CHIEF COMPLAINT: Diffuse, severe, non-radiating crampy abdominal pain

PRESENT ILLNESS: Ms [**Known lastname **] is an 81 year old italian speaking female with
multiple medical problems who presented to the emergency
department with complaints of severe non-radiating, crampy
abdominal pain with associated nausea and vomiting for 24 hours.
She complained of constipation, and reported no bowel movement
for the past 3 days.

MEDICAL HISTORY: PMH: hypothyroid, h/o SBO, thrombocytopenia secondary to
heparin: no diagnosed HIT. renal insufficiency, depression,
Breast CA, DM2, HTN, hypercholestremia, GERD, Neuropathy,Hernia,
stent x 4 years.

MEDICATION ON ADMISSION: Anastrozole 1 mg Tablet Sig: One (1) Tablet PO daily () as
needed for breast ca
Lipitor 10 mg po qd
Cipro 250 mg po qd
Lasix 20 mg po qd
Gabapentin 300 mg po qd
Humulin 70/30
Topamax 25/50
Lopressor 25 mg po bid
Elavil 10 mg po qhs
Omeprazole 20 mg po qd
Paxil 40 mg po qd

ALLERGIES: Amlodipine / Pro-Banthine / Zyprexa / Bactrim Ds / Iodine;
Iodine Containing

PHYSICAL EXAM: T: 99.0  HR 76  BP 160/70  RR 18, Spo2 94% on RA

FAMILY HISTORY: n/c

SOCIAL HISTORY: Lives at home with supportive son [**Name (NI) **] and daughter in law
[**Name (NI) 2152**], who is health care proxy.
Incisional ventral hernia with obstruction,Peritoneal adhesions (postoperative) (postinfection),Cardiac complications, not elsewhere classified,Subendocardial infarction, initial episode of care,Atrial fibrillation,Pneumonia, organism unspecified,Paralytic ileus,Congestive heart failure, unspecified,Acute kidney failure, unspecified,Intestinal infection due to Clostridium difficile,Thrombocytopenia, unspecified,Diabetes with other specified manifestations, type II or unspecified type, not stated as uncontrolled,Unspecified disorder of kidney and ureter,Unspecified acquired hypothyroidism,Depressive disorder, not elsewhere classified,Unspecified essential hypertension,Esophageal reflux,Personal history of malignant neoplasm of breast,Percutaneous transluminal coronary angioplasty status
Obstr incisional hernia,Peritoneal adhesions,Surg compl-heart,Subendo infarct, initial,Atrial fibrillation,Pneumonia, organism NOS,Paralytic ileus,CHF NOS,Acute kidney failure NOS,Int inf clstrdium dfcile,Thrombocytopenia NOS,DMII oth nt st uncntrld,Renal & ureteral dis NOS,Hypothyroidism NOS,Depressive disorder NEC,Hypertension NOS,Esophageal reflux,Hx of breast malignancy,Status-post ptca
Admission Date:  [**2108-5-8**]              Discharge Date:   [**2108-5-22**]

Date of Birth:  [**2026-11-18**]             Sex:   F

Service: SURGERY

Allergies:
Amlodipine / Pro-Banthine / Zyprexa / Bactrim Ds / Iodine;
Iodine Containing

Attending:[**Last Name (NamePattern1) 4659**]
Chief Complaint:
Diffuse, severe, non-radiating crampy abdominal pain

Major Surgical or Invasive Procedure:
Exploratory laparotomy
Extensive lysis of adhesions
Reduction and repair of incisional hernia


History of Present Illness:
Ms [**Known lastname **] is an 81 year old italian speaking female with
multiple medical problems who presented to the emergency
department with complaints of severe non-radiating, crampy
abdominal pain with associated nausea and vomiting for 24 hours.
She complained of constipation, and reported no bowel movement
for the past 3 days.

Past Medical History:
PMH: hypothyroid, h/o SBO, thrombocytopenia secondary to
heparin: no diagnosed HIT. renal insufficiency, depression,
Breast CA, DM2, HTN, hypercholestremia, GERD, Neuropathy,Hernia,
stent x 4 years.

Past surgical history: exploratory lap for small bowel
obstruction [**2101**]. Arthroplasty, left knee.


Social History:
Lives at home with supportive son [**Name (NI) **] and daughter in law
[**Name (NI) 2152**], who is health care proxy.

Family History:
n/c

Physical Exam:
T: 99.0  HR 76  BP 160/70  RR 18, Spo2 94% on RA

HEENT: aniceteric, no acute distress, PERRLA, membranes dry, no
JVD.
Cardivascular: Regular S1S2.
Pulmonary: Clear to auscultation bilaterally
Abdomen: obese, distended, diffusely tender, hernia in upper
midline
Rectal: guaic negative, normal tone


Pertinent Results:
CT abd/pelvis [**2108-5-8**]
IMPRESSION: Dilated proximal loops of small bowel and collapsed
distal ileum and colon are consistent with small-bowel
obstruction. Focal transition points are located within two
adjacent but separate right anterior abdominal wall hernias.
Findings suggest that there is some passage of fluid containing
oral contrast beyond the transition points. There are no
findings to suggest strangulation/incarceration.
.
ADDENDUM: Delayed images 3 hours after the initial study were
obtained to assess passage of contrast. There is some
progression of contrast in proximal small bowel loops, though
there is no significant progression of contrast into distal
loops, which remain collapsed, suggesting a high-grade
obstruction. These findings were discussed with the surgery
resident, Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] at 5:30 am on [**2108-5-8**].
.
Cardiac cath
PTCA COMMENTS:     The angiogram showed a mid circumflex lesion
of
90 percent. We planned to treat this lesion with POBA and stent
only if
needed. We used Bivalirudin, Aspirin and Clopidogrel
prophylactically. A
6F XB 3.5 guide provided adequate support. A Prowater wire
crossed in to
the distal vessel easily. We then performed PTCA of the lesion
with a
2.5 X 15mm Voyager balloon at10 atm X 3. The final angiogram
showed TIMI
III flow with no residual stenosis, small non flow limiting
dissection,
no perforation and no embolisation. The patient left the lab in
a stable
condition.
.
FINAL DIAGNOSIS:
1. Three vessel coronary artery disease. The totally occluded
diagonal
branch is not suitable for angioplasty.
2. New-onset atrial fibrillation with rapid ventricular response
and
hypotension.
3. Patient intubated.
4. Successful POBA of the mid LCX lesion
.
Echo
Conclusions:
The left ventricular cavity is small. Left ventricular systolic
function is  hyperdynamic (EF>75%). The right ventricular cavity
is small. Right
ventricular systolic function is normal. The mitral valve
leaflets are mildly  thickened. There is no mitral valve
prolapse. Trivial mitral regurgitation is  seen.
. Right upper extremity ultrasound
IMPRESSION: No evidence of deep venous thrombosis of the left
upper extremity
.
[**2108-5-8**] 04:09PM   GLUCOSE-138* LACTATE-3.6* NA+-137 K+-3.8
CL--110
[**2108-5-8**] 04:09PM   TYPE-ART PO2-163* PCO2-34* PH-7.42 TOTAL
CO2-23 BASE XS--1 INTUBATED-INTUBATED
[**2108-5-9**] 01:53AM BLOOD CK-MB-15* MB Indx-1.3 cTropnT-0.05*
[**2108-5-9**] 10:08AM BLOOD CK-MB-37* MB Indx-1.9 cTropnT-0.08*
[**2108-5-9**] 06:16PM BLOOD CK-MB-52* MB Indx-2.6 cTropnT-0.18*
[**2108-5-10**] 02:35AM BLOOD CK-MB-52* MB Indx-3.3 cTropnT-0.32*
[**2108-5-18**] 05:45AM BLOOD proBNP-223
[**2108-5-14**] 03:06AM BLOOD ALT-9 AST-17 AlkPhos-113 Amylase-44
TotBili-1.4 DirBili-1.0* IndBili-0.4
[**2108-5-7**] 08:50PM BLOOD Glucose-114* UreaN-32* Creat-1.1 Na-136
K-5.9* Cl-100 HCO3-20* AnGap-22*
[**2108-5-12**] 03:06AM BLOOD Glucose-159* UreaN-34* Creat-0.8 Na-137
K-3.8 Cl-105 HCO3-24 AnGap-12
[**2108-5-21**] 06:00PM BLOOD Glucose-122* UreaN-37* Creat-1.1 Na-135
K-5.0 Cl-97 HCO3-29 AnGap-14
[**2108-5-7**] 10:56AM BLOOD WBC-14.3* RBC-4.55 Hgb-14.3 Hct-44.9
MCV-99*# MCH-31.5 MCHC-32.0 RDW-13.8 Plt Ct-293
[**2108-5-21**] 06:00PM BLOOD WBC-11.9* RBC-3.77* Hgb-12.1 Hct-36.5
MCV-97 MCH-32.1* MCHC-33.1 RDW-14.6 Plt Ct-393
[**2108-5-9**] 01:53AM BLOOD WBC-22.2*# RBC-3.66* Hgb-11.6* Hct-35.5*
MCV-97 MCH-31.8 MCHC-32.7 RDW-14.1 Plt Ct-270#

Brief Hospital Course:
Ms [**Known lastname **] was evaluated in the ED and found to have a high grade
small bowel obstruction. She was taken to the OR directly. She
tolerated the procedure well, she was extubated and transferred
to ICU.
.
Cardiovascular: POD#1 developed low blood pressure and was
started on low dose Neo. POD#2, had positive troponins, ruled in
for MI. She was sent for emergent cardiac cath. She recieved
angioplasty of the left circumflex artery. Developed afib, and
was cardioverted. She was initiated on amiodarone drip.
Converted to sinus rhythm. Femoral sheaths pulled POD#5. Had
persistent hypertension throughout ICU course, managed by her
PCP. [**Name10 (NameIs) **] with nitro and metoprolol. Diuresed throughout
admission with lasix.
.
Pulmonary: Was reintubated POD#2 secondary to NSTEMI. POD#3
developed right upper lobe nosocomial pneumonia. Initiated on
Vanco/Zosyn. Extubated POD#5. Respiratory status improved with
antibiotics, weaned to room air at time of discharge.
.
Abdomen: remained soft, nontender with midline incision intact.
2 JP drains in place. JP#1 removed POD#11. JP#2 removed POD#12.
Staples removed POD#14. Incision remains dry and intact.
.
GI: Pt remained with NGT in place due to an ileus. NGT removed
and ileus resolved POD#7. Developed frequent diarrhea POD#8,
CDiff positive. Initiated Vanco liquid, due to intolerance to
Flagyl. On Vanco taper per Dr. [**First Name (STitle) 10113**], gastroenterology.
.
GU: Recieved aggressive fluid resuscitation for low urine
output. Foley catheter until POD#10. Incontinent of urine.
.
Nutrition: On TPN until POD#8. Tolerated regular diet on POD#9.
Monitored with calorie counts to ensure adequate oral intake.
TPN tapered off on POD#11.
.
Extremities: Edema of upper and lower extremities at times
during admission, due to aggressive fluid resuscitation and
history of CHF. Left upper extremity was swollen POD#9.
Ultrasound revealed no thrombus.
.
Musculoskeletal: PT worked with her consistently for
strengthening and conditioning.
.
Pt was transferred to med-[**Doctor First Name **] floor on POD#8. She continued to
follow an uneventful post-op course.
.

Medications on Admission:
Anastrozole 1 mg Tablet Sig: One (1) Tablet PO daily () as
needed for breast ca
Lipitor 10 mg po qd
Cipro 250 mg po qd
Lasix 20 mg po qd
Gabapentin 300 mg po qd
Humulin 70/30
Topamax 25/50
Lopressor 25 mg po bid
Elavil 10 mg po qhs
Omeprazole 20 mg po qd
Paxil 40 mg po qd

Discharge Medications:
1. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. Acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO Q8H (every
8 hours).
3. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
4. Clonidine 0.1 mg Tablet Sig: One (1) Tablet PO TID (3 times a
day).
5. Paroxetine HCl 20 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
6. Gabapentin 300 mg Capsule Sig: One (1) Capsule PO TID (3
times a day).
7. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
8. Anastrozole 1 mg Tablet Sig: One (1) Tablet PO daily () as
needed for breast ca.
9. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
10. Lorazepam 0.5 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime) as needed for sleep.
11. Ipratropium Bromide 0.02 % Solution Sig: One (1)  Inhalation
Q6H (every 6 hours).
12. Valsartan 80 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

13. Nystatin 100,000 unit/mL Suspension Sig: Five (5) ML PO QID
(4 times a day) as needed.
14. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours).
15. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day) for 14 days.
16. Lasix 20 mg Tablet Sig: One (1) Tablet PO once a day.
17. insulin
Breakfast Dinner
70 / 30      25  Units 70 / 30      22  Units
Insulin SC Sliding Scale
Breakfast     Lunch            Dinner             Bedtime
Regular       Regular          Regular            Regular
Glucose Insulin Dose Insulin Dose Insulin Dose Insulin Dose
0-60   mg/dL [**1-10**] amp D50 [**1-10**] amp D50 [**1-10**] amp D50 [**1-10**] amp D50
61-120   mg/dL 0   Units 0   Units 0   Units 0   Units
121-140   mg/dL 3   Units 3   Units 3   Units 2   Units
141-160   mg/dL 6   Units 6   Units 6   Units 4   Units
161-180   mg/dL 9   Units 9   Units 9   Units 6   Units
181-200   mg/dL 12   Units 12   Units 12   Units 8   Units
201-220   mg/dL 15   Units 15   Units 15   Units 10   Units
221-240   mg/dL 18   Units 18   Units 18   Units 12   Units
241-260   mg/dL 21   Units 21   Units 21   Units 14   Units
261-280   mg/dL 24   Units 24   Units 24   Units 16   Units
281-300   mg/dL 27   Units 27   Units 27   Units 18   Units
301-320   mg/dL 30   Units 30   Units 30   Units 20   Units

18. Amiodarone
After completion of 14 days of amiodarone 200 mg [**Hospital1 **], taper
dosing to Amiodarone 200 mg po qd. [**2108-5-22**] is day 2 of her dose
of amiodarone 200mg [**Hospital1 **].
19. Vancomycin
Vancomycin 250 mg po liquid q6 hours x 7 days.
then Vancomycin 250 mg po TID x 7 days.
then Vancomycin 250 mg po BID x 7 days.
then Vancomycin 250 mg po qd x 7 days.


Discharge Disposition:
Extended Care

Facility:
[**Hospital **] [**Hospital **] Nursing Home - [**Location (un) **]

Discharge Diagnosis:
Incarcerated incisional hernia
NSTEMI
post-op ileus
nosocomial pneumonia
Atrial fibrillation


Discharge Condition:
stable


Discharge Instructions:
Please call your surgeon if you develop chest pain, shortness of
breath, fever greater than 101.5, foul smelling or colorful
drainage from your incisions, redness or swelling, severe
abdominal pain or distention, persistent nausea or vomiting,
inability to eat or drink, or any other symptoms which are
concerning to you.

No tub baths or swimming. You may shower. If there is clear
drainage from your incisions, cover with a dry dressing. Leave
white strips above your incisions in place, allow them to fall
off on their own.

Activity: No heavy lifting of items [**10-22**] pounds until the
follow up
appointment with your doctor.

Medications: Resume your home medications. You should take a
stool softener, Colace 100 mg twice daily as needed for
constipation. You will be given pain medication which may make
you drowsy. No driving while taking pain medicine.


Followup Instructions:
Provider: [**Name10 (NameIs) 706**] Phone:[**Telephone/Fax (1) 327**] Date/Time:[**2108-6-5**] 10:00
Provider: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 722**], DPM Phone:[**Telephone/Fax (1) 543**]
Date/Time:[**2108-6-8**] 10:20
Provider: [**First Name4 (NamePattern1) 971**] [**Last Name (NamePattern1) **], [**MD Number(3) 1240**]:[**Telephone/Fax (1) 2041**]
Date/Time:[**2108-6-15**] 11:20

You have an apointment to see Dr. [**Last Name (STitle) **] on [**5-28**] at 12:45.
[**Telephone/Fax (1) 8792**]. [**Street Address(2) **], [**Location (un) **] [**Apartment Address(1) **] west.

Please make an appointment to see your cardiologist in 1 month
for follow up of your amiodarone.

Please call [**Telephone/Fax (1) 96976**] and schedule an appointment to see Dr.
[**First Name (STitle) 10113**] in 1 month.


                             [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] [**Name8 (MD) **] MD, [**MD Number(3) 4661**]

Completed by:[**2108-5-22**]
{'Incisional ventral hernia with obstruction,Peritoneal adhesions (postoperative) (postinfection),Cardiac complications, not elsewhere classified,Subendocardial infarction, initial episode of care,Atrial fibrillation,Pneumonia, organism unspecified,Paralytic ileus,Congestive heart failure, unspecified,Acute kidney failure, unspecified,Intestinal infection due to Clostridium difficile,Thrombocytopenia, unspecified,Diabetes with other specified manifestations, type II or unspecified type, not stated as uncontrolled,Unspecified disorder of kidney and ureter,Unspecified acquired hypothyroidism,Depressive disorder, not elsewhere classified,Unspecified essential hypertension,Esophageal reflux,Personal history of malignant neoplasm of breast,Percutaneous transluminal coronary angioplasty status'}


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: Diffuse, severe, non-radiating crampy abdominal pain

PRESENT ILLNESS: Ms [**Known lastname **] is an 81 year old italian speaking female with
multiple medical problems who presented to the emergency
department with complaints of severe non-radiating, crampy
abdominal pain with associated nausea and vomiting for 24 hours.
She complained of constipation, and reported no bowel movement
for the past 3 days.

MEDICAL HISTORY: PMH: hypothyroid, h/o SBO, thrombocytopenia secondary to
heparin: no diagnosed HIT. renal insufficiency, depression,
Breast CA, DM2, HTN, hypercholestremia, GERD, Neuropathy,Hernia,
stent x 4 years.

MEDICATION ON ADMISSION: Anastrozole 1 mg Tablet Sig: One (1) Tablet PO daily () as
needed for breast ca
Lipitor 10 mg po qd
Cipro 250 mg po qd
Lasix 20 mg po qd
Gabapentin 300 mg po qd
Humulin 70/30
Topamax 25/50
Lopressor 25 mg po bid
Elavil 10 mg po qhs
Omeprazole 20 mg po qd
Paxil 40 mg po qd

ALLERGIES: Amlodipine / Pro-Banthine / Zyprexa / Bactrim Ds / Iodine;
Iodine Containing

PHYSICAL EXAM: T: 99.0  HR 76  BP 160/70  RR 18, Spo2 94% on RA

FAMILY HISTORY: n/c

SOCIAL HISTORY: Lives at home with supportive son [**Name (NI) **] and daughter in law
[**Name (NI) 2152**], who is health care proxy. 

### Response:
{'Incisional ventral hernia with obstruction,Peritoneal adhesions (postoperative) (postinfection),Cardiac complications, not elsewhere classified,Subendocardial infarction, initial episode of care,Atrial fibrillation,Pneumonia, organism unspecified,Paralytic ileus,Congestive heart failure, unspecified,Acute kidney failure, unspecified,Intestinal infection due to Clostridium difficile,Thrombocytopenia, unspecified,Diabetes with other specified manifestations, type II or unspecified type, not stated as uncontrolled,Unspecified disorder of kidney and ureter,Unspecified acquired hypothyroidism,Depressive disorder, not elsewhere classified,Unspecified essential hypertension,Esophageal reflux,Personal history of malignant neoplasm of breast,Percutaneous transluminal coronary angioplasty status'}
