CHIEF COMPLAINT: Hypotension
Failure to Thrive

PRESENT ILLNESS: 67M well-known to our service, s/p Whipple procedure [**2187-7-3**] c/b
post-op intra-abdominal fluid collections, presented to OSH c
rigors, found to be febrile to ~102 and hypotensive (SBP 80
there
and was promptly transferred to [**Hospital1 18**].  En route, the patient
was
on dopamine which resulted in extreme tachycardia.  Denies
abdominal pain, distention, N/V, abnormal BM, chest pain,
dysuria, pulmonary symptoms.

MEDICAL HISTORY: ampullary adenoma, likely diagnosis of familial adenomatous
polyposis, ypertension, coronary artery disease, chronic
obstructive pulmonary disease (COPD), arthritis and peripheral
vascular disease

MEDICATION ON ADMISSION: Simvastatin 10', Aspirin 325', Toprol XL 50 mg', Lisinopril 10',
Omeprazole 20', reglan 10"", dilaudid 1-2q4hp, colace

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals- T ~101, HR 82, BP 117/70, RR 15, O2sat 96% 4L
Gen- NAD, alert
Head and neck- AT, NC, soft, supple, no masses
Heart- RRR, no murmurs
Lungs- CTAB, no rhonchi, no crackles
Abd- soft, ND, NT, decreased BS, incisions well healed
Ext- warm, well-perfused, no edema

FAMILY HISTORY: His family history is significant for his maternal grandfather
that was affected with colorectal cancer, mother that was
affected with polyposis, brother that was affected with
colorectal cancer, 2 daughters that are affected with polyposis,
a grandson that is affected with polyposis, a brother that was
lost to colorectal cancer and a son that is also affected with
polyposis.

SOCIAL HISTORY: SOCIAL HISTORY
His social history is significant for positive tobacco.  He
smokes half pack per day, no alcohol and no IV drugs use, and no
intranasal cocaine use.
Dehydration,Bacteremia,Adult failure to thrive,Coronary atherosclerosis of native coronary artery,Chronic airway obstruction, not elsewhere classified,Atherosclerosis of native arteries of the extremities, unspecified,Gastrostomy status,Unspecified essential hypertension
Dehydration,Bacteremia,Failure to thrive-adult,Crnry athrscl natve vssl,Chr airway obstruct NEC,Athscl extrm ntv art NOS,Gastrostomy status,Hypertension NOS
Admission Date:  [**2187-8-16**]              Discharge Date:   [**2187-8-21**]

Date of Birth:  [**2120-3-30**]             Sex:   M

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 473**]
Chief Complaint:
Hypotension
Failure to Thrive

Major Surgical or Invasive Procedure:
Dobhoff feeding tube


History of Present Illness:
67M well-known to our service, s/p Whipple procedure [**2187-7-3**] c/b
post-op intra-abdominal fluid collections, presented to OSH c
rigors, found to be febrile to ~102 and hypotensive (SBP 80
there
and was promptly transferred to [**Hospital1 18**].  En route, the patient
was
on dopamine which resulted in extreme tachycardia.  Denies
abdominal pain, distention, N/V, abnormal BM, chest pain,
dysuria, pulmonary symptoms.

Review of systems: denies chest pain, denies shortness of
breath,
denies headaches, all other systems WNL


Past Medical History:
ampullary adenoma, likely diagnosis of familial adenomatous
polyposis, ypertension, coronary artery disease, chronic
obstructive pulmonary disease (COPD), arthritis and peripheral
vascular disease

PSH: Whipple procedure, coronary artery bypass graft (CABG) and
carotid endarterectomy, total abdominal colectomy and end
ileostomy, ex-lap's for SBO, EVAR


Social History:
SOCIAL HISTORY
His social history is significant for positive tobacco.  He
smokes half pack per day, no alcohol and no IV drugs use, and no
intranasal cocaine use.


Family History:
His family history is significant for his maternal grandfather
that was affected with colorectal cancer, mother that was
affected with polyposis, brother that was affected with
colorectal cancer, 2 daughters that are affected with polyposis,
a grandson that is affected with polyposis, a brother that was
lost to colorectal cancer and a son that is also affected with
polyposis.


Physical Exam:
Vitals- T ~101, HR 82, BP 117/70, RR 15, O2sat 96% 4L
Gen- NAD, alert
Head and neck- AT, NC, soft, supple, no masses
Heart- RRR, no murmurs
Lungs- CTAB, no rhonchi, no crackles
Abd- soft, ND, NT, decreased BS, incisions well healed
Ext- warm, well-perfused, no edema


Pertinent Results:
[**2187-8-16**] 12:30AM BLOOD WBC-12.6*# RBC-3.81* Hgb-11.1* Hct-33.7*
MCV-89 MCH-29.2 MCHC-32.9 RDW-14.7 Plt Ct-241
[**2187-8-19**] 06:45AM BLOOD WBC-6.7 RBC-3.02* Hgb-9.0* Hct-26.6*
MCV-88 MCH-29.9 MCHC-33.9 RDW-14.9 Plt Ct-233
[**2187-8-19**] 06:45AM BLOOD Glucose-108* UreaN-7 Creat-0.9 Na-140
K-3.9 Cl-108 HCO3-24 AnGap-12
[**2187-8-19**] 06:45AM BLOOD ALT-33 AST-17 AlkPhos-214* Amylase-49
TotBili-0.4
[**2187-8-18**] 06:25AM BLOOD Lipase-36
[**2187-8-16**] 04:12AM BLOOD CK-MB-NotDone cTropnT-0.03*
[**2187-8-19**] 06:45AM BLOOD Albumin-2.8* Calcium-8.6 Phos-4.1 Mg-1.7
.
Radiology Report CHEST (PORTABLE AP) Study Date of [**2187-8-16**]
12:31 AM
IMPRESSION: No acute cardiopulmonary abnormalities. Apparent
increase in
nodularity of lateral aspect of right lung base scarring may be
artifactual, and dedicated PA and lateral radiographs are
recommended for further evaluation.
.
Radiology Report CT ABDOMEN W/CONTRAST Study Date of [**2187-8-16**]
9:04 AM
IMPRESSION:
1. Interval resolution of large intra-abdominal fluid
collections with only minimal fluid collection seen adjacent to
the gastrojejunostomy site (2, 38) measuring approximately 1.7
cm. No new fluid collections identified.
2. Prominent focal dilatation of the bile duct within the right
lobe segment VI of the liver.
.
Radiology Report ABDOMEN (SUPINE & ERECT) PORT Study Date of
[**2187-8-17**] 12:08 PM
FINDINGS: Single portable supine view of the abdomen
demonstrates the
Dobbhoff tube to be more advanced in the stomach as compared to
the previous study; however, the tip of the tube is not
visualized and cannot be confirmed if it has advanced into the
duodenum.
.






Brief Hospital Course:
This is a 67 year old male s/p Whipple on [**2187-7-3**] for ampullary
adenoma. He was admitted to the ICU for IVF resuscitation and
Vasopressor support as needed. He was started on Broad spectrum
antibiotics (Vanco/Zosyn).

A CT showed Interval resolution of large intra-abdominal fluid
collections with only
minimal fluid collection seen adjacent to the gastrojejunostomy
site measuring approximately 1.7 cm. No new fluid collections
identified.

The pressors were weaned and he was hemodynamically stable. We
held his regular home BP meds including Lopressor and
Lisinopril. He should discuss these medications with his PCP.

A Dobhoff feeding tube was placed and he was started on cycled
tube feedings. Calorie counts showed inadequate PO intake. He
was discharged with cycled tubefeedings.

ABD: His Abdomen was benign. The old incision looked C/D/I. His
ostomy was functioning well. He reported no pain.

ID: OSH labs revealed bacteremia pan-sensitive E. coli. His ABX
were switched to PO Cipro.
He was discharged home on a 6 week course of Augmentin to quell
any underlying cholangitis or other infection.


Medications on Admission:
Simvastatin 10', Aspirin 325', Toprol XL 50 mg', Lisinopril 10',
Omeprazole 20', reglan 10"", dilaudid 1-2q4hp, colace

Discharge Medications:
1. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
2. Metoclopramide 10 mg Tablet Sig: One (1) Tablet PO QIDACHS (4
times a day (before meals and at bedtime)).
Disp:*120 Tablet(s)* Refills:*2*
3. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO once a day.
4. Amoxicillin-Pot Clavulanate 875-125 mg Tablet Sig: One (1)
Tablet PO BID (2 times a day) for 6 weeks.
Disp:*84 Tablet(s)* Refills:*0*
5. Vytorin 10-40 10-40 mg Tablet Sig: One (1) Tablet PO once a
day.
6. Colace 100 mg Capsule Sig: One (1) Capsule PO twice a day.


Discharge Disposition:
Home With Service

Facility:
[**Location (un) 511**] Home Therapies

Discharge Diagnosis:
Bacteremia (OSH)
Failure to thrive, fever and hypotension


Discharge Condition:
Good


Discharge Instructions:
You were admitted with bacteremia, failure to thrive, fever and
hypotension.
Please call your doctor or return to the ER for any of the
following:
* You experience new chest pain, pressure, squeezing or
tightness.
* New or worsening cough or wheezing.
* If you are vomiting and cannot keep in fluids or your
medications.
* You are getting dehydrated due to continued vomiting, diarrhea
or other reasons.
* Signs of dehydration include dry mouth, rapid heartbeat or
feeling dizzy or faint when standing.
* You see blood or dark/black material when you vomit or have a
bowel movement.
* Your skin, or the whites of your eyes become yellow.
* Your pain is not improving within 8-12 hours or not gone
within 24 hours. Call or return immediately if your pain is
getting worse or is changing location or moving to your chest or
back.
* You have shaking chills, or a fever greater than 101.5 (F)
degrees or 38(C) degrees.
* Any serious change in your symptoms, or any new symptoms that
concern you.
.
* Take all new meds as ordered. Stop your Metoprolol and
Lisinopril. These contributed to your low blood pressure. Please
follow-up with your PCP about when to restart these medications.
* Do not drive or operate heavy machinery while taking any
narcotic pain medication. You may have constipation when taking
narcotic pain medications (oxycodone, percocet, vicodin,
hydrocodone, dilaudid, etc.); you should continue drinking
fluids, you may take stool softeners, and should eat foods that
are high in fiber.
* Continue to increase activity daily
* Monitor your incision for signs of infection.
* You may shower and wash, no tub baths or swimming.

Followup Instructions:
Provider: [**First Name8 (NamePattern2) 251**] [**Name11 (NameIs) **], MD Phone:[**Telephone/Fax (1) 476**] Date/Time:[**2187-10-1**]
10:15
Please follow-up with your PCP [**Last Name (NamePattern4) **] [**12-6**] weeks. Call to schedule an
appointment.



Completed by:[**2187-8-21**]
{'Dehydration,Bacteremia,Adult failure to thrive,Coronary atherosclerosis of native coronary artery,Chronic airway obstruction, not elsewhere classified,Atherosclerosis of native arteries of the extremities, unspecified,Gastrostomy status,Unspecified essential hypertension'}


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: Hypotension
Failure to Thrive

PRESENT ILLNESS: 67M well-known to our service, s/p Whipple procedure [**2187-7-3**] c/b
post-op intra-abdominal fluid collections, presented to OSH c
rigors, found to be febrile to ~102 and hypotensive (SBP 80
there
and was promptly transferred to [**Hospital1 18**].  En route, the patient
was
on dopamine which resulted in extreme tachycardia.  Denies
abdominal pain, distention, N/V, abnormal BM, chest pain,
dysuria, pulmonary symptoms.

MEDICAL HISTORY: ampullary adenoma, likely diagnosis of familial adenomatous
polyposis, ypertension, coronary artery disease, chronic
obstructive pulmonary disease (COPD), arthritis and peripheral
vascular disease

MEDICATION ON ADMISSION: Simvastatin 10', Aspirin 325', Toprol XL 50 mg', Lisinopril 10',
Omeprazole 20', reglan 10"", dilaudid 1-2q4hp, colace

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals- T ~101, HR 82, BP 117/70, RR 15, O2sat 96% 4L
Gen- NAD, alert
Head and neck- AT, NC, soft, supple, no masses
Heart- RRR, no murmurs
Lungs- CTAB, no rhonchi, no crackles
Abd- soft, ND, NT, decreased BS, incisions well healed
Ext- warm, well-perfused, no edema

FAMILY HISTORY: His family history is significant for his maternal grandfather
that was affected with colorectal cancer, mother that was
affected with polyposis, brother that was affected with
colorectal cancer, 2 daughters that are affected with polyposis,
a grandson that is affected with polyposis, a brother that was
lost to colorectal cancer and a son that is also affected with
polyposis.

SOCIAL HISTORY: SOCIAL HISTORY
His social history is significant for positive tobacco.  He
smokes half pack per day, no alcohol and no IV drugs use, and no
intranasal cocaine use. 

### Response:
{'Dehydration,Bacteremia,Adult failure to thrive,Coronary atherosclerosis of native coronary artery,Chronic airway obstruction, not elsewhere classified,Atherosclerosis of native arteries of the extremities, unspecified,Gastrostomy status,Unspecified essential hypertension'}
