  [**2153-2-19**]  16:05
JOB#:  [**Job Number **]
{'Cholangitis,Infection and inflammatory reaction due to other vascular device, implant, and graft,Intestinal or peritoneal adhesions with obstruction (postoperative) (postinfection),Other and unspecified postsurgical nonabsorption,Electrolyte and fluid disorders not elsewhere classified,Other and unspecified mycoses,Enlargement of lymph nodes,Anemia, unspecified'}


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 45-year-old male
status post Roux-en-Y gastric bypass at an outside hospital
in [**2152-5-10**].  Postoperative course was complicated by
pancreatitis, duodenal stump leak, stricture.  She had a
gastric bypass revision and hepatic jejunostomy at [**Hospital1 1444**] in [**2152-12-10**].  The
patient returned to [**Hospital1 69**] with
a temperature of 104, complaining of rigors.  Denies nausea,
vomiting.  Denies pain.  Denies jaundice.

MEDICAL HISTORY: 1.  Obesity.
2.  Malnutrition, chronic TPN.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Cholangitis,Infection and inflammatory reaction due to other vascular device, implant, and graft,Intestinal or peritoneal adhesions with obstruction (postoperative) (postinfection),Other and unspecified postsurgical nonabsorption,Electrolyte and fluid disorders not elsewhere classified,Other and unspecified mycoses,Enlargement of lymph nodes,Anemia, unspecified'}
