CHIEF COMPLAINT: complicated pancreatitis, pseudocyst

PRESENT ILLNESS: please see discharge note from [**Hospital1 **]Hospital for full
details of complicated hospital course

MEDICAL HISTORY: -Prior left foot surgery for a heel spur
-no other PMH prior to gallstone pancreatitis
-as above: ARDS, PNA, gallstones, pancreatitis, pseudocyst,
tachy-brady syndrome

MEDICATION ON ADMISSION: -Albuterol/Ipratropium -4 puffs TID
-Ferrous Sulfate 325mg daily
-Lovenox 40mg SC daily
-Guaifenesin 200mg q4hrs PRN
-Tylenol 650mg q6hrs PRN
-Albuterol INH, 4 puffs qhour PRN
-Lactobacillus Acidophilis/lactinex -1 tablet daily
-Miconazole 2% ointment PRN
-Octreotide acetate 100 mcg SC TID
-olanzapine 10mg PO qhs
-Protonix 40mg IV BID
-Vitamin A&D external cream PRN
-Zinc oxide ointment PRN

ALLERGIES: Codeine

PHYSICAL EXAM: VS: vital signs were temp 100F, BP 105/63, HR 102, O2 Sat was
99% on 10L at 35% FiO2 on trach collar.
GENERAL: No acute distress. Oriented to person, place and time,
affect appropriate.
HEENT: NC/AT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.
Thrush noted over tongue
NECK: Supple with JVP of 7-8cm. No lymphadenopathy noted, trach
site clean/dry/in tact, nonerythematous, minimal clear
secretions
CARDIAC: RRR, S1/S2 appreciated, no murmurs/rubs/gallops.
LUNGS: Respirations unlabored, no accessory muscle use. Diffuse
rhonchi noted over upper lung fields and decreased lung sounds
at bases (R>L). No wheezes noted.
ABDOMEN: Soft, nondistended. No HSM . Mild tenderness with
moderate palpation over LLQ, LUQ and epigastric region. No
external bruising noted, no guarding, no rebound. Small drain at
LLQ and LUQ draining yellowish fluid ( 50-75cc)
EXTREMITIES: No edema, 2+ pedal pulses bilaterally
SKIN: No rashes, +dermatitis on left and right buttocks, no
other ulcers or lesions
NEURO: CNs [**3-15**] grossly intact, no focal sensory or motor
deficits, gait assessment deferred

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: Patient lives in [**Hospital1 8**] and has a partner/boyfriend, has 3
grown children. Tobacco history: smoked 1PPD x 10 years and quit
in early [**2159**], stopped drinking ETOH 30 years ago, no illicit
drug use.
Acute pancreatitis,Obstruction of bile duct
Acute pancreatitis,Obstruction of bile duct
Admission Date:  [**2198-8-9**]              Discharge Date:   [**2198-8-10**]

Date of Birth:  [**2137-9-5**]             Sex:   F

Service: MEDICINE

Allergies:
Codeine

Attending:[**First Name3 (LF) 2297**]
Chief Complaint:
complicated pancreatitis, pseudocyst

Major Surgical or Invasive Procedure:
ERCP

History of Present Illness:
please see discharge note from [**Hospital1 **]Hospital for full
details of complicated hospital course

Ms. [**Known lastname **] is a 68-year-old female who is being transferred from
[**Hospital 8**] Hospital ICU for urgent ERCP management/intervention
in the setting of recent gallstone pancreatitis (initial
admission [**2198-6-8**])complicated by pseudocyst, multiple
intra-abdominal infections, PNA,  ARDS and persistent fevers. To
date, she has failed 3 ERCP ampulla cannulations at OSH. She is
now being transferred for additional ERCP attempt to cannulate
duct and for placement of possible stent. Per patient, she had
been very healthy with no significant prior medical conditions
before this recent hospital admission.
.
Per OSH, her last WBC count was 10.8 / LFTs last done 10 days
ago and were WNL. She has been having chronic low grade
temperatures in the 99-100F range and has been afebrile x 2 days
per OSH notes. She developed respiratory distress which was
originally attributed to PNA and she was given course of
Moxifloxacin. Respiratory failure followed which was felt to be
from ARDS and she needed eventual intubation on [**2198-6-11**] followed
by a long course on the mechanical ventilator followed by
tracheostomy on [**2198-7-12**] and she was weaned off of the ventilator
completely on [**2198-7-24**]. She is now stable on a tracheostomy
collar at FiO2 28%. She also has Dobhoff tube in place for
nutrition and is on tube feeds with Promote to 80-100cc/hr. She
continues to have a very low prealbumin. She had been on
vancomycin for empiric coverage for C.difficile (culture/toxins
negative to date) but this was discontinued. She is on no
additional antibiotics at present time.
.
While at OSH she also developed several episodes of bradycardia
with intermittent tachycardia and she was seen by cardiology and
diagnosed with tachy-brady syndrome and a transvenous pacemaker
was placed on [**7-25**] which is set at rate of 50bpm. Goal is for
eventual permanent PCM once she is stabilized at later date.
.
On arrival to the [**Hospital Unit Name 153**], her vital signs were temp 100F, BP
105/63, HR 102, O2 Sat was 99% on 10L at 35% FiO2 on trach
collar. She was in no apparent distress and was fully alert and
oriented. No abdominal pain complaints, denied nausea/emesis.
She is having [**2-2**] loose stools daily.


Past Medical History:
-Prior left foot surgery for a heel spur
-no other PMH prior to gallstone pancreatitis
-as above: ARDS, PNA, gallstones, pancreatitis, pseudocyst,
tachy-brady syndrome


Social History:
Patient lives in [**Hospital1 8**] and has a partner/boyfriend, has 3
grown children. Tobacco history: smoked 1PPD x 10 years and quit
in early [**2159**], stopped drinking ETOH 30 years ago, no illicit
drug use.

Family History:
Noncontributory

Physical Exam:
VS: vital signs were temp 100F, BP 105/63, HR 102, O2 Sat was
99% on 10L at 35% FiO2 on trach collar.
GENERAL: No acute distress. Oriented to person, place and time,
affect appropriate.
HEENT: NC/AT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.
Thrush noted over tongue
NECK: Supple with JVP of 7-8cm. No lymphadenopathy noted, trach
site clean/dry/in tact, nonerythematous, minimal clear
secretions
CARDIAC: RRR, S1/S2 appreciated, no murmurs/rubs/gallops.
LUNGS: Respirations unlabored, no accessory muscle use. Diffuse
rhonchi noted over upper lung fields and decreased lung sounds
at bases (R>L). No wheezes noted.
ABDOMEN: Soft, nondistended. No HSM . Mild tenderness with
moderate palpation over LLQ, LUQ and epigastric region. No
external bruising noted, no guarding, no rebound. Small drain at
LLQ and LUQ draining yellowish fluid ( 50-75cc)
EXTREMITIES: No edema, 2+ pedal pulses bilaterally
SKIN: No rashes, +dermatitis on left and right buttocks, no
other ulcers or lesions
NEURO: CNs [**3-15**] grossly intact, no focal sensory or motor
deficits, gait assessment deferred


Pertinent Results:
[**2198-8-9**] 09:30PM   PT-13.4 PTT-21.9* INR(PT)-1.1
[**2198-8-9**] 09:30PM   PLT COUNT-655*
[**2198-8-9**] 09:30PM   WBC-12.4* RBC-2.42* HGB-7.1* HCT-22.9* MCV-95
MCH-29.2 MCHC-30.8* RDW-20.1*
[**2198-8-9**] 09:30PM   CALCIUM-8.8 PHOSPHATE-3.8 MAGNESIUM-2.1
[**2198-8-9**] 09:30PM   ALT(SGPT)-18 AST(SGOT)-41* ALK PHOS-120* TOT
BILI-0.2
[**2198-8-9**] 09:30PM   estGFR-Using this
[**2198-8-9**] 09:30PM   GLUCOSE-88 UREA N-18 CREAT-0.5 SODIUM-141
POTASSIUM-4.9 CHLORIDE-101 TOTAL CO2-35* ANION GAP-10

Brief Hospital Course:
Patient was transferred from [**Location (un) **]Hospital to [**Hospital1 18**]
ICU without incident.  Patient remained clinically stable
overnight and was continued on prior management.  During ERCP in
am, ability to visualize the sphincter of oddi but unable to
pass the wire through the pancreatic duct.  ERCP attending
discussed case with surgical attending at [**Location (un) 25991**]Hospital and agreed on plan to transfer patient back to
[**Hospital1 **]Hospital.
Upon transfer, the patient was clinically stable.
BP 97/45   P101    RR 20 on 35% FiO2    T 97.6

Medications on Admission:
-Albuterol/Ipratropium -4 puffs TID
-Ferrous Sulfate 325mg daily
-Lovenox 40mg SC daily
-Guaifenesin 200mg q4hrs PRN
-Tylenol 650mg q6hrs PRN
-Albuterol INH, 4 puffs qhour PRN
-Lactobacillus Acidophilis/lactinex -1 tablet daily
-Miconazole 2% ointment PRN
-Octreotide acetate 100 mcg SC TID
-olanzapine 10mg PO qhs
-Protonix 40mg IV BID
-Vitamin A&D external cream PRN
-Zinc oxide ointment PRN

Discharge Medications:
-Albuterol/Ipratropium -4 puffs TID
-Ferrous Sulfate 325mg daily
-Lovenox 40mg SC daily
same medications on transfer:
-Guaifenesin 200mg q4hrs PRN
-Tylenol 650mg q6hrs PRN
-Albuterol INH, 4 puffs qhour PRN
-Lactobacillus Acidophilis/lactinex -1 tablet daily
-Miconazole 2% ointment PRN
-Octreotide acetate 100 mcg SC TID
-olanzapine 10mg PO qhs
-Protonix 40mg IV BID
-Vitamin A&D external cream PRN
-Zinc oxide ointment PRN

Discharge Disposition:
Extended Care

Facility:
[**Location (un) **]Hospital

Discharge Diagnosis:
complicated pancreatitis, pseudocyst

Discharge Condition:
stable

Discharge Instructions:
continue management as dictated by [**Hospital1 **]Hospital

Followup Instructions:
cont. current management
{'Acute pancreatitis,Obstruction of bile duct'}


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: complicated pancreatitis, pseudocyst

PRESENT ILLNESS: please see discharge note from [**Hospital1 **]Hospital for full
details of complicated hospital course

MEDICAL HISTORY: -Prior left foot surgery for a heel spur
-no other PMH prior to gallstone pancreatitis
-as above: ARDS, PNA, gallstones, pancreatitis, pseudocyst,
tachy-brady syndrome

MEDICATION ON ADMISSION: -Albuterol/Ipratropium -4 puffs TID
-Ferrous Sulfate 325mg daily
-Lovenox 40mg SC daily
-Guaifenesin 200mg q4hrs PRN
-Tylenol 650mg q6hrs PRN
-Albuterol INH, 4 puffs qhour PRN
-Lactobacillus Acidophilis/lactinex -1 tablet daily
-Miconazole 2% ointment PRN
-Octreotide acetate 100 mcg SC TID
-olanzapine 10mg PO qhs
-Protonix 40mg IV BID
-Vitamin A&D external cream PRN
-Zinc oxide ointment PRN

ALLERGIES: Codeine

PHYSICAL EXAM: VS: vital signs were temp 100F, BP 105/63, HR 102, O2 Sat was
99% on 10L at 35% FiO2 on trach collar.
GENERAL: No acute distress. Oriented to person, place and time,
affect appropriate.
HEENT: NC/AT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.
Thrush noted over tongue
NECK: Supple with JVP of 7-8cm. No lymphadenopathy noted, trach
site clean/dry/in tact, nonerythematous, minimal clear
secretions
CARDIAC: RRR, S1/S2 appreciated, no murmurs/rubs/gallops.
LUNGS: Respirations unlabored, no accessory muscle use. Diffuse
rhonchi noted over upper lung fields and decreased lung sounds
at bases (R>L). No wheezes noted.
ABDOMEN: Soft, nondistended. No HSM . Mild tenderness with
moderate palpation over LLQ, LUQ and epigastric region. No
external bruising noted, no guarding, no rebound. Small drain at
LLQ and LUQ draining yellowish fluid ( 50-75cc)
EXTREMITIES: No edema, 2+ pedal pulses bilaterally
SKIN: No rashes, +dermatitis on left and right buttocks, no
other ulcers or lesions
NEURO: CNs [**3-15**] grossly intact, no focal sensory or motor
deficits, gait assessment deferred

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: Patient lives in [**Hospital1 8**] and has a partner/boyfriend, has 3
grown children. Tobacco history: smoked 1PPD x 10 years and quit
in early [**2159**], stopped drinking ETOH 30 years ago, no illicit
drug use. 

### Response:
{'Acute pancreatitis,Obstruction of bile duct'}
