CHIEF COMPLAINT: abdominal pain, rectal bleeding and abdominal distension

PRESENT ILLNESS: 83 year old female with past medical history of CAD
with MI in [**Month (only) 956**], atrial fibrillation (not on
anticoagulation), Crohns disease and diabetes mellitus who had a
recent admission [**5-7**] - [**5-11**] after a fall with an
intertrochanteric femur fracture which was repaired with a hip
screw on [**5-8**].  She is weight bearing on that leg.  She did not
have any cardiac events. She was treated for a uti.  She was
discharged to rehab on lovenox.
She has had abd distension for 3 days.  She was disimpacted
yesterday and treated with Miralax.  She says she had many bms
and was passing flatus.  Today she developed bleeding per rectum
and increased abd pain and was brought here.
Currently not c/o SOB or chest pain.

MEDICAL HISTORY: -Coronary Artery Disease status post MI in [**2180-12-24**] (3VD
on cardiac cath but managed non-operatively)
-Depression
-Anxiety
-Atrial Fibrillation (not on anticoagulation)
-Crohn's Disease
-Chronic obstructive pulmonary disease
-distant history of tonsillectomy and adenoidectomy

MEDICATION ON ADMISSION: 1. Amiodarone 200 (once a day (in the morning)).
2. Aspirin 325 DAILY (Daily).
3. Captopril 12.5 (3 times a day).
4. Furosemide 40 (once a day (in the morning)).
5. Atorvastatin 80 once a day.
6. Lorazepam 0.5 mg [**Hospital1 **]
7. Lorazepam 1 PO HS (at bedtime)
8. Multivitamin    DAILY (Daily).
9. Metoprolol Tartrate 6.25 twice a day
10. Docusate Sodium 100 [**Hospital1 **] (2 times a day).
11. Bisacodyl 10 DAILY (Daily) as needed for constipation.
12. Enoxaparin 40 mg/0.4 mL Syringe Sig: 0.4 ml Subcutaneous Q
24H
13. Lactulose 10 gram/15 mL Syrup Sig: Thirty (30) ML PO Q8H
14. Acetaminophen 325 PO Q6H (every 6 hours)

ALLERGIES: Fosamax

PHYSICAL EXAM: Physical Exam:
VS: T 95.6, BP 125/56, P 60, RR 14, O2 98% RA
Gen: in distress
HEENT: dry mucous membranes
CV: Irregular rhythm
Pulm: CTAB
Abd: distended, soft, diffusely tender, no abd scars
Extrem: Warm and well perfused, no edema
Neuro: A and O*3

FAMILY HISTORY: She reports multiple family members with heart problems.

SOCIAL HISTORY: Lives alone on [**Hospital3 4298**]. Quit tobacco [**1-1**] after 68 pk
years
No ETOH in 30 years
Acute vascular insufficiency of intestine,Other specified peritonitis,Hemorrhage of rectum and anus,Hyposmolality and/or hyponatremia,Acute kidney failure, unspecified,Closed fracture of intertrochanteric section of neck of femur,Diverticulosis of colon (without mention of hemorrhage),Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Atrial fibrillation,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Chronic airway obstruction, not elsewhere classified,Dysthymic disorder,Disorders of magnesium metabolism
Ac vasc insuff intestine,Peritonitis NEC,Rectal & anal hemorrhage,Hyposmolality,Acute kidney failure NOS,Intertrochanteric fx-cl,Dvrtclo colon w/o hmrhg,Crnry athrscl natve vssl,Old myocardial infarct,Atrial fibrillation,DMII wo cmp nt st uncntr,Chr airway obstruct NEC,Dysthymic disorder,Dis magnesium metabolism
Name:  [**Known lastname 5219**],[**Known firstname **]                   Unit No:   [**Numeric Identifier 5220**]

Admission Date:  [**2181-5-14**]              Discharge Date:   [**2181-5-24**]

Date of Birth:  [**2098-1-8**]             Sex:   F

Service: SURGERY

Allergies:
Fosamax

Attending:[**First Name3 (LF) 3149**]
Addendum:
Ms. [**Known lastname **] remained afebrile, all cultures were negative,
wounds were healing without any erythema and the leukocytosis
was deemed secondary to her spleenectomy.

Discharge Disposition:
Extended Care

Facility:
[**Hospital3 14**] & Rehab Center - [**Hospital1 15**]

                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 2000**] MD [**MD Number(2) 3151**]

Completed by:[**2181-5-24**]

Admission Date:  [**2181-5-14**]              Discharge Date:   [**2181-5-24**]

Date of Birth:  [**2098-1-8**]             Sex:   F

Service: SURGERY

Allergies:
Fosamax

Attending:[**First Name3 (LF) 2836**]
Chief Complaint:
abdominal pain, rectal bleeding and abdominal distension

Major [**First Name3 (LF) 2947**] or Invasive Procedure:
Subtotal colectomy and splenectomy.


History of Present Illness:
83 year old female with past medical history of CAD
with MI in [**Month (only) 956**], atrial fibrillation (not on
anticoagulation), Crohns disease and diabetes mellitus who had a
recent admission [**5-7**] - [**5-11**] after a fall with an
intertrochanteric femur fracture which was repaired with a hip
screw on [**5-8**].  She is weight bearing on that leg.  She did not
have any cardiac events. She was treated for a uti.  She was
discharged to rehab on lovenox.
She has had abd distension for 3 days.  She was disimpacted
yesterday and treated with Miralax.  She says she had many bms
and was passing flatus.  Today she developed bleeding per rectum
and increased abd pain and was brought here.
Currently not c/o SOB or chest pain.


Past Medical History:
-Coronary Artery Disease status post MI in [**2180-12-24**] (3VD
on cardiac cath but managed non-operatively)
-Depression
-Anxiety
-Atrial Fibrillation (not on anticoagulation)
-Crohn's Disease
-Chronic obstructive pulmonary disease
-distant history of tonsillectomy and adenoidectomy

Social History:
Lives alone on [**Hospital3 4298**]. Quit tobacco [**1-1**] after 68 pk
years
No ETOH in 30 years

Family History:
She reports multiple family members with heart problems.

Physical Exam:
Physical Exam:
VS: T 95.6, BP 125/56, P 60, RR 14, O2 98% RA
Gen: in distress
HEENT: dry mucous membranes
CV: Irregular rhythm
Pulm: CTAB
Abd: distended, soft, diffusely tender, no abd scars
Extrem: Warm and well perfused, no edema
Neuro: A and O*3



Pertinent Results:
[**2181-5-14**] 01:35PM   WBC-7.3 RBC-3.62* HGB-10.7* HCT-31.8* MCV-88
MCH-29.6 MCHC-33.7 RDW-17.2*
[**2181-5-14**] 01:35PM   NEUTS-24* BANDS-48* LYMPHS-14* MONOS-5 EOS-0
BASOS-0 ATYPS-0 METAS-9* MYELOS-0
[**2181-5-14**] 01:35PM   GLUCOSE-102 UREA N-46* CREAT-1.9* SODIUM-118*
POTASSIUM-4.8 CHLORIDE-87* TOTAL CO2-23 ANION GAP-13

[**2181-5-14**]  Abdominal CT:1. Pneumatosis of the cecal wall
without evidence of portal venous gas. Mild
dilatation of the large and small bowel loops without evidence
of discrete
transition point. No pneumoperitoneum. Limited evaluation for
bowel wall
ischemia and vessel patency in the absence of IV contrast.
2. Dilated right renal collecting system suggestive of
ureteropelvic
obstruction. No obstructing stone identified.
3. Cholelithiasis without evidence of acute c

[**2181-5-15**] TEE:

The left atrium is moderately dilated. Due to suboptimal
technical quality, a focal wall motion abnormality cannot be
fully excluded. Overall left ventricular systolic function is
normal (LVEF>55%. . The aortic valve leaflets (3) are mildly
thickened. Mild (1+) aortic regurgitation is seen. Mild to
moderate ([**11-24**]+) mitral regurgitation is seen. Moderate [2+]
tricuspid regurgitation is seen.Overall right ventricular
function is depressed

[**2181-5-22**] Left Hip: IMPRESSION:

Left intertrochanteric femur fracture with DHS fixation. Notable
backing-out
of the dynamic screw compared to intra-operative radiograph


Brief Hospital Course:
Mrs. [**Known lastname 29878**] as admitted to the hospital and had an abdominal
CT which showed pneumatosis around the cecum and soon became
hypotensive requiring fluid resuscitation and pressors.  She
developed peritoneal signs on exam and was urgently taken to the
Operating Room where she underwent a subtotal colectomy and
splenectomy.

She returned to the SICU in stable condition but remained
intubated and required some pressor support and fluids post op.
She had some brief sinus bradycardia to the 30's  on post op day
#1 and then developed atrial fibrillation. Cardiac enzymes were
flat x 3 but she had a prolonged qtc on her EKG.  Cardiology was
consulted and recommended TEE which was done on [**2181-5-15**] which
revealed an EF >55% and no wall motion abnormalities.
Continuation of her amiodarone was recommended and she had no
further episodes of bradycardia.

She was extubated on post op day #3 and did well.  She underwent
vigorous pulmonary toilet including chest PT and incentive
spirometry and was able to remain free of any pulmonary
complications post op.

Following extubation she was sent to the [**Date Range **] floor for
further monitoring where she continued to make slow progress.
She gradually began a clear liquid diet and was eventually
increased to regular without difficulty. She did have a speech
and swallow evaluation which showed no evidence of aspiration.
Prior to her hospitalization she was taking Ensure supplements
and she continues to do so.  Her incision was healing well and
she was seen by the ostomy nurse for instructions and caring for
her ileostomy.

She was followed by the orthopedic service post op for
evaluation after her recent left hip surgery and she was also
seen daily by the Physical Therapist.  Her activity status was
touch-down weight bearing.  She did have left hip films done on
[**2181-5-22**] which showed some backing out of the intertrocanteric
screw.  These were reviewed by orthopedics and her activity
status will remain the same.  They will follow her with serial
xrays and a follow uo appointment in 6 weeks.

Due to a persistent leukocytosis post op multiple cultures were
done including B
blood, urine and stool for CDiff.  All were negative and she
remained afebrile without bandemia however her WBC was in the
20-26K range.

Ms. [**Known lastname 29878**] was very discouraged during her hospitalization
because of her recent setback after hip surgery.  Through
intervention with the staff including our social worker ,
encouragement was given and she wanted to be able to eventually
go back to the [**Location (un) **] and be able to take care of herself. She
was discharged to rehab with the [**Known firstname **] of returning home in a
month or so and she will follow up with Dr. [**First Name (STitle) **] and [**Location (un) **]
for further evaluation.



Medications on Admission:
1. Amiodarone 200 (once a day (in the morning)).
2. Aspirin 325 DAILY (Daily).
3. Captopril 12.5 (3 times a day).
4. Furosemide 40 (once a day (in the morning)).
5. Atorvastatin 80 once a day.
6. Lorazepam 0.5 mg [**Hospital1 **]
7. Lorazepam 1 PO HS (at bedtime)
8. Multivitamin    DAILY (Daily).
9. Metoprolol Tartrate 6.25 twice a day
10. Docusate Sodium 100 [**Hospital1 **] (2 times a day).
11. Bisacodyl 10 DAILY (Daily) as needed for constipation.
12. Enoxaparin 40 mg/0.4 mL Syringe Sig: 0.4 ml Subcutaneous Q
24H
13. Lactulose 10 gram/15 mL Syrup Sig: Thirty (30) ML PO Q8H
14. Acetaminophen 325 PO Q6H (every 6 hours)


Discharge Medications:
1. Albuterol Sulfate 2.5 mg /3 mL (0.083 %) Solution for
Nebulization Sig: 2.5 mg Inhalation Q6H (every 6 hours) as
needed for wheezing.
2. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
3. Captopril 12.5 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day): hold for SBP<100.
4. Furosemide 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

5. Enoxaparin 40 mg/0.4 mL Syringe Sig: Forty (40) mg
Subcutaneous DAILY (Daily).
6. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
7. Lorazepam 0.5 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for anxiety, aggitation.
8. Famotidine 20 mg Tablet Sig: One (1) Tablet PO Q24H (every 24
hours).
9. Amiodarone 200 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 anxiety.
11. Metoprolol Tartrate 25 mg Tablet Sig: 0.25 Tablet PO BID (2
times a day): Hold for HR<60 SBP<100.
12. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
13. Miconazole Nitrate 2 % Powder Sig: One (1) Appl Topical TID
(3 times a day).
14. Ipratropium Bromide 0.02 % Solution Sig: One (1) inh
Inhalation Q6H (every 6 hours) as needed for wheezing.


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 7**] & Rehab Center - [**Hospital1 8**]

Discharge Diagnosis:
Gangrene of the cecum through
transverse colon and of the left colon.


Discharge Condition:
stable


Discharge Instructions:
Please call your doctor or nurse practitioner or return to the
Emergency Department for any of the following:

*You experience new chest pain, pressure, squeezing or
tightness.

*New or worsening cough, shortness of breath, or wheeze.

*If you are vomiting and cannot keep down 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.

*You experience burning when you urinate, have blood in your
urine, or experience a discharge.

*Your pain in not improving within 8-12 hours or is not gone
within 24 hours. Call or return immediately if your pain is
getting worse or changes location or moving to your chest or
back.

*You have shaking chills, or fever greater than 101.5 degrees
Fahrenheit or 38 degrees Celsius.

*Any change in your symptoms, or any new symptoms that concern
you.

Please resume all regular home medications , unless specifically
advised not to take a particular medication. Also, please take
any new medications as prescribed.

Please get plenty of rest, continue to ambulate several times
per day, and drink adequate amounts of fluids. Avoid lifting
weights greater than [**4-1**] lbs until you follow-up with your
surgeon.

Avoid driving or operating heavy machinery while taking pain
medications.

Incision Care:

*Please call your doctor or nurse practitioner if you have
increased pain, swelling, redness, or drainage from the incision
site.

*Avoid swimming and baths until your follow-up appointment.

*You may shower, and wash [**Month/Year (2) **] incisions with a mild soap
and warm water. Gently pat the area dry.

*If you have staples, they will be removed at your follow-up
appointment.

*If you have steri-strips, they will fall off on their own.
Please remove any remaining strips 7-10 days after surgery.


Followup Instructions:
Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] (orthopedics) ([**Telephone/Fax (1) 29879**]) Call for an
appointment in 6 weeks

Call Dr. [**Last Name (STitle) **] ([**Telephone/Fax (1) 29822**]) for an appointment for follow up
after you are discharged from rehab.

Provider: [**Name10 (NameIs) **],[**First Name7 (NamePattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **] SPECIALTIES CC-3 (NHB)
Phone:[**Telephone/Fax (1) 274**] Date/Time:[**2181-6-6**] 1:15

Provider: [**Name10 (NameIs) **] XRAY (SCC 2) Phone:[**Telephone/Fax (1) 1228**]
Date/Time:[**2181-6-14**] 10:20

Provider: [**First Name11 (Name Pattern1) 2191**] [**Last Name (NamePattern4) 2192**], [**MD Number(3) 1240**]:[**Telephone/Fax (1) 1228**]
Date/Time:[**2181-6-14**] 10:40



Completed by:[**2181-5-24**]
{'Acute vascular insufficiency of intestine,Other specified peritonitis,Hemorrhage of rectum and anus,Hyposmolality and/or hyponatremia,Acute kidney failure, unspecified,Closed fracture of intertrochanteric section of neck of femur,Diverticulosis of colon (without mention of hemorrhage),Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Atrial fibrillation,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Chronic airway obstruction, not elsewhere classified,Dysthymic disorder,Disorders of magnesium metabolism'}


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, rectal bleeding and abdominal distension

PRESENT ILLNESS: 83 year old female with past medical history of CAD
with MI in [**Month (only) 956**], atrial fibrillation (not on
anticoagulation), Crohns disease and diabetes mellitus who had a
recent admission [**5-7**] - [**5-11**] after a fall with an
intertrochanteric femur fracture which was repaired with a hip
screw on [**5-8**].  She is weight bearing on that leg.  She did not
have any cardiac events. She was treated for a uti.  She was
discharged to rehab on lovenox.
She has had abd distension for 3 days.  She was disimpacted
yesterday and treated with Miralax.  She says she had many bms
and was passing flatus.  Today she developed bleeding per rectum
and increased abd pain and was brought here.
Currently not c/o SOB or chest pain.

MEDICAL HISTORY: -Coronary Artery Disease status post MI in [**2180-12-24**] (3VD
on cardiac cath but managed non-operatively)
-Depression
-Anxiety
-Atrial Fibrillation (not on anticoagulation)
-Crohn's Disease
-Chronic obstructive pulmonary disease
-distant history of tonsillectomy and adenoidectomy

MEDICATION ON ADMISSION: 1. Amiodarone 200 (once a day (in the morning)).
2. Aspirin 325 DAILY (Daily).
3. Captopril 12.5 (3 times a day).
4. Furosemide 40 (once a day (in the morning)).
5. Atorvastatin 80 once a day.
6. Lorazepam 0.5 mg [**Hospital1 **]
7. Lorazepam 1 PO HS (at bedtime)
8. Multivitamin    DAILY (Daily).
9. Metoprolol Tartrate 6.25 twice a day
10. Docusate Sodium 100 [**Hospital1 **] (2 times a day).
11. Bisacodyl 10 DAILY (Daily) as needed for constipation.
12. Enoxaparin 40 mg/0.4 mL Syringe Sig: 0.4 ml Subcutaneous Q
24H
13. Lactulose 10 gram/15 mL Syrup Sig: Thirty (30) ML PO Q8H
14. Acetaminophen 325 PO Q6H (every 6 hours)

ALLERGIES: Fosamax

PHYSICAL EXAM: Physical Exam:
VS: T 95.6, BP 125/56, P 60, RR 14, O2 98% RA
Gen: in distress
HEENT: dry mucous membranes
CV: Irregular rhythm
Pulm: CTAB
Abd: distended, soft, diffusely tender, no abd scars
Extrem: Warm and well perfused, no edema
Neuro: A and O*3

FAMILY HISTORY: She reports multiple family members with heart problems.

SOCIAL HISTORY: Lives alone on [**Hospital3 4298**]. Quit tobacco [**1-1**] after 68 pk
years
No ETOH in 30 years 

### Response:
{'Acute vascular insufficiency of intestine,Other specified peritonitis,Hemorrhage of rectum and anus,Hyposmolality and/or hyponatremia,Acute kidney failure, unspecified,Closed fracture of intertrochanteric section of neck of femur,Diverticulosis of colon (without mention of hemorrhage),Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Atrial fibrillation,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Chronic airway obstruction, not elsewhere classified,Dysthymic disorder,Disorders of magnesium metabolism'}
