CHIEF COMPLAINT: Abdominal pain

PRESENT ILLNESS: [**Age over 90 **] y/o F mild dementia, HTN who presented to [**Hospital1 18**] [**Location (un) 620**] for
right-sided abdominal pain. At [**Location (un) 620**] found to have a
perforated, emphysematous gallbladder and consequently
transferred to [**Hospital1 18**] [**Location (un) 86**]. On arrival to our ED T 98.1 BP
114/73 HR 128 RR 24 O2Sat 99% 3 L NC. Patient with BP decreased
to 78/48-85/60. Patient given morphine 2 mg IV, zofran 4mg IV
and Vancomycin IV. Patient given Zosyn and 1.5 L NS prior to
transfer. Surgery evaluated patient and deemed not a surgical
candidate.
.
On arrival to MICU patient is alert. She reports progressive
right-sided abdominal pain of 1 week duration. She reports
associated nausea and vomiting. Otherwise history is limited due
to patient's pain.

MEDICAL HISTORY: 1. Hypertension.
2. Mitral valve prolapse.
3. Parathyroid adenoma.
S/P R distal radius fx, closed reduction and perc pinning ([**2101**])

MEDICATION ON ADMISSION: Vitamin B
Miralax
Multivitamin
Omeprazole
Vitamin E
Niferex GOLD Oral 750 mg
Calcium Carbonate 750 mg
Temazepam 15 mg daily

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: On Admission:
GEN: elderly frail female in pain. Alert, oriented to name and
person (not place or date). Able to have conversation but
limited due to pain.
HEENT: PERRL, EOMI, anicteric, dryMM
RESP: Anterior breath sounds clear
CV: RR, S1 and S2 wnl, no m/r/g
ABD: firm, + rebound, + gaurding, tender to palpation in all
quadrants, limited bowel sounds
EXT: no c/c/e
SKIN: no rashes/no jaundice/no splinters

FAMILY HISTORY: n/c

SOCIAL HISTORY: She lives alone and uses a walker for assistance. Denies any
tobacco, alcohol or drug use.
Unspecified septicemia,Perforation of gallbladder,Other specified peritonitis,Sepsis,Unspecified essential hypertension,Mitral valve disorders,Other persistent mental disorders due to conditions classified elsewhere,Encounter for palliative care
Septicemia NOS,Perforation gallbladder,Peritonitis NEC,Sepsis,Hypertension NOS,Mitral valve disorder,Mental disor NEC oth dis,Encountr palliative care
Admission Date:  [**2109-4-9**]              Discharge Date:   [**2109-4-10**]


Service: MEDICINE

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 8404**]
Chief Complaint:
Abdominal pain

Major Surgical or Invasive Procedure:
None

History of Present Illness:
[**Age over 90 **] y/o F mild dementia, HTN who presented to [**Hospital1 18**] [**Location (un) 620**] for
right-sided abdominal pain. At [**Location (un) 620**] found to have a
perforated, emphysematous gallbladder and consequently
transferred to [**Hospital1 18**] [**Location (un) 86**]. On arrival to our ED T 98.1 BP
114/73 HR 128 RR 24 O2Sat 99% 3 L NC. Patient with BP decreased
to 78/48-85/60. Patient given morphine 2 mg IV, zofran 4mg IV
and Vancomycin IV. Patient given Zosyn and 1.5 L NS prior to
transfer. Surgery evaluated patient and deemed not a surgical
candidate.
.
On arrival to MICU patient is alert. She reports progressive
right-sided abdominal pain of 1 week duration. She reports
associated nausea and vomiting. Otherwise history is limited due
to patient's pain.


Past Medical History:
1. Hypertension.
2. Mitral valve prolapse.
3. Parathyroid adenoma.
S/P R distal radius fx, closed reduction and perc pinning ([**2101**])

R hip fx ORIF DHS ([**2101**])


Social History:
She lives alone and uses a walker for assistance. Denies any
tobacco, alcohol or drug use.


Family History:
n/c

Physical Exam:
On Admission:
GEN: elderly frail female in pain. Alert, oriented to name and
person (not place or date). Able to have conversation but
limited due to pain.
HEENT: PERRL, EOMI, anicteric, dryMM
RESP: Anterior breath sounds clear
CV: RR, S1 and S2 wnl, no m/r/g
ABD: firm, + rebound, + gaurding, tender to palpation in all
quadrants, limited bowel sounds
EXT: no c/c/e
SKIN: no rashes/no jaundice/no splinters


Pertinent Results:
Admission:
[**2109-4-8**] 11:47PM BLOOD WBC-2.3*# RBC-4.26 Hgb-12.2# Hct-36.8#
MCV-87 MCH-28.7 MCHC-33.2 RDW-14.1 Plt Ct-233
[**2109-4-8**] 11:47PM BLOOD Neuts-37* Bands-50* Lymphs-7* Monos-5
Eos-0 Baso-0 Atyps-0 Metas-1* Myelos-0 Other-0
[**2109-4-8**] 11:34PM BLOOD PT-13.1 PTT-26.8 INR(PT)-1.1
[**2109-4-8**] 11:47PM BLOOD Glucose-166* UreaN-27* Creat-0.8 Na-145
K-4.0 Cl-108 HCO3-25 AnGap-16
[**2109-4-8**] 11:47PM BLOOD ALT-13 AST-19 AlkPhos-56 TotBili-0.6
[**2109-4-8**] 11:47PM BLOOD Albumin-3.5 Calcium-8.0*
[**2109-4-8**] 11:25PM BLOOD Lactate-2.5*
.
CT A/[**Initials (NamePattern4) **] [**Last Name (NamePattern4) 620**] images reviewed - free fluid and free air
tracking from emphysematous gallbladder wall, free fluid
spillage throughout abdomen.

Brief Hospital Course:
[**Age over 90 **] y/o F HTN, dementia who presents with acute abdominal pain
and found to have ganrenous gallbladder with perforation
complicated by peritonitis and sepsis. Condition associated with
high mortality with surgery or without surgery. Patient
evaluated by surgery and deemed not a surgical candidate.
Discussed by phone with her HCP who later came in. HCP and
family were very clear that Ms. [**Known lastname 105623**], in this circumstance,
would prefer to focus on comfort and quality of life (and
avoidance of pain) rather than on attempts to extend life. She
was transitioned to comfort-focused care and passed away with
family by the bed-side.

Medications on Admission:
Vitamin B
Miralax
Multivitamin
Omeprazole
Vitamin E
Niferex GOLD Oral 750 mg
Calcium Carbonate 750 mg
Temazepam 15 mg daily


Discharge Medications:
None

Discharge Disposition:
Expired

Discharge Diagnosis:
passed away

Discharge Condition:
passed away

Discharge Instructions:
passed away

Followup Instructions:
passed away

                             [**Name6 (MD) **] [**Name8 (MD) **] MD [**MD Number(2) 8405**]

Completed by:[**2109-4-10**]
{'Unspecified septicemia,Perforation of gallbladder,Other specified peritonitis,Sepsis,Unspecified essential hypertension,Mitral valve disorders,Other persistent mental disorders due to conditions classified elsewhere,Encounter for palliative care'}


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: Abdominal pain

PRESENT ILLNESS: [**Age over 90 **] y/o F mild dementia, HTN who presented to [**Hospital1 18**] [**Location (un) 620**] for
right-sided abdominal pain. At [**Location (un) 620**] found to have a
perforated, emphysematous gallbladder and consequently
transferred to [**Hospital1 18**] [**Location (un) 86**]. On arrival to our ED T 98.1 BP
114/73 HR 128 RR 24 O2Sat 99% 3 L NC. Patient with BP decreased
to 78/48-85/60. Patient given morphine 2 mg IV, zofran 4mg IV
and Vancomycin IV. Patient given Zosyn and 1.5 L NS prior to
transfer. Surgery evaluated patient and deemed not a surgical
candidate.
.
On arrival to MICU patient is alert. She reports progressive
right-sided abdominal pain of 1 week duration. She reports
associated nausea and vomiting. Otherwise history is limited due
to patient's pain.

MEDICAL HISTORY: 1. Hypertension.
2. Mitral valve prolapse.
3. Parathyroid adenoma.
S/P R distal radius fx, closed reduction and perc pinning ([**2101**])

MEDICATION ON ADMISSION: Vitamin B
Miralax
Multivitamin
Omeprazole
Vitamin E
Niferex GOLD Oral 750 mg
Calcium Carbonate 750 mg
Temazepam 15 mg daily

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: On Admission:
GEN: elderly frail female in pain. Alert, oriented to name and
person (not place or date). Able to have conversation but
limited due to pain.
HEENT: PERRL, EOMI, anicteric, dryMM
RESP: Anterior breath sounds clear
CV: RR, S1 and S2 wnl, no m/r/g
ABD: firm, + rebound, + gaurding, tender to palpation in all
quadrants, limited bowel sounds
EXT: no c/c/e
SKIN: no rashes/no jaundice/no splinters

FAMILY HISTORY: n/c

SOCIAL HISTORY: She lives alone and uses a walker for assistance. Denies any
tobacco, alcohol or drug use. 

### Response:
{'Unspecified septicemia,Perforation of gallbladder,Other specified peritonitis,Sepsis,Unspecified essential hypertension,Mitral valve disorders,Other persistent mental disorders due to conditions classified elsewhere,Encounter for palliative care'}
