CHIEF COMPLAINT: intraperitoneal hemorrhage and splenic hematoma

PRESENT ILLNESS: 54 year old male with history of NPH s/p VP shunt, CAD s/p MI
with stent now with chronic abdominal pain since [**2109**] which
worsened 2 days prior to admission in the LUQ. It was severe
crampy abdominal pain which worsened after eating cereal.  He
did have emesis x1 which was bilous non-bloody and he has
noticed distention and constipation.  Admitted first to [**Hospital 1474**]
hospital [**2111-1-24**] for rule out MI which was negative. He continued
to have persistent abdominal pain and his Hemotocrit dropped
from 30.6 to 19.1 which he recieved 4 units which then bumped
his hemotocrit to 27.  His last Bowel movement was sunday and he
continues to have flatus.  He was transferred on [**2111-1-26**]

MEDICAL HISTORY: -[**2109-12-13**] Cardiac Catheterization - LAD with proximal 40% and
mid
70% stenosis. Ramus with a large mid 90% stenosis was stented
with 2.5 x 23mm CYPHER DES and 3 x 13mm CYPHER DES with TIMI 3
flow. RCA was occluded in the mid segment and could not be
engaged but was filled with left-right callaterals.
-Bipolar
- NPH status post Rigt VP shunt in [**6-26**] and revision [**9-26**]
-Asthma
-ADHD
-High Cholesterol
-HTN
-PTSD
-AAA
- DJD
PSH: [**Name (NI) 10259**], PTCA, VP shunt [**6-26**] ([**Hospital1 336**]), revision of VP shunt [**9-26**]
([**Doctor Last Name **])

MEDICATION ON ADMISSION: 1. Protonix 40mg PO daily
2. Plavix 75mg PO daily
3. ASA 81mg PO daily
4. Simvastatin 80mg PO daily
5. Lisinopril 10mg PO daily
6. Toprol 100mg PO BID
7. Albuterol 2 puffs [**Hospital1 **]

ALLERGIES: Levofloxacin / Codeine

PHYSICAL EXAM: VS: T 97.5 BP 138/64 HR 83 RR 16 O2Sat 99% RA
General: no acute distress, alert and oriented x 3
Neuro 5/5 strength. FROM
HEENT: PERRLA, EOMI, CV II-XII grossly intact
CV: regular rate and rhythm
Lungs: Cleart to ausculation bilaterally
Abdomen: soft, markedly distended, + taympanic LUQ, diffuse
tenderness to palpation, no guarding
Extremeties: No clubbing, edema, 2+ DP/PT pulses bilaterally

FAMILY HISTORY: (+) [**Name (NI) 41900**] CAD Father has CAD and CHF. Social History: Married
for 15 years with two children 10 daughter and 14 son.

SOCIAL HISTORY: (+) cigarette smoking -quit in [**11-25**] 60ppy history, [**12-24**] ppd
on and off for 40 years
Other diseases of spleen,Hemoperitoneum (nontraumatic),Unspecified pleural effusion,Urinary tract infection, site not specified,Communicating hydrocephalus,Presence of cerebrospinal fluid drainage device,Percutaneous transluminal coronary angioplasty status,Constipation, unspecified,Hyperplasia of prostate, unspecified, with urinary obstruction and other lower urinary symptoms (LUTS),Retention of urine, unspecified,Old myocardial infarction
Spleen disease NEC,Hemoperitoneum,Pleural effusion NOS,Urin tract infection NOS,Communicat hydrocephalus,Ventricular shunt status,Status-post ptca,Constipation NOS,BPH NOS w ur obs/LUTS,Retention urine NOS,Old myocardial infarct
Admission Date:  [**2111-1-27**]              Discharge Date:   [**2111-2-5**]

Date of Birth:  [**2056-2-3**]             Sex:   M

Service: SURGERY

Allergies:
Levofloxacin / Codeine

Attending:[**First Name3 (LF) 6346**]
Chief Complaint:
intraperitoneal hemorrhage and splenic hematoma

Major Surgical or Invasive Procedure:
none


History of Present Illness:
54 year old male with history of NPH s/p VP shunt, CAD s/p MI
with stent now with chronic abdominal pain since [**2109**] which
worsened 2 days prior to admission in the LUQ. It was severe
crampy abdominal pain which worsened after eating cereal.  He
did have emesis x1 which was bilous non-bloody and he has
noticed distention and constipation.  Admitted first to [**Hospital 1474**]
hospital [**2111-1-24**] for rule out MI which was negative. He continued
to have persistent abdominal pain and his Hemotocrit dropped
from 30.6 to 19.1 which he recieved 4 units which then bumped
his hemotocrit to 27.  His last Bowel movement was sunday and he
continues to have flatus.  He was transferred on [**2111-1-26**]

Past Medical History:
-[**2109-12-13**] Cardiac Catheterization - LAD with proximal 40% and
mid
70% stenosis. Ramus with a large mid 90% stenosis was stented
with 2.5 x 23mm CYPHER DES and 3 x 13mm CYPHER DES with TIMI 3
flow. RCA was occluded in the mid segment and could not be
engaged but was filled with left-right callaterals.
-Bipolar
- NPH status post Rigt VP shunt in [**6-26**] and revision [**9-26**]
-Asthma
-ADHD
-High Cholesterol
-HTN
-PTSD
-AAA
- DJD
PSH: [**Name (NI) 10259**], PTCA, VP shunt [**6-26**] ([**Hospital1 336**]), revision of VP shunt [**9-26**]
([**Doctor Last Name **])


Social History:
(+) cigarette smoking -quit in [**11-25**] 60ppy history, [**12-24**] ppd
on and off for 40 years


Family History:
(+) [**Name (NI) 41900**] CAD Father has CAD and CHF. Social History: Married
for 15 years with two children 10 daughter and 14 son.


Physical Exam:
VS: T 97.5 BP 138/64 HR 83 RR 16 O2Sat 99% RA
General: no acute distress, alert and oriented x 3
Neuro 5/5 strength. FROM
HEENT: PERRLA, EOMI, CV II-XII grossly intact
CV: regular rate and rhythm
Lungs: Cleart to ausculation bilaterally
Abdomen: soft, markedly distended, + taympanic LUQ, diffuse
tenderness to palpation, no guarding
Extremeties: No clubbing, edema, 2+ DP/PT pulses bilaterally

Pertinent Results:
[**2111-1-28**] CT OF THE ABDOMEN WITH AND WITHOUT IV CONTRAST: There are
bibasilar opacities, most suggestive of atelectasis, as well as
a small left basilar low density effusion. The liver appears
normal. The patient is status post cholecystectomy. The
pancreas, adrenal glands are within normal limits. There is a
low density cystic lesion in the lower pole of the right kidney
consistent with a simple renal cyst.

There is a large subcapsular hematoma along the lateral aspect
of the spleen, which measures approximately 12 x 9 cm in axial
dimensions, likely with a small perisplenic component. The
hematoma is of a high density suggesting recent hemorrhage, but
on arterial and portal venous phase imaging, there is no
evidence of active contrast extravasation.

There is a ventriculoperitoneal shunt catheter terminating in
the right mid abdomen. There is a small-to-moderate amount of
low-density ascites throughout the abdomen. Although the
presence of a small amount of hemorrhage within the fluid cannot
be entirely excluded, appearance is most compatible with a fluid
related to ventriculoperitoneal shunting. The stomach, small and
large bowel are within normal limits. There is no
lymphadenopathy, or free air.

CT ANGIOGRAM: There is an accessory left hepatic artery
emanating from the left gastric artery. There is a replaced
right hepatic artery originating from the superior mesenteric
artery. An accessory left renal artery serving the lower pole of
the left kidney is noted. Immediately above the aortic
bifurcation, and below the takeoff of the inferior mesenteric
artery, the infrarenal shows focal ectasia up to 33 mm in
diameter. The major mesenteric veins are patent.

BONE WINDOWS: There are no suspicious lytic or blastic lesions.

IMPRESSION:
1. Large subcapsular hematoma without evidence of active
contrast extravasation.

2. Small amount of ascites within the pelvis, most likely
related to the presence of a ventriculoperitoneal shunt
catheter.

3. Ectactic infrarenal aorta measuring up to 33 mm in diameter.

Shortly after the study, a preliminary [**Location (un) 1131**] was provided by
Dr. [**First Name4 (NamePattern1) 5656**] [**Last Name (NamePattern1) **], which stated, "large high attenuation collection
adjacent to spleen, appears to be subcapsular hematoma. No
evidence of active extravasation of contrast. Large amount of
free fluid seen within abdomen. Small right pleural effusion
with associated atelectasis."


Brief Hospital Course:
[**Known firstname **] [**Known lastname 97020**] was transferred from [**Hospital 1474**] Hospital on [**2111-1-27**].
 Hct was 26.3 after receiving PRBCs at the outside hospital.  A
repeat CT scan showed a large subcapsular hematoma without
evidence of active contrast extravasation; and a small amount of
ascites within the pelvis, most likely related to the presence
of a ventriculoperitoneal shunt catheter.  He was admitted to
the ICU for serial exams and monitoring. He was placed on
bedrest. At HD 5 his Hct was stable and he was transferred to
the floor. He continued to complain of pain and abdominal
distention. A bowel regimen was started.  At HD 6 his activity
was advanced.  His urinary catheter was removed. The Hct was
stable at 31.4.  He remained distended and with abdominal pain.
A CXR was completed for SOB/DOE which showed a left pleural
effusion. At HD7 He was afebrile and ambulatory. Urine culture
was positive for E. Coli. Bactrim was started. He had increased
oxygen requirements with walking, and continued to complain of
abdominal distention, pain, and difficulty eating due to
abdominal pressure.  PVCs were noted on telemetry. EKGs were
obtained without evidence of acute event. He was maintained on
telemetry with no acute events.  His hemocrit continued to be
stable up to his discharge on HD 10.  He also did have three
bowel movements on HD 9 after receiving lactulose.  On HD 9 he
felt that he had difficulty urinating. UA was sent which was
negative and on prostate exam he did have a slightly enlarged
prostate for which he was started on Flomax.  On discharge he
was tolerating a regular diet with a bowel movement the previous
day and hematocrit stable.  He was also advise to follow with
his primary care physician about his chronic constipation and
his starting Flomax.

Medications on Admission:
1. Protonix 40mg PO daily
2. Plavix 75mg PO daily
3. ASA 81mg PO daily
4. Simvastatin 80mg PO daily
5. Lisinopril 10mg PO daily
6. Toprol 100mg PO BID
7. Albuterol 2 puffs [**Hospital1 **]

Discharge Medications:
1. Simvastatin 40 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
2. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
3. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

4. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
5. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
Disp:*60 Tablet(s)* Refills:*2*
6. Metoprolol Tartrate 50 mg Tablet Sig: Two (2) Tablet PO BID
(2 times a day).
7. Morphine 15 mg Tablet Sustained Release Sig: One (1) Tablet
Sustained Release PO BID (2 times a day) for 4 weeks.
Disp:*56 Tablet Sustained Release(s)* Refills:*0*
8. Tamsulosin 0.4 mg Capsule, Sust. Release 24HR Sig: One (1)
Capsule, Sust. Release 24HR PO HS (at bedtime).
Disp:*30 Capsule, Sust. Release 24HR(s)* Refills:*1*
9. Morphine 15 mg Tablet Sig: One (1) Tablet PO every twelve
(12) hours as needed for pain for 2 weeks.
Disp:*20 Tablet(s)* Refills:*0*
10. Lactulose 10 g/15 mL Solution Sig: One (1) 10 g PO once a
day as needed for constipation for 5 doses.
Disp:*5 10 g packets* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital1 1474**] VNA

Discharge Diagnosis:
contained splenic hematoma


Discharge Condition:
Good


Discharge Instructions:
* Increasing pain or persistent pain that is not relieved by
pain medications
*Inability to urinate
* Fever (>101.5 F)
*Nausea or Vomiting that last longer than 24 hours
* Inability to pass gas or stool
* Other symptoms concerning to you

Please take all your medications as ordered.
No strenous activity for 2 months.  NO CONTACT sports for 2
months.

Followup Instructions:
1. Please follow up with Dr. [**First Name (STitle) 2819**] in 2 weeks.  Call ([**Telephone/Fax (1) 35203**] to make an appointment.
2. Need to follow up with your PCP [**Last Name (NamePattern4) **]. [**Last Name (STitle) 17887**] about starting
flomax and to talk to her about your chronic constipation and
abdominal pain. Call [**Telephone/Fax (1) 3183**] to make an appointment.



Completed by:[**2111-2-5**]
{'Other diseases of spleen,Hemoperitoneum (nontraumatic),Unspecified pleural effusion,Urinary tract infection, site not specified,Communicating hydrocephalus,Presence of cerebrospinal fluid drainage device,Percutaneous transluminal coronary angioplasty status,Constipation, unspecified,Hyperplasia of prostate, unspecified, with urinary obstruction and other lower urinary symptoms (LUTS),Retention of urine, unspecified,Old myocardial infarction'}


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: intraperitoneal hemorrhage and splenic hematoma

PRESENT ILLNESS: 54 year old male with history of NPH s/p VP shunt, CAD s/p MI
with stent now with chronic abdominal pain since [**2109**] which
worsened 2 days prior to admission in the LUQ. It was severe
crampy abdominal pain which worsened after eating cereal.  He
did have emesis x1 which was bilous non-bloody and he has
noticed distention and constipation.  Admitted first to [**Hospital 1474**]
hospital [**2111-1-24**] for rule out MI which was negative. He continued
to have persistent abdominal pain and his Hemotocrit dropped
from 30.6 to 19.1 which he recieved 4 units which then bumped
his hemotocrit to 27.  His last Bowel movement was sunday and he
continues to have flatus.  He was transferred on [**2111-1-26**]

MEDICAL HISTORY: -[**2109-12-13**] Cardiac Catheterization - LAD with proximal 40% and
mid
70% stenosis. Ramus with a large mid 90% stenosis was stented
with 2.5 x 23mm CYPHER DES and 3 x 13mm CYPHER DES with TIMI 3
flow. RCA was occluded in the mid segment and could not be
engaged but was filled with left-right callaterals.
-Bipolar
- NPH status post Rigt VP shunt in [**6-26**] and revision [**9-26**]
-Asthma
-ADHD
-High Cholesterol
-HTN
-PTSD
-AAA
- DJD
PSH: [**Name (NI) 10259**], PTCA, VP shunt [**6-26**] ([**Hospital1 336**]), revision of VP shunt [**9-26**]
([**Doctor Last Name **])

MEDICATION ON ADMISSION: 1. Protonix 40mg PO daily
2. Plavix 75mg PO daily
3. ASA 81mg PO daily
4. Simvastatin 80mg PO daily
5. Lisinopril 10mg PO daily
6. Toprol 100mg PO BID
7. Albuterol 2 puffs [**Hospital1 **]

ALLERGIES: Levofloxacin / Codeine

PHYSICAL EXAM: VS: T 97.5 BP 138/64 HR 83 RR 16 O2Sat 99% RA
General: no acute distress, alert and oriented x 3
Neuro 5/5 strength. FROM
HEENT: PERRLA, EOMI, CV II-XII grossly intact
CV: regular rate and rhythm
Lungs: Cleart to ausculation bilaterally
Abdomen: soft, markedly distended, + taympanic LUQ, diffuse
tenderness to palpation, no guarding
Extremeties: No clubbing, edema, 2+ DP/PT pulses bilaterally

FAMILY HISTORY: (+) [**Name (NI) 41900**] CAD Father has CAD and CHF. Social History: Married
for 15 years with two children 10 daughter and 14 son.

SOCIAL HISTORY: (+) cigarette smoking -quit in [**11-25**] 60ppy history, [**12-24**] ppd
on and off for 40 years 

### Response:
{'Other diseases of spleen,Hemoperitoneum (nontraumatic),Unspecified pleural effusion,Urinary tract infection, site not specified,Communicating hydrocephalus,Presence of cerebrospinal fluid drainage device,Percutaneous transluminal coronary angioplasty status,Constipation, unspecified,Hyperplasia of prostate, unspecified, with urinary obstruction and other lower urinary symptoms (LUTS),Retention of urine, unspecified,Old myocardial infarction'}
